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PubMed2003

On the importance of age-adjustment methods in ecological studies of social determinants of mortality.

OBJECTIVE: To illustrate the potential sensitivity of ecological associations between mortality and certain socioeconomic factors to different methods of age-adjustment. DATA SOURCES: Secondary analysis employing state-level data from several publicly available sources. Crude and age-adjusted mortality rates for 1990 are obtained from the U.S. Centers for Disease Control. The Gini coefficient for family income and percent of persons below the federal poverty line are from the U.S. Bureau of Labor Statistics. Putnam's (2000) Social Capital Index was downloaded from http://www.bowlingalone.com; the Social Mistrust Index was calculated from responses to the General Social Survey, following the method described in Kawachi et al. (1997). All other covariates are obtained from the U.S. Census Bureau. STUDY DESIGN: We use least squares regression to estimate the effect of several state-level socioeconomic factors on mortality rates. We examine whether these statistical associations are sensitive to the use of alternative methods of accounting for the different age composition of state populations. Following several previous studies, we present results for the case when only mortality rates are age-adjusted. We contrast these results with those obtained from regressions of crude mortality on age variables. PRINCIPAL FINDINGS: Different age-adjustment methods can cause a change in the sign or statistical significance of the association between mortality and various socioeconomic factors. When age variables are included as regressors, we find no significant association between mortality and either income inequality, minority racial concentration, or social capital. CONCLUSIONS: Ecological associations between certain socioeconomic factors and mortality may be extremely sensitive to different age-adjustment methods.

Adolescent↗

PubMed2006

Canada and Brazil. Health satisfaction older adults.

PURPOSE: The purpose of this study was to compare patterns of social factors explaining health satisfaction of older adults in selected regions of Canada and Brazil. DESIGN: The study was a secondary analysis of data from two descriptive exploratory studies of quality of life of older adults in Canada and Brazil. METHODS: A secondary analysis of two data sets was conducted. The data sets included responses from 202 older adults from Canada and 288 older adults from Brazil. The Canadian data were collected in a mail survey of randomly selected older adults conducted in early 2004 and the Brazilian data were collected in a household survey in the fall of 2004. In both countries, instruments used in data collection were the short version of the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) and a demographic data sheet. Multiple regression analyses were used to examine predictors of health satisfaction in each of the samples. The independent variables were: age, gender, perceptions of access to health services, transport, social support, personal relationships, capacity for work, opportunities for leisure activities and enough money to meet needs. All indicators (except for age and gender) were taken from the WHOQOL-BREF instrument and were measured by a single global item on a five point Likert scale. FINDINGS: In the Canadian data set, it was found that perceptions regarding capacity to work and opportunities for leisure activities were significant predictors of health satisfaction. In Brazil, the significant predictors were perceptions of capacity to work and enough money to meet needs. CONCLUSIONS: This study identifies some common social factors that explain health satisfaction, but many other variables thought to be important were not significant in these samples. Examination of social factors influencing health at the individual as well as societal level may help in planning interventions that enhance health and well-being of older adults.

Aged↗

PubMed1996

Secondary structure determination of proteins in aqueous solution by infrared spectroscopy: a comparison of multivariate data analysis methods.

The accuracy of the secondary structure prediction from an infrared spectra data base of 39 proteins with known X-ray structure was investigated by different methods of multivariate data analysis. The best agreements with the secondary structure determined by X-ray crystallography are obtained if both the amide I and amide II bands are used for calibration. With optimized parameters the methods singular value decomposition, partial least squares, and ridge regression yield similar results. As judged by the standard error of prediction, the secondary structure elements helix and beta-sheet can be predicted with the highest accuracy. Small data sets of less than 20 protein spectra, which exhibit the variance in secondary structure content of the whole set, can pretend an increased prediction accuracy only if column cross-validation is used as reference; however, with these calibration sets the average secondary structure prediction of all 39 proteins is debased. The hydrogen-bonded turns or bridges are predicted with higher accuracy than the assigned secondary structure types helix and beta-sheet.

Multivariate Analysis↗

PubMed2004

Proposal for the creation of a Web-based heterogeneous distributed archive for psychological data.

