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HMO enrollment and Medicaid. Survival analysis with a Weibull function.

This paper analyzes the length of enrollment in Health Maintenance Organizations (HMOs) by performing secondary data analysis. It estimates a Weibull survival function using only simple regression. For middle-class enrollees in one HMO, the hazard rate (the disenrollment rate for the remaining members of a cohort) falls sharply with the length of enrollment. For medicaid beneficiaries allowed to remain in the fee-for-service sector, the hazard rate in another HMO is much greater but falls less sharply. Limiting the choice of Medicaid beneficiaries to HMOs would increase their length of enrollment, lowering a major barrier to HMOs' participation in Medicaid.

Epidemiologic Methods↗

[Secondary infection with methacillin resistant Staphylococcus aureus in Dutch hospitals (July 1997-June 1996].

OBJECTIVE: To study the spread of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals, especially secondary MRSA infections in relation to the origin of the MRSA strain and the measures taken regarding contact isolation. DESIGN: Secondary data analysis. METHODS: As part of the national MRSA surveillance of the National Institute of Public Health and the Environment, data were collected using questionnaires. The analysis covered the period July 1994-June 1996 and was performed for index cases of secondary infections versus sporadic cases. Possible risk factors were determined. RESULTS: In the study period 30 index cases of (clusters of) secondary infections and 191 sporadic cases were found. The size of the clusters was limited. Strict contact isolation as described in the guidelines of the Dutch Working Group on Infection Prevention prevented secondary infections in most cases. Patients for whom no relation could be found between the MRSA infection and a stay abroad were found to have caused more secondary infections, even when the data were corrected for contact isolation measures.

Cross Infection↗

What is the link between poor ultrafiltration and increased mortality in anuric patients on automated peritoneal dialysis? Analysis of data from EAPOS.

BACKGROUND: Primary analysis of the European Automated Peritoneal Dialysis Outcomes Study (EAPOS) found that patients with daily ultrafiltration (UF) below a predefined target of 750 mL at baseline experienced increased mortality and continuing low UF over 2 years. SETTING: Multicenter, prospective observational study of prevalent, functionally anuric patients on automated peritoneal dialysis (APD) treated to predefined standards. METHODS: Secondary data analysis to determine clinical covariates that might support a link between poor UF and outcome, including pattern of comorbidity, prescription, nutrition as determined by Subjective Global Assessment (SGA), membrane function, and blood pressure (BP). Ultrafiltration was treated as a categorical (comparing patients above and below target at baseline) and continuous dependent variable in univariate and multivariate regression. The relationship between BP and survival was also explored. RESULTS: Of 177 patients recruited from 28 centers across Europe, 43 were below the UF target at baseline. Compared to those above target, there were no differences in the spread of comorbidity, type of APD prescription, SGA, BP, hemoglobin, HCO3, or parathyroid hormone, at baseline or at any later time. At baseline, plasma calcium and, at 12 months, plasma phosphate were lower in the low UF group. There was a weak positive correlation between baseline systolic or diastolic BP and UF, which remained on multivariate analysis but accounted for just 9% of the variability in BP. There was no clear relationship between baseline BP and survival, although, if anything, low BP was associated with earlier death. Poor UF was associated with lower mean dialysate glucose concentration during the first 4 months and with consistently worse membrane function. CONCLUSIONS: The increased mortality associated with poor UF is likely multifactorial and not easily explained by clear differences in comorbidity, nutritional state, or other indices of treatment at baseline. The lower plasma phosphate suggests a subsequent fall in appetite. Poor BP control is unlikely to be the explanation, and a link between lower BP, reduced UF, and earlier death is suggested. Failure to achieve adequate UF due to worse membrane function remains an important and potentially reversible or preventable cause.

Anuria↗

The effect of Channeling on in-home utilization and subsequent nursing home care: a simultaneous equation perspective.

OBJECTIVE: This study explored the relationship between participation in a home/community-based long-term care case management intervention (known as the Channeling demonstration), use of formal in-home care, and subsequent nursing home utilization. STUDY DESIGN: Structural analysis of the randomized Channeling intervention was conducted to decompose the total effects of Channeling on nursing home use into direct and indirect effects. DATA COLLECTION METHOD: Secondary data analysis of the National Long-Term Care Data Set. PRINCIPAL FINDINGS: The use of formal in-home care, which was increased by the Channeling intervention, was positively associated with nursing home utilization at 12 months. However, the negative direct effect of Channeling on nursing home use was of sufficient magnitude to offset this positive indirect effect, so that a small but significant negative total effect of Channeling on subsequent nursing home utilization was found. CONCLUSIONS: This study shows why Channeling did not have a large total impact on nursing home utilization. The analysis did not provide evidence of direct substitution of in-home care for nursing home care because the direct reductions in nursing home utilization due to other aspects of Channeling (including, but not limited to case management) were substantially offset by the indirect increases in nursing home utilization associated with additional home care use.

