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Results for “Secondary Data Analysis”

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PubMed2001

Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants.

This secondary data analysis examined if time of initiation of milk expression and pumping frequency influenced milk weight weeks 2-5 postpartum. Of the 39 subjects in the convenience sample, 20 were in the early initiating (EI) group, (n = 12 high frequency [HF], n = 8 low frequency [LF]), and 19 were in the late intiating (LI) group, (n = 7 HF, n = 12 LF). The EI group initiated pumping < or = 48 hours after birth; the HF group pumped a minimum of 6.25 times daily. A two-way analysis of variance indicated that milk weight was significantly higher in the HF as compared to the LF group. While there was no significant difference in milk weight between the EI and LI groups, there was a significant interaction between frequency and initiation. Milk weight for the LF/EI group appeared to be positively influenced by the initiation of mechanical expression soon after birth.

Adult↗

PubMed2003

Thinking ahead: factors associated with executing advance directives.

This article examines why older adults do or do not execute advance directives. METHODS. Secondary data analysis was conducted on data from the Charlotte County (Florida) Healthy Aging Study, on 451 adults who were relatively healthy and affluent. Exploratory logistic regressions were conducted on the probability that respondents had executed advance directives. RESULTS. Findings indicated that increasing age and higher income were the most consistent indicators of having executed an advance directive. Also, individuals reporting taking more prescription medications were more likely to have all the advance directives, except the durable power of attorney for health care. Reporting more negative life events was predictive of having executed the durable power of attorney for health care. DISCUSSION. These findings suggest that in addition to awareness of advance directives, demographic, health, and situational factors may affect the willingness of older adults to execute advance directives. Further research should examine other, more representative, samples to confirm these findings.

Advance Directives↗

PubMed2005

The social distribution of psychological distress and depression in older adults.

OBJECTIVE: This study examines the associations between social position and mental health and explores whether differences in distress and depression by social position can be accounted for by differences in the major components of the stress process model. We extend previous work by including an ethnocultural measure alongside more traditional measures of social position. METHOD: Secondary data analysis of the 1994 National Population Health Survey. RESULTS: Consistent with findings from studies of younger adults, mental health in later life is determined in part by age, gender, marital status, education, and ethnocultural factors. The data indicate that the life experiences connected to these social positions are largely responsible for these effects. DISCUSSION: Our findings suggest that key social factors are related to mental health in late life, because one's position in the social structure shapes the stressors they encounter and the resources they have at their disposal to cope with them.

Age Factors↗

PubMed1998

Religion, health, and psychological well-being in older adults: findings from three national surveys.

This study examines the impact of religious involvement on health status and psychological well-being using data on older adults from three national probability surveys: the Myth and Reality of Aging (N = 2,797), the Quality of American Life (N = 1,209), and Americans' Changing Lives (N = 1,669) studies. Constructs are measured by single items and indices that vary across data sets. A proposed theoretical model specifies direct effects of religiosity on health and well-being and indirect effects on well-being through health. Analyses consist of structural-equation modeling of confirmed measurement models using weighted least squares estimation in LISREL 8.03. The model is analyzed first as specified and is then rerun controlling for the effects of six exogenous constructs: age, gender, race, marital status, education, and geographical region. Findings reveal excellent overall fit in all three samples and the presence of statistically significant religious effects, notably positive net effects of organizational religiosity, in all three samples. These results build on those of prior studies based mostly on samples limited regionally or methodologically or to particular racial or ethnic groups. This study also underscores the value of replicated secondary data analysis as a strategy for gerontologists seeking to confirm or examine a given structural model. Finally, an agenda is proposed for future research in this area.

Adaptation, Psychological↗

PubMed2004

Racial disparities in hospitalized elderly patients with chronic heart failure.