This report presents a proposal to create archives of data from psychological research and associated metadata Web pages and link them into a heterogeneous distributed archive on the World-Wide Web. Several specific recommendations are made concerning some of the issues faced by the data archivist and data archive user hoping to use the Web. In particular, a recommendation is made to create a publicly accessible Web page for each data set and place keywords, experimental methods, data descriptions, pointers to journal articles, and pointers to other archive Web pages pertinent to this data set on this metadata Web page. If the archivist includes a special keyword (PsychologyDataArchive) on the metadata Web page, Web-based search engines will automatically be able to subset all participating data archives for indexing and semantic analysis. The secondary data analyst can then include the word PsychologyDataArchive in his Web search and will be able to effectively find relevant participating Web data archives.

Archives↗

PubMed2000

Depressive symptoms among African American women with HIV disease.

Depressive symptoms are a common response to HIV disease and evidence suggests that women may be at particular risk. Very little of the research on depressive symptoms within the context of HIV disease has included women, however, and even fewer studies have targeted African American women. In a beginning effort to address this gap, the authors performed a secondary analysis of data collected from 1992-1995 in a sample of 264 HIV+ women. The purpose of the secondary analysis was to describe the levels of depressive symptoms for a subsample of 152 African American subjects and to identify significant covariates. The original analysis was based on a stress and coping framework and was designed to provide a description of stressors, resistance factors, and adaptational outcomes of HIV+ women. It included various measures of psychological distress and quality of life. Depressive symptoms were not examined in the original analysis as an outcome of HIV disease, however. In the secondary analysis, depressive symptoms were operationalized using a depression subscale of the Brief Symptom Inventory (BSI) (Deragotis, 1993). Major categories of correlates examined included person resources, environmental resources, coping responses, and disease-related stressors. The data used in the analysis were collected during the fourth and fifth interviews of the longitudinal study, with 152 of the African American women having completed both interviews. Variance in depressive symptoms was analyzed using ANOVA, zero-order correlations, and multiple regression analysis. The mean depressive symptoms score for the subsample of African American women was considerably higher than published means for female and male normative samples, respectively. The regression model accounted for over half of the variance in depressive symptoms (R2 = .515). Significant correlates included self-esteem, family cohesion, HIV symptoms and quality of life. The findings support personal and social resources and disease-related factors as important correlates of HIV+ African American women's depressive symptoms and suggest the need for interventions to address such factors.

Adaptation, Psychological↗

PubMed1992

The kappa statistic for establishing interrater reliability in the secondary analysis of qualitative clinical data.

Analysis of extant clinical records is receiving increased emphasis in nursing investigations. Appropriate use of this approach to patient research requires careful attention to data management, including assessment of reliability. Percent agreement, phi, and Kappa all serve as estimates of interrater reliability in the analysis of data. Kappa has particular merit as a measure of interrater reliability; it also has some peculiar problems in implementation and interpretation. The nature and computation of Kappa and its application in analysis of clinical data are discussed.

Data Collection↗

PubMed1982

EPSDT impact on health status: estimates based on secondary analysis of administratively generated data.

EPSDT (early and periodic screening, diagnosis and treatment), a large-scale operational screening program that has generated a tremendous volume of data on the sociodemographic characteristics and health status of Medicaid-eligible children, seems to provide an ideal context within which to evaluate the effectiveness of preventive child care. Concern about health care expenditures generally, and the effectiveness of preventive child health services specifically, lead to the question of whether the impact on the health status of the children served can be measured without significantly adding to the cost of these services with primary data collection. We employ a quasi-experimental research design, using administratively generated data from an operational EPSDT program to estimate program impact on the prevalence of serious abnormalities among the children served. We found that, compared either with themselves across time or with a control group, a representative sample of 1,831 children had almost 30 per cent fewer abnormalities requiring care on rescreening.

Child↗

PubMed2004

Overview of the Social Transition in the North project 1995- 1998.