Aged↗

Disparities in colorectal cancer screening: a guideline-based analysis of adherence.

PURPOSE: This study's primary objective was to describe colorectal cancer (CRC) screening disparities using a guideline-derived definition of CRC screening adherence while controlling for confounding factors associated with CRC screening. METHODS: This secondary data analysis of the 2000 National Health Interview Survey (NHIS) included 12,677 individuals age > or = 50 years. The primary outcome assessed was adherence to CRC screening guidelines, defined as a sigmoidoscopy or proctoscopy within the last five years, colonoscopy within the last 10 years, or home fecal occult blood test within the last 12 months. Age, race/ethnicity, gender, physical disability, household income, insurance status, education level, marriage status, rural or urban geographic area, and family history of CRC were analyzed as covariates in a logistic regression model. We assessed the association between these sociodemographic variables and receipt of physician recommendation for CRC screening among those respondents not adherent to CRC screening recommendations. RESULTS: In the multivariate model, the odds for being adherent with current CRC screening recommendations were lower for Hispanics (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.59-0.86) and African Americans (OR 0.82, 95% CI 0.71-0.95) than for Whites. Residents of urban areas had higher odds (OR 1.19, 95% CI 1.06-1.34) of being up-to-date than rural residents. Among subjects who were not up-to-date with CRC screening, similar disparities were noted in receipt of physician recommendation for CRC screening. CONCLUSIONS: Certain groups are at increased risk of not receiving CRC screening or recommendations for screening from their physicians. Interventions to reduce these disparities should be an integral part of overall efforts to improve CRC prevention and control.

Black or African American↗

Effect of blood pressure and diabetes mellitus on cognitive and physical functions in older adults: a longitudinal analysis of the advanced cognitive training for independent and vital elderly cohort.

OBJECTIVES: To evaluate the effect of blood pressure (BP) and diabetes mellitus (DM) on cognitive and physical performance in older, independent-living adults. DESIGN: Longitudinal study with secondary data analysis from the Advanced Cognitive Training for Independent and Vital Elderly randomized intervention trial. SETTING: Six field sites in the United States. PARTICIPANTS: Two thousand eight hundred two independent-living subjects aged 65 to 94. MEASUREMENTS: Cognitive functions in different domains and physical functions measured using activities of daily living, instrumental activities of daily living (IADLs), and the physical function subscale from the Medical Outcomes Study Short Form-36 (SF-36) Health Survey. RESULTS: After the first annual examination, hypertension was associated with a faster decline in performance on logical reasoning tasks (ability to solve problems following a serial pattern), whereas DM was associated with accelerated decline on the Digit Symbol Substitution Test (speed of processing). The reasoning and Digit Symbol Substitution test are executive function tasks thought to be related to frontal-lobe function. Hypertension and DM were associated with a significantly faster pace of decline on the SF-36 physical function component score. Individuals with DM had a faster pace of decline in IADL functioning than nondiabetic subjects. There was no evidence for an interaction between BP and DM on cognitive or physical function decline. CONCLUSION: Hypertension and DM are associated with accelerated decline in executive measures and physical function in independent-living elderly subjects. Further research is needed to determine whether cardiovascular risk modification ameliorates cognitive and functional decline in elderly people.

Activities of Daily Living↗

Secondary data analyses of dietary surveys undertaken in South Africa to determine usual food consumption of the population.