The purpose of this study was to examine the impact of race on length of hospital stay (LOS) and number of procedures on elderly persons hospitalized with chronic heart failure (CHF). Secondary data analysis was used to obtain data on 99,543 hospitalized Medicare patients with CHF age 65 years or older. MANOVA was utilized to examine the effects of race, age, and total hospital charges on LOS, number of procedures, and diagnosis. Asian American Pacific Islanders had significantly higher number of procedures and LOS compared to Whites. The combined dependent variables were significantly affected by race, F(9, 99,543) = 121.95, p =.000; the covariates of age, F(3, 99,543) = 720.65, p =.000; and total charges F(3, 99,543) = 38,962.95, p =.000. LOS accounted for 50% of the variance. Studies that examine cultural variables and their effect on LOS and number of procedures are needed.

Black or African American↗

PubMedDate not supplied

Social networks among elderly women: implications for health education practice.

The general aim of the present study was to examine and help clarify the properties of the distinctions between social networks and social support, their relationship to health status, and their implications for health education practice. More specifically, a secondary data analysis was conducted with 130 white women, community residents, between the ages of 60 and 68, which examined the relationship between psychological well-being and social network characteristics. These characteristics are categorized along three broad dimensions: structure--links in the overall network (size and density); interaction--nature of the linkages themselves (frequency, homogeneity, content, reciprocity, intensity, and dispersion); and functions which networks provide (affective support and instrumental support). A combination was made and relative strength investigated of several network characteristics representative of the quality of interactions (i.e., reciprocal affective support, intensity, and affective support) and those representing the quantity of interactions (i.e., size, density, and frequency).

Age Factors↗

PubMed2006

Nonadherence with immunosuppressive drugs: U.S. compared with European kidney transplant recipients.

BACKGROUND: System factors increasingly are suggested as important yet understudied correlates of nonadherence. OBJECTIVE: To explore the relationship between healthcare system and prevalence of nonadherence with immunosuppressive regimen by studying variation in nonadherence between European and US kidney transplant recipients and as well as nonadherence in European countries. METHODS: We performed a secondary data analysis on data collected in 3 independent cross-sectional studies using comparable methodology including patients from the United States, the Netherlands, Belgium, and Switzerland. Nonadherence was measured using 1 item of the Siegal questionnaire. Patients were categorized as nonadherent if they reported missing a dose of immunosuppression in the last 4 weeks. Analyses were performed by multiple mixed logistic regression, with center as a random effect and clinical and demographical differences between groups as fixed effects. RESULTS: 1563 U.S. and 614 European patients from 3 different countries (Belgium [n=187], the Netherlands [n=85], and Switzerland [n=342]) were included. Prevalence of nonadherence in the United States and Europe was 19.3% and 13.2.%, respectively. This higher nonadherence in US patients was confirmed in a multiple logistic regression analysis (OR = 1.78; 95% CI, 1.10-2.89). Nonadherence differed between Belgium (16%) and the Netherlands (14.1%) (OR = 0.27; 95% CI, 0.09-0.80) and between Belgium and Switzerland (11.4%; OR = 0.17; 95% CI, 0.0-0.42). CONCLUSION: This is the first study showing differences in prevalence of nonadherence between European and US patients and among European patients. Further research should aim at unraveling the dynamics explaining these differences.

Adult↗

PubMed2005

The relationships between depression and other outcomes of chronic illness caregiving.

BACKGROUND: Many caregivers with chronically ill relatives suffer from depression. However, the relationship of depression to other outcomes of chronic caregiving remains unclear. This study tested a hypothesized model which proposed that hours of care, stressful life events, social support, age and gender would predict caregivers' outcomes through perceived caregiver stress. Depression was expected to mediate the relationship between perceived stress and outcomes of chronic caregiving (physical function, self-esteem, and marital satisfaction). METHODS: The sample for this secondary data analysis consisted of 236 and 271 subjects from the Americans' Changing Lives, Wave 1, 1986, and Wave 2, 1989, data sets. Measures were constructed from the original study. Structural equation modeling was used to test the hypothesized model, and an exploratory structural modeling method, specification search, was used to develop a data-derived model. Cross-validation was used to verify the paths among variables. RESULTS: Hours of care, age, and gender predicted caregivers' outcomes directly or through perceived caregiver stress (p < .01). Depression mediated the relationship between perceived stress and psychological outcomes and explained 40% and 11% of the variance in self-esteem and marital satisfaction, respectively. CONCLUSION: Depression predicted psychological outcomes. Whether depression predicts physical health outcomes needs to be further explored.

