The development and validation of measures to assess cooking skills and food skills

BACKGROUND: With the increase use of convenience food and eating outside the home environment being linked to the obesity epidemic, the need to assess and monitor individuals cooking and food skills is key to help intervene where necessary to promote the usage of these skills. Therefore, this research aimed to develop and validate a measure for cooking skills and one for food skills, that are clearly described, relatable, user-friendly, suitable for different types of studies, and applicable across all sociodemographic levels. METHODS: Two measures were developed in light of the literature and expert opinion and piloted for clarity and ease of use. Following this, four studies were undertaken across different cohorts (including a sample of students, both 'Food preparation novices' and 'Experienced food preparers', and a nationally representative sample) to assess temporal stability, psychometrics, internal consistency reliability and construct validity of both measures. Analysis included T-tests, Pearson's correlations, factor analysis, and Cronbach's alphas, with a significance level of 0.05. RESULTS: Both measures were found to have a significant level of temporal stability (P < 0.001). Factor analysis revealed three factors with eigenvalues over 1, with two items in a third factor outside the two suggested measures. The internal consistency reliability for the cooking skills confidence measure ranged from 0.78 to 0.93 across all cohorts. The food skills confidence measure's Cronbach's alpha's ranged from 0.85 to 0.94. The two measures also showed a high discriminate validity as there were significant differences (P < 0.05 for cooking skills confidence and P < 0.01 for food skills confidence) between Food preparation novices' and 'Experienced food preparers.' CONCLUSIONS: The cooking skills confidence measure and the food skills confidence measure have been shown to have a very satisfactory reliability, validity and are consistent over time. Their user-friendly applicability make both measures highly suitable for large scale cross-sectional, longitudinal and intervention studies to assess or monitor cooking and food skills levels and confidence

How Reliable Are Administrative Data for Capturing Stroke Patients and Their Care

Background/Aims: The reliability of diagnostic coding of acute stroke and transient ischemic attack (TIA) in administrative data is uncertain. The purpose of this study is to determine the agreement between administrative data sources and chart audit for the identification of stroke type, stroke risk factors, and the use of hospital-based diagnostic procedures in patients with stroke or TIA. Methods: Medical charts for a population-based sample of patients (n = 14,508) with ischemic stroke, intracerebral hemorrhage (ICH), or TIA discharged from inpatient and emergency departments (ED) in Ontario, Canada, between April 1, 2012 and March 31, 2013, were audited by trained abstractors. Audited data were linked and compared with hospital administrative data and physician billing data. The positive predictive value (PPV) of hospital administrative data and kappa agreement for the reporting of stroke type were calculated. Kappa agreement was also determined for stroke risk factors and for select stroke-related procedures. Results: The PPV for stroke type in inpatient administrative data ranged from 89.5% (95% CI 88.0-91.0) for TIA, 91.9% (95% CI 90.2-93.5) for ICH, and 97.3% (95% CI 96.9-97.7) for ischemic stroke. For ED administrative data, PPV varied from 78.8% (95% CI 76.3-81.2) for ischemic, 86.3% (95% CI 76.8-95.7) for ICH, and 95.3% (95% CI 94.6-96.0) for TIA. The chance-corrected agreement between the audited and administrative data was good for atrial fibrillation (k = 0.60) and very good for diabetes (k = 0.86). Hospital administrative data combined with physician billing data more than doubled the observed agreement for carotid imaging (k = 0.65) and echocardiography (k = 0.66) compared to hospital administrative data alone. Conclusions: Inpatient and ED administrative data were found to be reliable in the reporting of the International Classification of Diagnosis, 10th revision, Canada (ICD-10-CA)-coded ischemic stroke, ICH and TIA, and for the recording of atrial fibrillation and diabetes. The combination of physician billing data with hospital administrative data greatly improved the capture of some diagnostic services provided to inpatients

Stroke care and case fatality in people with and without schizophrenia: a retrospective cohort study