OBJECTIVE: The primary objective of this study was to generate a reference table of food items and average amounts of these items consumed by South Africans, for the Department of Health. The reference table was required to be representative of foods and beverages eaten frequently by children and adults from all age and ethnic groups in order for the Department of Health to test for contaminants in these foods. DESIGN: The National Food Consumption Survey (NFCS) served as a framework for compiling data on children since this was a national representative survey of 1-9-year-old children undertaken in South Africa in 1999. However, there has never been a national dietary survey on adults in South Africa. Consequently the data had to be extrapolated from existing isolated surveys on adults. Secondary data analysis was conducted on existing dietary databases (raw data) obtained from surveys undertaken on adults in South Africa between 1983 and 2000. Available datasets were regional and independent, and were not individually representative of the South African diet. It was therefore necessary to use different statistical methods, including factor analyses, weighting and correlations, to generate ethnic and geographic representative data for adults. Two methods were used: Method 1, which corresponded with results of the NFCS (over-sampled for low socio-economic status), and Method 2, which was based on ethnic proportions of the population. RESULTS: The secondary data analyses generated food items most commonly consumed by the South African adult population (Method 1) in descending frequency of usage and average (mean) amount per day: maize porridge (78%/848 g), white sugar (77%/27 g), tea (68%/456 g), brown bread (55%/165 g), white bread (28%/163 g), non-dairy creamer (25%/6 g), brick margarine (21%/19 g), chicken meat (19%/111 g), full-cream milk (19%/204 g) and green leaves (17%/182 g). In 6-9-year-olds, maize porridge (72%/426 g), sugar (76%/23 g), tea (51%/258 g), full-cream milk (35%/171 g) and white bread (33%/119 g) were eaten most frequently. Similarly, in 1-5-year-olds, the foods consumed most frequently were maize porridge (80%/426 g), sugar (76%/21 g), tea (44%/224 g), full-cream milk (39%/186 g) and white bread (24%/83 g). In order to evaluate the validity of the adult data generated, kilojoule values of the individual food items (per capita) were compared with food balance sheets (FBSs). The comparison was favourable except that the FBSs had a higher overall energy intake per capita of between 22 and 28%. CONCLUSION: Reference tables of commonly consumed foods and beverages were generated at minimal cost based on secondary data analyses of past dietary surveys in different South African populations.

Adolescent↗

Secondary analysis of primary and preventive services accessed and perceived service barriers by children with developmental disabilities and their families.

Children and youths with developmental disabilities (DD) have needs for more community-based services to address ongoing health, educational, employment, housing, transportation, and recreational concerns. Secondary data analysis was conducted to examine the array of services accessed and service obstacles to primary, preventive and special health care services of 102 children and youths with developmental disabilities. The two services most frequently reported as being used by families were SSI (29.4%) and MediCal (California's Medicaid program) (27.8%). Speech therapy was the most frequently identified support service accessed by respondents (51%). Respondents identified a number of unaddressed concerns and perceived barriers to having these concerns addressed as it related to service referrals for speech therapy, nutrition services, dental services, and behavior management services.

Adolescent↗

Modifiable determinants of healthcare utilization within the African-American population.

BACKGROUND: Significant health disparities directly affect the African-American population. Most previous studies of disparities in access to and utilization of healthcare have focused on black-white differences rather than focusing on "within-group" analysis of African Americans. OBJECTIVE: To tease out the differential effects of modifiable risk factors (such as health insurance, usual source of care, and poverty) from personal characteristics (age, gender, rural residence) on healthcare utilization within the African-American population. METHODS: Secondary data analysis of 3462 records from African-American respondents to the 1999 Medical Expenditure Panel Survey (MEPS) Household File, a nationally representative survey of the civilian, noninstitutionalized U.S. population in 1999. RESULTS: We found significant variation in the number of office visits, outpatient clinic visits, hospital discharges, days hospitalized, and fills of prescribed medication among 3462 African-American respondents who represent a U.S. population of 36,538,639 persons. Personal nonmodifiable characteristics such as age and gender were significantly related to healthcare utilization. Poverty and rural residence were also significantly correlated, but the strongest modifiable predictors of healthcare utilization for Afrcan-American persons in 1999 were whether or not individuals had health insurance and/or a usual source of care. Emergency department visits were the only form of care that showed remarkably little variation based on these modifiable risk factors. CONCLUSIONS: The three modifiable factors of poverty, uninsurance, and having a primary care medical home have a dramatic effect on patterns of care for African-American patients and could be independently targeted for intervention.

Adolescent↗

Effect of epidural analgesia for labor on the cesarean delivery rate.

