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1.
Gynecol Oncol ; 147(2): 433-438, 2017 11.
Article in English | MEDLINE | ID: mdl-28888542

ABSTRACT

INTRODUCTION: Older women with ovarian cancer (OC) are less likely to receive guideline concordant treatment. Differences in values and worries about treatment may explain why. METHODS: Women with OC in 2013-2015 were surveyed about values and worries at the time of initial treatment. Existing values (11 item, e.g., maintaining quality of life) and worries (12 items, e.g., treatment side effects) scales were adapted based on OC literature. Responses were very/somewhat/a little/not at all important or worried. Principal Component Analyses (PCA) identified groups of values and worries that best explained scales' variation. We examined proportions reporting very/somewhat important/worried on ≥1 item in each component by age (older ≥65years, younger <65years). RESULTS: Of 170 respondents, 42.3% were older. PCA components for values were: functional well-being (3 survey items, proportion of variance explained [PoVE] 26.3%), length of life and sexual functioning (3 items, PoVE 20.1%), attitudes (3 items, PoVE 14.2%), and not becoming a burden (2 items, PoVE 13.7%). PCA components for worries were: economic (4 items, PoVE 27.2%), uncertainty (6 items, PoVE 26.0%), and family impact (2 items, PoVE 16.3%). Older women were less likely to indicate very/somewhat worried to ≥1 item in the economic (51.4% vs 72.4%, p=0.006), uncertainty (80.6% vs. 98.0%, p=0.001), and family impact component (55.6% vs. 70.4%, p=0.03). No other age differences were found. CONCLUSIONS: While worry during OC treatment decision-making may differ across age groups, values do not. Research should assess how differences in worry might affect OC medical decision-making for older and younger women.


Subject(s)
Ovarian Neoplasms/psychology , Adult , Age Factors , Aged , Aged, 80 and over , Anxiety/etiology , Anxiety/psychology , Female , Humans , Middle Aged , Quality of Life , Surveys and Questionnaires , Young Adult
2.
J Gerontol A Biol Sci Med Sci ; 69(9): 1146-53, 2014 Sep.
Article in English | MEDLINE | ID: mdl-24589863

ABSTRACT

BACKGROUND: Nutritional risk and low BMI are common among community-dwelling older adults, but it is unclear what associations these factors have with health services utilization and mortality over long-term follow-up. The aim of this study was to assess prospective associations of nutritional risk and BMI with all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality over 8.5 years. METHODS: Data are from 1,000 participants in the University of Alabama at Birmingham Study of Aging, a longitudinal, observational study of older black and white residents of Alabama aged 65 and older. Nutritional risk was assessed using questions associated with the DETERMINE checklist. BMI was categorized as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), class I obese (30.0-34.9), and classes II and III obese (≥35.0). Cox proportional hazards models were fit to assess risk of all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality. Covariates included social support, social isolation, comorbidities, and demographic measures. RESULTS: In adjusted models, persons with high nutritional risk had 51% greater risk of all-cause hospitalization (95% confidence interval: 1.14-2.00) and 50% greater risk of nonsurgical hospitalizations (95% confidence interval: 1.11-2.01; referent: low nutritional risk). Persons with moderate nutritional risk had 54% greater risk of death (95% confidence interval: 1.19-1.99). BMI was not associated with any outcomes in adjusted models. CONCLUSIONS: Nutritional risk was associated with all-cause hospitalizations, nonsurgical hospitalizations, and mortality. Nutritional risk may affect the disablement process that leads to health services utilization and death. These findings point to the need for more attention on nutritional assessment, interventions, and services for community-dwelling older adults.


Subject(s)
Body Mass Index , Independent Living , Nursing Homes/statistics & numerical data , Nutritional Status , Aged , Alabama , Comorbidity , Follow-Up Studies , Humans , Longitudinal Studies , Mortality , Patient Admission , Proportional Hazards Models , Risk Factors , Social Isolation , Social Support
3.
Community Dent Oral Epidemiol ; 41(2): 143-53, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23036131

ABSTRACT

OBJECTIVES: Practice-based research networks (PBRNs) provide a venue to foster evidence-based care. We tested the hypothesis that a higher level of participation in a dental PBRN is associated with greater stated change toward evidence-based practice. METHODS: A total of 565 dental PBRN practitioner-investigators completed a baseline questionnaire entitled 'Assessment of Caries Diagnosis and Treatment'; 405 of these also completed a follow-up questionnaire about treatment of caries and existing restorations. Certain questions (six treatment scenarios) were repeated at follow-up a mean (SD) of 36.0 (3.8) months later. A total of 224 were 'full participants' (enrolled in clinical studies and attended at least one network meeting); 181 were 'partial participants' (did not meet 'full' criteria). RESULTS: From 10% to 62% of practitioners were 'surgically invasive' at baseline, depending on the clinical scenario. Stated treatment approach was significantly less invasive at follow-up for four of six items. Change was greater among full participants and those with a more-invasive approach at baseline, with an overall pattern of movement away from the extremes. CONCLUSIONS: These results are consistent with a preliminary conclusion that network participation fostered movement of scientific evidence into routine practice. PBRNs may foster movement of evidence into everyday practice as practitioners become engaged in the scientific process.