Journal Article↗

PubMed2006

International medical graduates in family medicine in the United States of America: an exploration of professional characteristics and attitudes.

BACKGROUND: The number of international medical graduates (IMGs) entering family medicine in the United States of America has steadily increased since 1997. Previous research has examined practice locations of these IMGs and their role in providing care to underserved populations. To our knowledge, research does not exist comparing professional profiles, credentials and attitudes among IMG and United States medical graduate (USMG) family physicians in the United States. The objective of this study is to determine, at the time when a large influx of IMGs into family medicine began, whether differences existed between USMG and IMG family physicians in regard to personal and professional characteristics and attitudes that may have implications for the health care system resulting from the increasing numbers of IMGs in family medicine in the United States. METHODS: This is a secondary data analysis of the 1996-1997 Community Tracking Study (CTS) Physician Survey comparing 2360 United States medical graduates and 366 international medical graduates who were nonfederal allopathic or osteopathic family physicians providing direct patient care for at least 20 hours per week. RESULTS: Compared to USMGs, IMGs were older (p < 0.001) and practised in smaller (p = 0.0072) and younger practices (p < 0.001). Significantly more IMGs practised in metropolitan areas versus rural areas (p = 0.0454). More IMG practices were open to all new Medicaid (p = 0.018) and Medicare (p = 0.0451) patients, and a greater percentage of their revenue was derived from these patients (p = 0.0020 and p = 0.0310). Fewer IMGs were board-certified (p < 0.001). More IMGs were dissatisfied with their overall careers (p = 0.0190). IMGs and USMGs did not differ in terms of self-rated ability to deliver high-quality care to their patients (p = 0.4626). For several of the clinical vignettes, IMGs were more likely to order tests, refer patients to specialists or require office visits than USMGs. CONCLUSION: There are significant differences between IMG and USMG family physicians' professional profiles and attitudes. These differences from 1997 merit further exploration and possible follow-up, given the increased proportion of family physicians who are IMGs in the United States.

Journal Article↗

PubMedDate not supplied

The effects of health state, hemoglobin, global symptom distress, mood disturbance, and treatment site on fatigue onset, duration, and distress in patients receiving radiation therapy.

PURPOSE/OBJECTIVES: To describe the fatigue experience of patients with cancer receiving radiation therapy and determine to what extent diverse correlates of fatigue affect fatigue onset, duration, and distress. DESIGN: Descriptive correlational study completed by secondary data analysis. SAMPLE/SETTING: Data were obtained from 384 subjects recruited from two urban, university-affiliated, radiation oncology clinics located in a large, Midwestern city. METHODS: The effects of health indicators and treatment site on fatigue onset, duration, and distress were examined using correlational analyses and analyses of variance. MAIN RESEARCH VARIABLES: Hemoglobin, health status, global symptom distress, mood disturbance, treatment site, and fatigue onset, duration, and distress. FINDINGS: Fatigue started near the middle of the second week of treatment, was moderately distressing, and lasted approximately 32 days. Higher levels of health and hemoglobin at the start of therapy were associated with a delayed onset, shorter duration, and lower levels of fatigue distress. In contrast, higher pretreatment levels of global symptom distress and mood disturbance were associated with an earlier onset, longer duration, and greater severity of fatigue distress. CONCLUSION: The fatigue experience in patients undergoing radiation therapy is highly individualized. Variations in the health states of patients as well as the area of the body being treated can influence fatigue onset, duration, and distress. IMPLICATIONS FOR NURSING: Pretreatment screening for fatigue and its correlates is needed to identify patients at risk for an earlier onset, longer duration, and more distressing levels of fatigue.

