Do Provider Service Networks Result in Lower Expenditures Compared with HMO s or Primary Care Case Management in Florida's Medicaid Program?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106942/1/hesr12129-sup-0001-Author-appendix.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/106942/2/hesr12129.pd

Prevalence of and risk factors for degenerative mitral valve disease in dogs attending primary-care veterinary practices in england

Background To date, epidemiological studies on degenerative mitral valve disease (DMVD) in dogs have largely reported referral caseloads or been limited to predisposed breeds. Analysis of primary‐care data to identify factors associated with DMVD would help clinicians identify high‐risk individuals and improve understanding. Objectives To estimate the prevalence of and identify risk factors for DMVD in dogs attending primary‐care veterinary practices in England. Animals Cases were identified within the electronic patient records of 111,967 dogs attending 93 practices. Four hundred and 5 dogs were diagnosed with DMVD (diagnosed cases) and a further 3,557 dogs had a heart murmur (HM) consistent with DMVD (possible cases). Methods Retrospective cross‐sectional study design. Prevalence was adjusted for the sampling approach. Mixed effects logistic regression models identified factors associated with DMVD. Results Prevalence estimates of diagnosed DMVD and HMs consistent with DMVD (both diagnosed and possible cases) were 0.36% (95% confidence interval [CI]: 0.29–0.45) and 3.54% (95% CI: 3.26–3.84) respectively. In the multivariable analysis, males had higher odds of diagnosed DMVD than did females (odds ratio [OR] 1.40, 95% CI: 1.12–1.74). Insured dogs had increased odds of DMVD compared with noninsured dogs (OR 3.56, 95% CI: 2.79–4.55) and dogs ≥20 kg had approximately half the odds of DMVD diagnosis compared with dogs(OR 0.51, 95% CI: 0.36–0.74). Strong associations between a DMVD diagnosis and individual breeds and age were identified. Conclusions and Clinical Importance Degenerative mitral valve disease was a common disorder in practice‐attending dogs. Knowledge of identified risk factors for DMVD could improve clinical diagnosis and direct future research

Consenting to health record linkage: evidence from a multi-purpose longitudinal survey of a general population

Background: The British Household Panel Survey (BHPS) is the first long-running UK longitudinal survey with a non-medical focus and a sample covering the whole age range to have asked for permission to link to a range of administrative health records. This study determines whether informed consent led to selection bias and reflects on the value of the BHPS linked with health records for epidemiological research. Methods. Multivariate logistical regression is used, with whether the respondent gave consent to data linkage or not as the dependent variable. Independent variables were entered as four blocks; (i) a set of standard demographics likely to be found in most health registration data, (ii) a broader set of socio-economic characteristics, (iii) a set of indicators of health conditions and (iv) information about the use of health services. Results: Participants aged 16-24, males and those living in England were more likely to consent. Consent is not biased with respect to socio-economic characteristics or health. Recent users of GP services are underrepresented among consenters. Conclusions: Whilst data could only be linked for a minority of BHPS participants, the BHPS offers a great range of information on people's life histories, their attitudes and behaviours making it an invaluable source for epidemiological research. © 2012 Knies et al; licensee BioMed Central Ltd

Images of psychiatry and psychiatrists.

OBJECTIVE: This study surveyed medical teaching faculty to determine their attitudes toward psychiatry and psychiatrists. METHOD: We conducted a multisite survey of a probability sample of 1057 teaching medical faculty members from 15 academic teaching centers in the United Kingdom, Europe, and Asia stratified by early, middle, and late career stage. The average response rate across countries was 65%. RESULTS: The outstanding findings were that 90% of respondents considered that psychiatrists were not good role models for medical students, 84% thought psychiatric patients were unsuitable to be treated outside of specialized facilities, and 73% thought psychiatric patients were emotionally draining. We noted statistically significant differences by country, gender, career stage, and specialty. CONCLUSION: These results highlight why recruitment into psychiatry is problematic in many countries and suggest that greater attention should be given to improving the perception of psychiatrists as good role models and the efficacy of psychiatric treatments

Is objective and accurate cognitive assessment across the menstrual cycle possible? A feasibility study

YesOBJECTIVES: Variation in plasma hormone levels influences the neurobiology of brain regions involved in cognition and emotion processing. Fluctuations in hormone levels across the menstrual cycle could therefore alter cognitive performance and wellbeing; reports have provided conflicting results, however. The aim of this study was to assess whether objective assessment of cognitive performance and self-reported wellbeing during the follicular and luteal phases of the menstrual cycle is feasible and investigate the possible reasons for variation in effects previously reported. METHODS: The Cambridge Neuropsychological Test Automated Battery and Edinburgh Postnatal Depression Scale were used to assess the cognitive performance and wellbeing of 12 women. Data were analysed by self-reported and hormone-estimated phases of the menstrual cycle. RESULTS: Recruitment to the study and assessment of cognition and wellbeing was without issue. Plasma hormone and peptide estimation showed substantial individual variation and suggests inaccuracy in self-reported menstrual phase estimation. CONCLUSION: Objective assessment of cognitive performance and self-assessed wellbeing across the menstrual cycle is feasible. Grouping data by hormonal profile rather by self-reported phase estimation may influence phase-mediated results. Future studies should use plasma hormone and peptide profiles to estimate cycle phase and group data for analyses

