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At least 649 records · Page 36Linked to original sources
PubMed1998

Changes in self-rated health, disability and contact with services in a very elderly cohort: a 6-year follow-up study.

OBJECTIVES: To study the relationships between global self-rated health, reported physical symptoms and depressive symptoms and the receipt of community services by very elderly people, and to examine changes in these variables over time. DESIGN: Three-wave study with follow-up at 2.4 and 6 years after first interview. Structured interview, incorporating cognitive examination (Mini-Mental State Examination) and enquiring specifically about overall self-rated health, physical symptoms and depressive symptoms. SETTING: Community setting in city of Cambridge, UK. PARTICIPANTS: 2609 were initially recruited: all patients aged 75 years and over from lists of six general practices (and one in three from a seventh practice). At 2.4 years, 1173 individuals re-examined and at 6 years 628 individuals. MEASUREMENTS: General health self-rated in comparison to others of similar age and individual physical and depressive symptoms self-rated as present or absent. Symptoms were added to produce physical health and depressive symptom scores. Data presented from cross-sectional analysis of 6-year sample; also examined longitudinal data from all three waves of study for ageing and cohort effects. Finally the effect of health variables on the receipt of services was examined. Statistics used included chi(2) and non-parametric statistics for continuous data, also odds ratios for likelihood of receiving services. RESULTS: At 6 years, 70% rated their overall health as good or very good. Overall self-rated health showed both ageing and cohort effects, improving with increasing age and especially with more recent cohort. Reported physical symptoms increased with ageing. Depression scores also increased with ageing but the relationship between depressive symptoms and ageing was less clear-cut. Receipt of services was associated with poor self-rated health and reported physical symptoms as well as with ageing. Higher depression scores at 2.4 years were associated with increased service receipt at 6 years, indicating a lag between the symptoms and the service response. Individuals in the more recent cohort were less likely to receive services, but those who did so received more frequent contact. CONCLUSIONS: Although very elderly people have a high prevalence of reported physical symptoms, they often rate their overall health as good. There was a stronger relationship between ageing and physical symptoms than with depressive symptoms. Symptoms of both kinds influenced the likelihood of receiving services, although there was a lag between depressive symptoms and service response. Cohort effects on service receipt may reflect changes in public service policy.

Aged↗
PubMed2006

Combining dependent tests to compare the diagnostic accuracies--a non-parametric approach.

In this paper, we propose a non-parametric approach for comparing diagnostic accuracies in multi-reader receiver operating characteristic (ROC) studies. The approach constructs a test from each reader by extending the conventional non-parametric method and then combines all the individual test statistics to draw an overall conclusion on the relative accuracies of different diagnostic tests. The method can handle both continuous and ordinal data. Compared to the existing non-parametric methods, the method is robust and effectively deals with the possible heterogeneity among readers. It can also be applied to the analysis of correlated ROC studies. The method is applied to a real example and its finite sample performance is examined through simulation studies.

Analysis of Variance↗
PubMed2006

Tests of equivalence and non-inferiority for diagnostic accuracy based on the paired areas under ROC curves.

Assessment of equivalence or non-inferiority in accuracy between two diagnostic procedures often involves comparisons of paired areas under the receiver operating characteristic (ROC) curves. With some pre-specified clinically meaningful limits, the current approach to evaluating equivalence is to perform the two one-sided tests (TOST) based on the difference in paired areas under ROC curves estimated by the non-parametric method. We propose to use the standardized difference for assessing equivalence or non-inferiority in diagnostic accuracy based on paired areas under ROC curves between two diagnostic procedures. The bootstrap technique is also suggested for both non-parametric method and the standardized difference approach. A simulation study was conducted empirically to investigate the size and power of the four methods for various combinations of distributions, data types, sample sizes, and different correlations. Simulation results demonstrate that the bootstrap procedure of the standardized difference approach not only can adequately control the type I error rate at the nominal level but also provides equivalent power under both symmetrical and skewed distributions. A numerical example using published data illustrates the proposed methods.

Computer Simulation↗
PubMed1991

Targeting preventive interventions: enhancing risk estimates through theory.

Incorporation of mediational screening procedures within targeted preventive interventions must be grounded in a substantial theoretical and epidemiological knowledge base. Essential information includes an etiological model of the disorder(s) to be prevented and epidemiological confirmation that risk factors used for the selection of intervention recipients have been prospectively confirmed. Targeting these recipients using a combination of indicated and selective criteria is expected to increase the base rate at which the disorder(s) to be prevented occurs in the intervention population and thus the power of the evaluation design used to confirm reductions in proximal and distal indices of disorder(s). Caution is urged, however, to consider the potential iatrogenic effects of overly focused targeting and the potential reductions in intervention effectiveness resulting from application to homogeneous vs. heterogeneous populations. Mediational screening's heuristic contribution to theory is discussed.