Adult↗

PubMed2006

Symptom clusters and quality of life in survivors of lung cancer.

PURPOSE/OBJECTIVES: To explore the prevalence and intensity of depression, fatigue, and pain in survivors of lung cancer; to examine the relationship of symptoms in a cluster; and to examine the relationship of the symptom cluster to quality of life (QOL). DESIGN: Secondary data analysis. SETTING: Online lung cancer support group. SAMPLE: 51 patients diagnosed with lung cancer. METHODS: Mailed survey with self-report of depression, fatigue, and pain measured by subscales of the Short-Form 36 Health Status Survey and QOL measured by the Fox Simple QOL Scale. Pearson's correlation and multiple regression analyses were used to examine the possible symptom cluster. MAIN RESEARCH VARIABLES: Depression, fatigue, pain, and QOL. FINDINGS: Depression, fatigue, and pain were found in a majority of survivors, with pain being the least common symptom. Fatigue was the most intense of the three symptoms. Two significantly correlated symptoms were depression and fatigue. The cluster explained 29% (p less than 0.01) of the variance in QOL in the lung cancer survivors. CONCLUSIONS: The data provided preliminary support for the presence of a symptom cluster in patients with lung cancer consisting of depression and fatigue. The cluster had a negative relationship with QOL. Survivors of lung cancer have depression and fatigue that affect QOL. IMPLICATIONS FOR NURSING: Healthcare providers must assess the potential for symptoms to cluster, adversely affecting key patient outcomes such as QOL. Through increased knowledge of symptom clusters, clinicians will be able to more effectively target the most distressing set of symptoms for intervention.

Adult↗

PubMed2006

Categorizing urgency of infant emergency department visits: agreement between criteria.

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 (kappa) 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 (kappa = 0.57) with implicit criteria. Of limited data methods, resources demonstrated the best concordance (78.1%) and agreement (kappa = 0.56), while ED triage (67.9%) and diagnosis (71.6%) exhibited lower concordance and agreement (kappa = 0.35 and kappa = 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.

Emergency Service, Hospital↗

PubMed1998

Preschool children at risk for repeat injuries.

Home-related injuries are a major problem in young children. This study investigated maternal and child characteristics related to repeat injuries in preschool children. A secondary data analysis was conducted on a national probability sample of African American and White mothers who participated in the longitudinal study of the National Maternal and Infant Health Survey. Repeat injuries in the African group were associated with poor maternal health status, maternal use of alcohol, and Ipecac in the home. Significant factors for the White group were male child, unmarried mother, difficulty managing the child, maternal depression, poor maternal health status, and Ipecac in the home. Findings support the need to identify high-risk children and to provide interventions specially aimed at amelioration of those factors related to repeat injuries.

Accidents, Home↗

PubMed2026

Surgical Management of Young Women with High-Risk Breast Cancer Receiving Neoadjuvant Systemic Therapy on the I-SPY2 Trial.

BACKGROUND: Mastectomy rates in women with breast cancer are higher in younger women than in older women. The impact of this more extensive surgery on overall survival (OS) and locoregional recurrence in younger women is unknown, especially after neoadjuvant systemic therapy (NST). This study evaluated surgical management and outcomes of patients aged ≤ 45 versus > 45 years enrolled in multicenter NST clinical trial, I-SPY2.0 (NCT01042379, PMID 37325931). METHODS: We conducted a secondary data analysis comparing locoregional treatment in patients aged ≤ 45 versus > 45 years with clinical or molecular high-risk clinical stage II-III breast cancer treated from April 2010 to June 2022. Multivariate Cox proportional hazards models were used to evaluate associations between type of breast surgery with OS and locoregional recurrence-free interval by age group and tumor receptor subtype. RESULTS: Of 1737 patients, 698 (40.2%) were aged ≤ 45 years. There were no significant differences in patient or tumor characteristics or residual cancer burden distribution between age groups. Although breast-conserving surgery was significantly less common in younger women (36.8% vs 48.5%, p < 0.001), surgery type was not associated with OS or locoregional recurrence-free interval for patients aged ≤ 45 years. CONCLUSIONS: Greater extent of breast surgery was not associated with improved outcomes in women aged ≤ 45 years. Choice of surgical procedure in the management of breast cancer is multifactorial, but young age alone does not warrant mastectomy following NST.