OBJECTIVE: This paper describes the overall aims and design of the Social Transitions in the North study. The objective of the STN study was to assess how epidemiological, demographic and domestic changes have affected Northern communities. STUDY DESIGN: Sixteen communities in the Russian Far East and Alaska were compared. Survey data were collected in three phases with a response rate of 70%. METHODS: The experiences of indigenous peoples with demographic, epidemiological and domestic changes were measured using forced-choice questionnaires, focus groups, oral histories, protocol interviews, interviews with institutional informants, genealogies and analysis of secondary data. RESULTS: The principal researchers died during a boating accident before the analysis phase. Alaska researchers were asked to review the data for utility. CONCLUSIONS: The STN data was developed using rigorous cross-cultural research team. It was be used by social science researchers and others to better understand the impact of rapid changes in the Arctic.

Alaska↗

PubMed2006

Secondary analysis of case-control data.

We extend the discussion of Lee et al. and others on methods for performing secondary analyses of case-control sampled data and carry out an extensive investigation of efficiency and robustness. We find that, with the exception of the 'analyse-the-controls-only' strategy for populations in which cases are rare, ad hoc methods in common usage often lead to extremely misleading conclusions and that it is not possible to tell in advance when this will happen. Weighted likelihood and semi-parametric maximum likelihood methods are justified theoretically. We find that semi-parametric maximum likelihood can be as much as twice as efficient as the weighted method, but is subject to bias in estimating parameters of interest when the nuisance models this method requires have been mis-specified. The weighted method needs no nuisance models and thus is robust in this regard, but we cannot tell when it is going to be very inefficient without sophisticated modelling as through the SPML method. Practitioners should routinely use both methods and will often have to weigh up the practical consequences of severe inefficiency and lack of robustness in the context of their enquiries.

Bias↗

PubMed2005

[Measles epidemiology in the State of Santa Catarina, Brazil, 1996-2000].

This ecological study, based on an analysis of secondary data from epidemiological surveillance and using the municipality (county) as the unit of analysis, showed that measles vaccine coverage was lower than necessary for eradication (95%) and control (90%) in many municipalities in the State of Santa Catarina, Brazil, both before and during the last epidemic in 1997, particularly regarding the second dose of the vaccine, applied as a component of the MMR vaccine, scheduled at 15 months of age. Low vaccine coverage was associated with higher measles incidence. However, during the 1997 epidemic small-scale measles outbreaks were recorded even in municipalities with first-dose coverage of 95% or higher, particularly among those which also had low second-dose coverage for MMR. Approximately 80% of all measles cases during 1996-2000 occurred among schoolchildren and young adults. Measles virus circulation in the municipality in the previous year and population density increased the risk of measles. Two imported cases of measles in Santa Catarina in 2004 illustrate that it would be premature to describe the current situation as one of eradication.

Adolescent↗

PubMed2004

Acne prevalence in secondary school students and their perceived difficulty in accessing acne treatment.

AIMS: To describe the epidemiology of acne in New Zealand adolescents and their access to acne treatment. METHODS: Secondary analysis of data collected in the 'Youth2000' survey. A random sample of 12,934 Year 9-13 students, from 133 secondary schools across New Zealand, was invited to participate. The survey included items asking about self-perceived acne and access to acne treatment. RESULTS: The 'Youth2000' school response rate was 85.7%, the student response rate 75.0%, and the overall response rate 64.3%. Of the 9570 students who completed the questions on acne, 67.3% reported having acne. 'Problem acne' was reported by 14.1% of students and was more frequently reported by female, Pacific, and older students. Students with 'problem acne' (as well as female, Maori, and Pacific students) were significantly more likely to report difficulty accessing medical treatment for acne (46.0% vs 13.3%; OR 5.29). These differences persisted after controlling for socioeconomic factors. CONCLUSIONS: Acne is perceived as a significant health problem by nearly 1 in 7 adolescents. For those with 'problem acne,' effective treatment is available but not necessarily accessible. There are also disparities in access to treatment, particularly for females, Maori, and Pacific ethnic groups. This important youth health issue needs to be addressed.

Acne Vulgaris↗

PubMed1991

Protein secondary structure from Fourier transform infrared spectroscopy: a data base analysis.