OBJECTIVE: To use meta-analysis to evaluate the effect of epidural analgesia on the cesarean delivery rate. DATA SOURCES: The MEDLINE data base was searched for articles published in English between January 1981 and April 1992. We also interviewed experts and conducted a bibliographic follow-up and manual review of recent journals published from April to July 1992. METHODS OF STUDY SELECTION: We excluded articles with irrelevant titles, and those case studies, book chapters, or articles that did not provide primary and relevant data. Two hundred thirty articles were read, including articles that reported on women of standard obstetric risk and on cesarean delivery rates for an epidural group and for a concurrent no-epidural group. These criteria yielded six studies for a primary analysis and two others for a secondary analysis. DATA EXTRACTION AND SYNTHESIS: The sample size of the epidural and no-epidural groups and the number of cesareans within each group were extracted. Tests of homogeneity were conducted. The pooled cesarean delivery risk difference as a result of epidural analgesia was estimated. The cesarean rate for women undergoing epidural analgesia was ten percentage points greater than for no-epidural women (P < .05). More than a nine percentage point increase was shown for cesarean deliveries for dystocia (P < .05), when pooling either all studies or only randomized studies. CONCLUSIONS: The results of this meta-analysis strongly support an increase in cesarean delivery associated with epidural analgesia. Further research should evaluate the balance between analgesia associated with the use of epidurals, and postpartum morbidity and costs associated with cesarean deliveries.

Analgesia, Epidural↗

Improved detection of depression in primary care through severity evaluation.

OBJECTIVES: To determine whether the use of a symptom severity measure to augment an existing Diagnostic and Statistical Manual of Mental Disorders-Third Edition, Revised (DSM-III-R) criteria-based depression screener (PRIME-MD) would decrease the difficulties associated with depression screening in primary care by filtering out patients with minimal impairment. STUDY DESIGN: The study design was secondary data analysis. POPULATION: The study sample comprised 1317 patients, with intentional oversampling by ethnicity and sex, presenting for routine care at a university family practice center in Galveston, Texas. OUTCOMES MEASURED: The primary outcomes were cross-sectional, health-related quality-of-life outcomes of subjects who met symptom severity criteria as well as criteria for a DSM-III-R mood disorder. Health care utilization outcomes were examined as secondary outcomes. RESULTS: The combination of a 6-item depression severity instrument and the PRIME-MD resulted in 71% of depressed subjects being categorized as severely symptomatic and 29% as minimally symptomatic. Severely symptomatic subjects had significantly worse SF-36 Mental Health Component Summary scale (MCS) scores than did minimally symptomatic subjects (32.8 vs 43.5, P <.05). Minimally symptomatic subjects had MCS scores similar to those of a third group of subjects who did not meet DSM-III-R "threshold" criteria for mood disorder but who were severely symptomatic. Adjusted health care utilization was higher for the initial 3-month charge period in the severely symptomatic depressed subjects compared with minimally symptomatic depressed subjects ($679.20 vs $462.38, P <.05). CONCLUSIONS: The 6-item depression severity measure effectively separated patients meeting DSM-III-R "threshold" depression criteria into 2 groups: one presenting with severe symptoms and impairment and the other presenting with mild symptoms and significantly less impairment. A strategy of initial screening using a brief depression severity instrument, followed with a DSM criteria-based instrument, could decrease the immediate clinician workload by one third and focus treatment on those most likely to benefit.

Adult↗

A randomized trial of dehumidification in the control of house dust mite.

BACKGROUND: House dust mites (HDM) are sensitive to humidity. Few studies have adequately examined the potential of dehumidification in reducing HDM numbers. OBJECTIVE: The study examined the effect of portable domestic dehumidifiers, and a behavioural programme to reduce humidity, on HDM counts and HDM allergen levels. METHODS: A randomized controlled trial was undertaken. A total of 76 homes were allocated to three groups that received a portable domestic dehumidifier, a behavioural programme, or no intervention. Humidity, temperature, HDM counts (trap and vacuum samples), HDM allergen, and other details of the home environment were measured on four occasions over a period of 1 year. Interventions and measurements were concerned predominantly with one bedroom. RESULTS: There was a reduction in relative humidity in the dehumidifier group, but not the behavioural group. A decline in HDM trap counts was observed for all three groups. Change scores did not indicate that the dehumidifier group had a greater decline than the other groups. A secondary analysis examining presence or absence of HDM showed a shift from households having HDM at baseline to households not having HDM in the final round for some trap measures. Change score analysis indicated that this shift was greater in the dehumidifier group compared with other groups. The dehumidifier group did not show a greater decline in HDM allergen than that seen in the other two groups. CONCLUSION: Neither the dehumidifier nor the behavioural intervention had a major effect on HDM counts or allergen levels. However, the study did have a number of limitations relating to size, timing of intervention, and running of the dehumidifiers. The secondary data analysis may indicate some effect of dehumidification, but clearly this effect was small. There is a need for more information on the effects of reducing ambient humidity on the distribution of HDM within their habitats.