Breast cancer↗

PubMed2002

Social support, medication compliance and HIV/AIDS.

Social work practitioners and researchers have greatly understudied the idea of how social support correlates with combination therapy medication compliance, in people living with HIV disease. Meanwhile, such data could help health social workers better assist HIV-infected people who want to cope well, live long, and avoid drug resistance. Therefore, this article presents findings from a three-stage empirical secondary data analysis that examined seven specific types of social support, psychological history and stage of illness variables, and sociodemographics and their connection to medication compliance ratings. A sub-sample of 179 HIV-infected clinical trial study participants enrolled in a federally funded combination therapy treatment study and a nested compliance study were analyzed. Analysis of 14 bivariate hypotheses and 20 predictor variables at the multivariate level revealed that having emotional support and being employed seemed to be predictive of being a "Good Complier." Also, having higher levels of HIV symptoms appeared to be associated with being a "Poor Complier."

Acquired Immunodeficiency Syndrome↗

PubMed2006

Predictors of emotional strain among spouse and adult child caregivers.

This study used data from the 1999 National Long Term Care Survey to examine predictors of emotional strain between spouse and adult child caregivers using the frameworks of role theory and the stress process model. Secondary data analysis examined if and how emotional strain differed between the groups and what the predictors of emotional strain were for each group. Common group predictors of emotional strain were elder's disruptive behaviors, caregiver's perceived overload, family disagreement, limitations on the caregiver's life, and utilization of personal coping strategies by the caregiver. There were predictors unique to spouse's emotional strain but elders' race and respite availability were unique predictors of adult child caregiver's emotional strain. Ways in which predictors of emotional strain can be used to design effective and efficient social work interventions are discussed.

Adaptation, Psychological↗

PubMed2005

Contextual effects on life satisfaction of older men and women.

Differences occur in the demographic, health, and social network contexts of men and women, all of which are associated with successful aging. The objectives of this study were to determine whether differences exist in satisfaction in specific domains, in general life satisfaction and in the paths for life satisfaction for men and women. A secondary data analysis was conducted on selected variables from the Aging in the Community data set (Beland et al., 1998). The responses of 958 older Canadian francophone adults were examined. There were no differences in general or domain life satisfaction between women and men. Path analyses revealed good model fit for separate models for both male and female samples. For men, life satisfaction is explained positively by age, income, and perceived control, and negatively by recall errors, illness, and functional limitations. For women, life satisfaction is explained positively by age, education, income, social support, perceived control, and physical activity, and negatively by illness and functional limitations. The results suggest that social support had direct positive effects on life satisfaction but reduced perceived control for women. As hypothesized, although there are similarities in paths to life satisfaction for older men and women, the path models indicated that there are also important differences.

Aged↗

PubMed2005

The impact of welfare reforms, health, and insurance status on welfare recipients' health care access.

This study explores ways in which welfare reforms have affected utilization of four health services (physician visits, hospital care, prescription medication, and dentist visits) and the impact of health insurance on these services. A secondary data analysis of a nationally representative sample of 1,259 non-elderly adult current and former welfare recipients shows that use of health services is significantly affected by state-specific welfare policy, health insurance, and race/ethnicity, when other variables are controlled. More restrictive state welfare policies were variously associated with lower likelihood of using dental care, visiting a physician and using prescriptions. Non-Hispanic whites in the sample were more likely than members of other racial/ethnic groups to use prescriptions; Hispanics were less likely than non-Hispanic whites to visit physicians or dentists. The proportion of respondents reporting fair or poor health was three times as great as the estimated proportion of non-elderly adults reporting fair or poor health in the general population. Policy implications are discussed.

Adolescent↗