An infrared (ir) method to determine the secondary structure of proteins in solution using the amide I region of the spectrum has been devised. The method is based on the circular dichroism (CD) matrix method for secondary structure analysis given by Compton and Johnson (L. A. Compton and W. C. Johnson, 1986, Anal. Biochem. 155, 155-167). The infrared data matrix was constructed from the normalized Fourier transform infrared spectra from 1700 to 1600 cm-1 of 17 commercially available proteins. The secondary structure matrix was constructed from the X-ray data of the seventeen proteins with secondary structure elements of helix, beta-sheet, beta-turn, and other (random). The CD and ir methods were compared by analyzing the proteins of the CD and ir databases as unknowns. Both methods produce similar results compared to structures obtained by X-ray crystallographic means with the CD slightly better for helix conformation, and the ir slightly better for beta-sheet. The relatively good ir analysis for concanavalin A and alpha-chymotrypsin indicate that the ir method is less affected by the presence of aromatic groups. The concentration of the protein and the cell path length need not be known for the ir analysis since the spectra can be normalized to the total ir intensity in the amide I region. The ir spectra for helix, beta-sheet, beta-turn, and other, as extracted from the data-base, agree with the literature band assignments. The ir data matrix and the inverse matrix necessary to analyze unknown proteins are presented.

Circular Dichroism↗

PubMed2006

Disparities in the reporting and treatment of health conditions in children: an analysis of the Medical Expenditure Panel Survey.

OBJECTIVES: To determine whether racial and ethnic disparities in health care use differ for physical and behavioral health conditions. DATA SOURCES: Secondary analysis of the 1996-1997 Medical Expenditure Panel Survey. STUDY DESIGN: Retrospective cohort study of children aged 2-18 years old who were members of participating households. Children were categorized as Hispanic, black, or white. Differences in caregiver-reported behavioral and physical health conditions and services use were compared, and estimates were weighted to reflect the complex sampling scheme. PRINCIPAL FINDINGS: Of eligible children weighted to represent over 44 million in each year, 13-15 percent were Hispanic, 14 percent black, and 68-70 percent white. After adjusting for potential confounding, Hispanic and black children were less likely to report externalizing behavioral conditions than white children. Black but not Hispanic children were more likely than white children to report asthma. In addition, Hispanic and black children were less likely to report ambulatory visits, and black children were less likely to report receiving a prescription medication than white children. There were no differences in reported emergency room visits or hospitalizations. Interactions between race and various health conditions, health status, insurance, and income were not significant. CONCLUSIONS: In this nationally representative sample, we identified racial and ethnic disparities in the reporting of health conditions and the use of discretionary health services. Disparities differed between those with behavioral conditions and those with physical conditions. These disparities were not explained by traditional measures including the presence of health conditions, health status, insurance, and family income, and suggest that national surveys such as Medical Expenditure Panel Survey may benefit from the inclusion of additional explanatory measures.

Adolescent↗

PubMed2004

Are gatekeeper requirements associated with cancer screening utilization?

OBJECTIVE: There is widespread debate over whether health plans should require enrollees to use "gatekeepers," which are primary care providers that coordinate care and control access to specialists. However, little is known about whether health plan gatekeeper requirements improve or reduce quality-of-care. Our objective was to examine whether gatekeeper requirements are associated with the utilization of cancer screening for breast, cervical, and prostate cancer. DATA SOURCES: Three linked sources (N = 13,534): (1) 1996 Medical Expenditure Panel Survey (MEPS) Household Survey, a nationally representative, ongoing survey sponsored by the Agency for Healthcare Research and Quality; (2) 1996 MEPS Health Insurance Plan Abstraction, which codes data from health plan booklets obtained from privately insured respondents, and (3) 1995 National Health Interview Survey. STUDY DESIGN/DATA COLLECTION: Cross-sectional, multivariate logistic regression analysis using secondary data. PRINCIPAL FINDINGS: We found in multivariate analyses that women in gatekeeper plans were significantly more likely to obtain mammography screening (Odds Ratio [OR] = 1.22, 95 percent Confidence Interval [CI] 1.07-1.40), clinical breast examinations (OR = 1.39, 95 percent CI 1.23-1.57), and Pap smears (OR = 1.33, 95 percent CI 1.16-1.52) than women not in gatekeeper plans. In contrast, gatekeeper requirements were not associated with prostate cancer screening (OR = 1.11, 95 percent CI 0.93-1.33). We found no association between screening utilization and aggregate plan types (HMO, POS, PPO, FFS). CONCLUSIONS: Gatekeeper requirements are associated with higher utilization of widely recommended cancer screening procedures, but not with utilization of a less uniformly recommended cancer screening procedure. Researchers should consider the analysis of specific plan characteristics rather than aggregate plan types in conducting future research, and insurers and policymakers should consider the potential benefits of gatekeepers with respect to preventive care when designing health plans and legislation.