Health Services Research↗
PubMed1996

[Regional variations in health services: various methodological problems].

Many studies show strong variation of health consumption between regions, suggesting that theses variations are related to the uncertainty of medical practice or to other factors related to health services or patients attitude. However the statistical interpretation of these variations is far from easy: apart from usual and specific information bias, there are statistical problems when observing incidence of events like health care consumption: it is in fact a rare event, which is observed within small population, and among regions with unequal number of person. Therefore, most of the variation reported might be well explained by a purely statistical phenomenon. This paper presents some aspects of this variability for three common indicators of variation, and suggest the use of ad hoc simulation to get statistical criteria.

Bias↗
PubMed1983

Assessing adolescent health needs: a factor analytic approach.

Advances in technology are rapidly expanding health educators' resources for presenting information tailored to meet individual health needs and interests. A self-administered questionnaire was given to 510 youths in grades 6 through 9 to ascertain adolescents' health concerns and thus develop more appropriate educational programs. Smoking, diet and weight control, physical fitness, and general health items were included. Factor analysis methods identified ten concerns; smoking, weight control, exercise effects, peer approval of appearance, preparatory health behaviors, planning and maintaining a personal health program, feeling good about oneself, communication issues, comparisons with others, and resistance to negative peer influences. Sex and grade were significantly associated with particular responses. Recommendations include the value of addressing each area of the content domain as it relates to health lessons to ensure that information is relevant to the needs and interests of individual adolescents.

Adolescent↗
PubMed1995

Public reporting of performance measures in home care.

BACKGROUND: In 1992 DependiCare Home Health, Inc (Broadview, Ill), a 62-employee home medical equipment/respiratory therapy (HME) business in the Chicago metropolitan area, discovered that managed care organizations need quantifiable data from vendors in the form of measurements or outcomes. In response to this need, DependiCare developed its "Under the Microscope" program. This program provides quarterly reports (starting in April 1994) on service efficiency, patient satisfaction, and outcome statistics to referral sources, including physicians, discharge planners, and hospital executives. MEASUREMENTS: Performance measures, which represent information from DependiCare's internal operations, can be viewed as the company's quarterly report card. Areas reported on include target-time performance, same-day and under-two-hour delivery, patient (and referral source) satisfaction, equipment breakdown, and fillrate statistics. Outcome statistics include discontinuation of service by diagnosis and number of months on oxygen by diagnosis. USE OF RESULTS: Measurements help to identify weaknesses that need to be addressed by organizational or operational changes, as well as to uncover strengths that can be capitalized on for sales and marketing. Hospital-based discharge planning departments, a substantial referral source, most often use the Under the Microscope program to justify referring patients to DependiCare. Little is known about managed care customers' use of the data. CONCLUSIONS: In the long term, an integrated, automated way to track individual patients across the continuum of care from the physician, to the hospital, and to home care is needed. A centralized database of patient experience, including outcomes, could assist in health care decision making.

Capitation Fee↗
PubMed1993

Factor analysis as a tool in primary care research.

Research in primary health care is increasingly relying on questionnaires and surveys to address relevant research questions. In many cases, a variety of items are assessed representing attitude sets or multidimensional constructs. Factor analysis is an effective and efficient method for identifying underlying dimensions in a group of variables. In addition, factor analysis allows the investigator to reduce a large set of original variables to a smaller set of new composite factors for use in future investigations, with a minimum loss of information. The issues and methods of factor analysis are described and illustrated with data from an investigation of a medical school's attitudes toward gifts from industry.

Data Interpretation, Statistical↗
PubMed1993

The interpretation of averages in health professions research. An empirical examination.

A potential misinterpretation regarding measures of central tendency was identified in several health sciences textbooks presenting basic statistical procedures. The misinterpretation involves measures of central tendency derived from skewed unimodal sample distributions. The reviewed textbooks state or imply that in asymmetrical distributions the median is always located between the mode and mean. An example is presented illustrating the fallacy of this assumption. The mean and median will always be to the right of the mode in a positively skewed unimodal distribution and to the left of the mode in a negatively skewed distribution, but the order of the mean and median is impossible to predict or generalize. The assumption that the median always falls between the mode and mean in the calculation of coefficients of skewness has implications for the interpretation of health sciences research.

Data Interpretation, Statistical↗