Animals↗

Analysis of emergency department utilization by elderly patients under National Health Insurance.

Elderly persons are thought to use emergency departments (EDs) disproportionately. This phenomenon has implications for policy-making as the population of the elderly continues to increase. This study aimed to characterize national ED utilization by elderly patients (> or = 65 years old), compared with that by younger patients (15-64 years old). The sample was selected from the National Health Insurance Research Database for the year 2000. There were 519,003 visits to adult EDs in the 12 medical centers sampled. The study used a secondary data analysis and included 14 variables. The elderly accounted for 28.5% of all adult ED visits. Compared with younger patients, a greater proportion of elderly patients were male (61.6% vs. 47.7%, p < 0.001), had chronic diseases (11.9% vs. 8.0%, p < 0.001), were major cases (6.7% vs. 4.1%, p < 0.001), made no co-payment (38.5% vs. 5.8%, p < 0.001), were frequent users of outpatient services (28.4% vs. 9.9%, p < 0.001), were higher-level emergencies (60.0% vs. 43.7%, p < 0.001), had longer stays in the ED (14.0% vs. 4.7%, p < 0.001), and had higher costs per visit (NT dollars 4,814 +/- 6,046 vs. 2,779 +/- 5,533, p < 0.001). In addition, elderly patients used 40.8% of total adult ED costs. Older patients have distinct patterns of ED use, and use emergency services at a higher rate than younger patients. ED staff should be knowledgeable about the unique and complex presentations of older ED patients.

Adult↗

Work disability resulting from chronic health conditions.

OBJECTIVES: To describe current programs and policies for addressing work disability among adults with chronic health conditions, and to identify opportunities for new research aimed at reducing the problem. METHODS: The authors conducted secondary data analysis and a literature review. RESULTS: Millions of Americans with a chronic health condition have a work disability or are at risk of developing one. This public health problem is costing hundreds of billions of dollars a year nationally in lost productivity and diminishing the quality of life of millions of Americans. The medical care system, employers, and government--three traditional sources of help for adults with chronic health problems--are not sufficiently oriented toward the primary or secondary prevention of work disability. CONCLUSIONS: New research is urgently needed to reduce the burden of work disability on individuals and society.

Chronic Disease↗

Cancer risk-reduction behaviors of breast cancer survivors.

Using secondary data analysis, the aim was to determine if postmenopausal women, who have survived breast cancer, have adopted healthy nutritional and physical activity behaviors recommended in the American Cancer Society guidelines as cancer risk-reduction strategies, and in guidelines for prevention of other chronic diseases or for improving general health. From their personal health history, women who have survived breast cancer would be likely candidates to adopt healthy behaviors recommended as cancer risk-reduction strategies or for prevention of other chronic diseases. A secondary aim was to determine the perceived general health and affective state of these women. These breast cancer survivors had a high perception of their general health, a positive affective state, and have adopted some healthy lifestyle behaviors, but they are not fully adhering to the ACS nutrition and physical activity guidelines or other health related guidelines for cancer risk reduction or prevention of other chronic diseases.

Adult↗

Continuing exposure to hexavalent chromium, a known lung carcinogen: an analysis of OSHA compliance inspections, 1990-2000.