Educational outcomes in extremely preterm children : neuropsychological correlates and predictors of attainment

This study assessed the impact of extremely preterm birth on academic attainment at 11 years of age, investigated neuropsychological antecedents of attainment in reading and mathematics, and examined early predictors of educational outcomes. Children born extremely preterm had significantly poorer academic attainment and a higher prevalence of learning difficulties than their term peers. General cognitive ability and specific deficits in visuospatial skills or phoneme deletion at 6 years were predictive of mathematics and reading attainment at 11 years in both extremely preterm and term children. Phonological processing, attention, and executive functions at 6 years were also associated with academic attainment in children born extremely preterm. Furthermore, social factors, neonatal factors (necrotizing enterocolitis, breech delivery, abnormal cerebral ultrasound, early breast milk provision), and developmental factors at 30 months (head circumference, cognitive development), were independent predictors of educational outcomes at 11 years. Neonatal complications combined with assessments of early cognitive function provide moderate prediction for educational outcomes in children born extremely preterm

Is the Framingham Coronary Heart Disease Absolute Risk Function Applicable to Aboriginal People?

Objective: To determine the extent to which the Framingham function predicts the risk of coronary heart disease (CHD) in Aboriginal people. Design and setting: Cohort study in an Aboriginal community in the Northern Territory. Participants: 687 Aboriginal people aged 20-74 years were followed up from a baseline examination in 1992-1995 through to 31 December 2003. Main outcome measure: First CHD events were identified through hospital and death records during the follow-up period. Methods: An original Framingham function was used to predict CHD risk according to the duration of follow-up and the values of traditional risk factors, which included age, sex, total cholesterol level, high-density lipoprotein (HDL) cholesterol level, blood pressure, the presence of diabetes, and smoking status. The predicted CHD incidence using the Framingham function was 4.4 per 1000 person-years, while the observed incidence was 11.0 (95% CI, 8.7-13.9) per 1000 person-years. The observed number of CHD events (68) was 2.5 times the number predicted (27) using the Framingham function. The observed incidence was about four and three times the predicted incidence for age groups < 35 and 35-44 years, respectively, and about twice the predicted incidence for those over 45 years of age. The Framingham function was a particularly unreliable predictor for women, especially younger women, in whom the observed CHD rate was 30 times the predicted rate. Conclusions: The Framingham function substantially underestimates the actual risk of CHD observed in Aboriginal people in a remote community, especially for women and younger adults. This implies that traditional risk factors have different degrees of impact and/or that other factors are contributing to risk. A population-specific risk function is needed

How standard is standard care? Exploring control group outcomes in behaviour change interventions for young people with type 1 diabetes

Objective: Poor descriptions of standard care may compromise interpretation of results in randomised controlled trials (RCTs) of health interventions. We investigated quality of standard care in RCTs of behaviour change interventions for young people with type 1 diabetes and consider implications for evaluating trial outcomes. Design: We conducted systematic searches for articles published between 1999 and 2012. We extracted standard care descriptions and contacted trial authors to complete a checklist of standard care activities. The relationship between standard care quality and outcomes was examined via subgroup meta-analyses and meta-regression. Main outcome measures: Standard care descriptions, standard care quality, and relationships between standard care quality with medical and psychological outcomes. Results: We identified 20 RCTs described across 26 articles. Published descriptions of standard care were limited to service-level features. Author responses indicated standard care provision extended beyond published accounts. Subgroup analyses suggested control groups receiving higher standard care quality showed larger improvements in both medical and psychological outcomes, although standard care quality did not predict outcomes significantly. Conclusion: The quality of care delivered to control group participants can influence outcomes of RCTs. Inadequate reporting exacerbates this issue by masking variations between trials. We argue for increased clarity in reporting standard care in future trials

The substantive and practical significance of citation impact differences between institutions: Guidelines for the analysis of percentiles using effect sizes and confidence intervals

In our chapter we address the statistical analysis of percentiles: How should the citation impact of institutions be compared? In educational and psychological testing, percentiles are already used widely as a standard to evaluate an individual's test scores - intelligence tests for example - by comparing them with the percentiles of a calibrated sample. Percentiles, or percentile rank classes, are also a very suitable method for bibliometrics to normalize citations of publications in terms of the subject category and the publication year and, unlike the mean-based indicators (the relative citation rates), percentiles are scarcely affected by skewed distributions of citations. The percentile of a certain publication provides information about the citation impact this publication has achieved in comparison to other similar publications in the same subject category and publication year. Analyses of percentiles, however, have not always been presented in the most effective and meaningful way. New APA guidelines (American Psychological Association, 2010) suggest a lesser emphasis on significance tests and a greater emphasis on the substantive and practical significance of findings. Drawing on work by Cumming (2012) we show how examinations of effect sizes (e.g. Cohen's d statistic) and confidence intervals can lead to a clear understanding of citation impact differences