Breast Neoplasms↗

PubMed2004

Does it matter what a hospital is "high volume" for? Specificity of hospital volume-outcome associations for surgical procedures: analysis of administrative data.

OBJECTIVE: To determine whether the improved outcome of a surgical procedure in high volume hospitals is specific to the volume of the same procedure. DESIGN AND SETTING: Analysis of secondary data in Ontario, Canada. PARTICIPANTS: Patients having an oesophagectomy, colorectal resection for cancer, pancreaticoduodenectomy, major lung resection for cancer, or repair of an unruptured abdominal aortic aneurysm between 1994 and 1999. MAIN OUTCOME MEASURES: Odds ratio for death within 30 days of surgery in relation to the hospital volume of the same surgical procedure and the hospital volume of the other four procedures. Estimates were adjusted for age, sex, and comorbidity and accounted for hospital level clustering. RESULTS: With the exception of colorectal resection, 30 day mortality seemed to be inversely related not only to the hospital volume of the same procedure but also to the hospital volume of most of the other procedures. In some cases the effect of the volume of a different procedure was stronger than the effect of the volume of the same procedure. For example, the association of mortality from pancreaticoduodenectomy with hospital volume of lung resection (odds ratio for death in hospitals with a high volume of lung resection compared with low volume 0.36, 95% confidence interval 0.23 to 0.57) was much stronger than the association of mortality from pancreaticoduodenectomy with hospital volume of pancreaticoduodenectomy (0.76, 0.44 to 1.32). CONCLUSION: The inverse association between high volume of procedure and risk of operative death is not specific to the volume of the procedure being studied.

Female↗

PubMed2004

Does it matter what a hospital is "high volume" for? Specificity of hospital volume-outcome associations for surgical procedures: analysis of administrative data.

Aortic Aneurysm, Abdominal↗

PubMedDate not supplied

Gender differences in stories of everyday Internet use.

This study is a secondary analysis of data collected from four web-based focus groups of nurses and computer scientists who were frequent Internet users. Our aim in this secondary study was to examine gender differences and shared practices in the interpretation of narratives when using this technology. We found that women have different values than men when using the Internet. We can use this information to inform nurses of the gender values that are reflected in Internet usage to increase their understanding of the potential gender stereotyping practices that occur on a medium that is theoretically bias-free.

Adult↗

PubMed1995

Characteristics of residents with do-not-resuscitate orders in nursing homes.

We determined patient characteristics associated with do-not-resuscitate (DNR) status in nursing homes using cross-sectional analysis of secondary data derived from Minimum Data Set documents in 14 nursing homes from one state in the upper Midwest. The primary outcome variable was DNR status. Bivariate analysis was first carried out on all variables. Variables associated with DNR status at this stage were then included in a stepwise logistic regression to determine variables independently associated with DNR status. Overall, 71% of patients had DNR orders. Variables found to be independently associated with a higher probability of DNR status were increasing age, female gender, worse cognitive function, durable power of attorney, being self-paying, or having commercial insurance. Lack of daily contact with relatives and friends and lack of involvement with others were associated with lower probability of DNR status. A higher prevalence of DNR status in nursing homes was seen than in prior literature. The patient characteristics shown to be associated with DNR status may give important insight into the reasons that such decisions are made.

Age Factors↗