BACKGROUND: Hexavalent chromium is widely recognized to be a lung carcinogen. However, the U.S. Occupational Safety and Health Administration (OSHA) has failed to reduce the permissible exposure limit (PEL), despite having acknowledged in 1994 that the current limit is too high. In 1993, Public Citizen and the Paper, Allied-Industrial, Chemical and Energy Workers International Union (PACE) petitioned to lower the PEL from the current 100 microg/m(3) to 0.5 microg/m(3) as an 8-hr time-weighted average (TWA). METHODS: To assess industry compliance with the current PEL, and to determine the feasibility of achieving the proposed lower limit of 0.5 microg/m(3), we conducted a secondary data analysis of OSHA's Integrated Management Information System (IMIS) database. This database contains 813 measurements of hexavalent chromium exposure from inspections performed during the years 1990-2000. RESULTS: There was a statistically significant decline in the annual number of measurements over the study period from 127 in 1990 to 67 in 2000 (F = 0.0009; linear regression). The median TWA measurement was 10 microg/m(3) (range: 0.01-13,960 microg/m(3)) and the median ceiling measurement was 40.5 microg/m(3) (range: 0.25-25,000 microg/m(3)). Neither median TWA nor median ceiling exposures (if hexavalent chromium was detected) declined significantly during the study period (F = 0.065 and 0.57, respectively). Overall, 13.7% of TWA measurements were at or below the Public Citizen/PACE proposed standard; 65.0% were between the Public Citizen/PACE proposal and the current OSHA PEL; and 21.3% exceeded the OSHA PEL. Compared to OSHA measurements, state measurements were less likely to detect hexavalent chromium (40.2% vs. 52.1%; P = 0.0007; chi-square) and less likely to issue any citation (9.3% vs. 19.1%; P = 0.0003), including citations for overexposure if the exposure exceeded the PEL (54.8% vs. 78.8%; P = 0.012). CONCLUSIONS: U.S. workers continue to be exposed to dangerously high hexavalent chromium levels, but low exposure levels were found in some industries. Further investigations should examine whether state plans provide weaker enforcement than federal OSHA.

Carcinogens, Environmental↗

Do race, gender, and source of payment impact on anesthetic technique for inguinal hernia repair?

STUDY OBJECTIVE: To evaluate the potential differences in the type of anesthesia provided to patients of different race, gender, and source of payment undergoing inguinal hernia repair (IHR). DESIGN: Retrospective cohort study. SETTING: Ambulatory surgical centers/National Survey of Ambulatory Surgery. PATIENTS: 5810 patients older than 14 years who underwent IHR in an ambulatory surgical center. INTERVENTIONS: Inguinal hernia repair under different types of anesthesia. MEASUREMENTS: The association of race, gender, and source of payment with different types of anesthesia for IHR as determined by multivariate regression analysis. RESULTS: Significant discrepancies in the use of various anesthetics between patients of different race, gender, and source of payment were found. Patients identified as black and those of other minority groups were significantly more likely to receive general anesthesia compared with those identified as white (odds ratio [OR] 2.76, confidence interval [CI] 1.96-3.88 and OR 1.66, CI 1.14-2.42, respectively). Those identified as black were less likely to receive epidural anesthesia compared with their white counterparts (OR 0.36, CI 0.14-0.95). Women were less likely than men to undergo IHR with epidural anesthesia (OR 0.5, 95% CI 0.3-0.85). CONCLUSION: Significant discrepancies in the use of various anesthetics for IHR between patients of different race, gender, and insurance status were found. Despite limitations inherent to secondary data analysis, the findings raise the possibility that nonmedical factors may influence anesthetic management.

Adolescent↗

Research publications in vascular and interventional radiology: research topics, study designs, and statistical methods.

PURPOSE: Statistical analysis is the universal language of medical research and is a vital tool for communicating the results of vascular and interventional radiology (VIR) procedures. Major articles in two radiology journals were surveyed to characterize the research topics, study designs, and statistical methods seen in recent VIR research publications. MATERIALS AND METHODS: The authors retrospectively reviewed 130 major clinical VIR articles published from July 2000 to June 2001: 72 articles (55%) from JVIR and 58 articles (45%) from RADIOLOGY: Articles were categorized by research topic and study design. Data were collected on the statistical methodology of each article. RESULTS: Research topics included vascular intervention in 65 of 130 articles (50%), nonvascular intervention in 26 (20%), vascular imaging in 23 (18%), biopsy in nine (7%), and other topics in seven (5%). Study design was descriptive in 87 studies (67%), comparative in 39 studies (30%), and involved secondary data analysis in four studies (3%). Of 126 primary clinical studies, outcome was cross-sectional (assessed at a single time point) in 40 studies (32%) and longitudinal (measured over time) in 86 studies (68%). Median sample size was 61. Basic tests of association (t-test, chi(2) test, etc.) were used in 71 articles (56%) and advanced tests of association (regression analysis) were presented in 25 (20%). Survival analysis was applied in 34 articles (27%). Decision statistics such as sensitivity/specificity were not used commonly (12%). Confidence intervals and power calculations were reported infrequently (15% and 7%, respectively). CONCLUSIONS: VIR publications focus on time-dependent outcomes after therapeutic interventions. Readers should understand basic tests of association and survival analysis--these include only 20 named statistical tests.

Periodicals as Topic↗