Background Schizophrenia is associated with an increased risk of death following stroke; however, the magnitude and underlying reasons for this are not well understood.Objective To determine the association between schizophrenia and stroke case fatality, adjusting for baseline characteristics, stroke severity and processes of care.Design Retrospective cohort study used linked clinical and administrative databases.Setting All acute care institutions (N=152) in the province of Ontario, Canada.Participants All patients (N=52 473) hospitalised with stroke between 1 April 2002 and 31 March 2013 and included in the Ontario Stroke Registry. Those with schizophrenia (n=612) were identified using validated algorithms.Main outcomes and measures We compared acute stroke care in those with and without schizophrenia and used Cox proportional hazards models to examine the association between schizophrenia and mortality, adjusting for demographics, comorbidity, stroke severity and processes of care.Results Compared with those without schizophrenia, people with schizophrenia were less likely to undergo thrombolysis (10.1% vs 13.4%), carotid imaging (66.3% vs 74.0%), rehabilitation (36.6% vs 46.6% among those with disability at discharge) or be treated with antihypertensive, lipid-lowering or anticoagulant therapies. After adjustment for age and other factors, schizophrenia was associated with death from any cause at 1 year (adjusted HR (aHR) 1.33, 95% CI 1.14 to 1.54). This was mainly attributable to early deaths from stroke (aHR 1.47, 95% CI 1.20 to 1.80, with survival curves separating in the first 30 days), and the survival disadvantage was particularly marked in those aged over 70 years (1-year mortality 46.9% vs 35.0%).Conclusions Schizophrenia is associated with increased stroke case fatality, which is not fully explained by stroke severity, measurable comorbid conditions or processes of care. Future work should focus on understanding this mortality gap and on improving acute stroke and secondary preventive care in people with schizophrenia

Sex differences in direct healthcare costs following stroke: a population-based cohort study

Abstract Background The economic burden of stroke on the healthcare system has been previously described, but sex differences in healthcare costs have not been well characterized. We described the direct person-level healthcare cost in men and women as well as the various health settings in which costs were incurred following stroke. Methods In this population-based cohort study of patients admitted to hospital with stroke between 2008 and 2017 in Ontario, Canada, we used linked administrative data to calculate direct person-level costs in Canadian dollars in the one-year following stroke. We used a generalized linear model with a gamma distribution and a log link function to compare costs in women and men with and without adjustment for baseline clinical differences. We also assessed for an interaction between age and sex using restricted cubic splines to model the association of age with costs. Results We identified 101,252 patients (49% were women, median age [Q1-Q3] was 76 years [65–84]). Unadjusted costs following stroke were higher in women compared to men (mean ± standard deviation cost was $54,012 ± 54,766 for women versus$52,829 ± 59,955 for men, and median cost was $36,703 [$16,496–$72,227] for women versus$32,903 [$15,485–$66,007] for men). However, after adjustment, women had 3% lower costs compared to men (relative cost ratio and 95% confidence interval 0.97 [0.96,0.98]). The lower cost in women compared to men was most prominent among people aged over 85 years (p for interaction = 0.03). Women incurred lower costs than men in outpatient care and rehabilitation, but higher costs in complex continuing care, long-term care, and home care. Conclusions Patterns of resource utilization and direct medical costs were different between men and women after stroke. Our findings inform public payers of the drivers of costs following stroke and suggest the need for sex-based cost-effectiveness evaluation of stroke interventions with consideration of costs in all care settings

Resiliency in the Age of COVID-19: A Policy Toolkit

Twenty-nine LBJ School authors have come together to craft interdisciplinary and resilience-based policy solutions in one toolkit called Resiliency in the Age of COVID-19. In 18 articles that span public management, climate change, economic development, national security and more, LBJ School policy authors provide a forward-thinking lens on what went wrong and what leadership, public policies and initiatives it will take to fix the system flaws exposed by the pandemic. Published during the LBJ School’s 50th anniversary year, the toolkit also provides a snapshot of the school’s depth and breadth of policy and research engagement at this moment in time.Public Affair