Subject(s)
Community-Based Participatory Research , Dental Caries/therapy , Dental Restoration, Permanent/methods , Evidence-Based Dentistry , Air Abrasion, Dental/methods , Attitude of Health Personnel , Composite Resins/chemistry , Dental Amalgam/chemistry , Dental Caries/diagnostic imaging , Dental Caries/prevention & control , Dental Caries Susceptibility/physiology , Dental Cavity Preparation/instrumentation , Dental Enamel/diagnostic imaging , Dental Materials/chemistry , Dental Polishing/methods , Dental Prosthesis Repair , Dental Restoration, Permanent/classification , Dentin/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Patient Care Planning , Pit and Fissure Sealants/therapeutic use , Practice Patterns, Dentists' , Radiography , Retreatment , Surveys and Questionnaires
4.
Health Serv Res ; 48(3): 1135-53, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23206237

ABSTRACT

OBJECTIVE: To examine disparities in utilization of gynecologic oncologists (GOs) across race and other sociodemographic factors for women with ovarian cancer. DATA SOURCES: Obtained SEER-Medicare linked dataset for 4,233 non-Hispanic White, non-Hispanic African American, Hispanic of any race, and Non-Hispanic Asian women aged ≥ 66 years old diagnosed with ovarian cancer during 2000-2002 from 17 SEER registries. Physician specialty was identified by linking data to the AMA master file using Unique Physician Identification Numbers. STUDY DESIGN: Retrospective claims data analysis for 1999-2006. Logistic regression models were used to analyze the association between GO utilization and race/ethnicity in the initial, continuing, and final phases of care. PRINCIPAL FINDINGS: GO use decreased from the initial to final phase of care (51.4-28.8 percent). No racial/ethnic differences were found overall and by phase of cancer care. Women >70 years old and those with unstaged disease were less likely to receive GO care compared to their counterparts. GO use was lower in some SEER registries compared to the Atlanta registry. CONCLUSIONS: GO use for the initial ovarian cancer treatment or for longer term care was low but not different across racial/ethnic groups. Future research should identify factors that affect GO utilization and understand why use of these specialists remains low.


Subject(s)
Gynecology/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Medical Oncology/statistics & numerical data , Ovarian Neoplasms/ethnology , Ovarian Neoplasms/therapy , Black or African American , Age Factors , Aged , Aged, 80 and over , Female , Hispanic or Latino , Humans , Insurance Claim Review/statistics & numerical data , Medicare/statistics & numerical data , Retrospective Studies , SEER Program/statistics & numerical data , Socioeconomic Factors , United States , White People
5.
Arch Intern Med ; 171(21): 1910-7, 2011 Nov 28.
Article in English | MEDLINE | ID: mdl-22123798

ABSTRACT

BACKGROUND: Cardiovascular risk reduction in ambulatory patients who survive myocardial infarction (MI) is effective but underused. We sought to evaluate a provider-directed, Internet-delivered intervention to improve cardiovascular management for post-MI outpatients. METHODS: The Department of Veterans Affairs (VA) MI-Plus study was a cluster-randomized trial involving 168 community-based primary care clinics and 847 providers in 26 states, the Virgin Islands, and Puerto Rico, from January 1, 2002, through December 31, 2008, with the clinic as the randomization unit. We collected administrative data for 15,847 post-MI patients and medical record data for 10,452 of these. A multicomponent, Internet-delivered intervention included quarterly educational modules, practice guidelines, monthly literature summaries, and automated e-mail reminders delivered to providers for 27 months. Main outcome measures included percentage of patients who achieved each of 7 clinical indicators, a composite score of the 7 clinical indicators, and mean low-density lipoprotein cholesterol and hemoglobin A(1c) levels. RESULTS: Clinics had a median of 3 providers (interquartile range, 2-6), with a median of 50.0% of providers (33.3%-66.7%) participating in the study. Patients in intervention clinics had greater improvements (from 70.0% to 85.5%) in the percentages prescribed ß-blockers than patients in control clinics (71.9% to 84.0%; adjusted improvement gain for intervention vs control, 2.6%; 95% CI, 0.1%-4.1%). We found nonsignificant differences in improvements favoring patients in intervention clinics for 5 of 6 remaining clinical indicators and levels of low-density lipoprotein cholesterol and hemoglobin A(1c). CONCLUSION: A longitudinal, Internet-delivered intervention improved only 1 of 7 clinical indicators of cardiovascular management in ambulatory post-MI patients.


Subject(s)
Ambulatory Care Facilities/standards , Myocardial Infarction/therapy , Quality Indicators, Health Care/statistics & numerical data , Aged , Education, Medical, Continuing/methods , Female , Guideline Adherence/statistics & numerical data , Humans , Internet , Male , Middle Aged , Practice Guidelines as Topic , Reminder Systems , Risk Factors , United States , United States Department of Veterans Affairs
6.
J Health Commun ; 15(4): 413-27, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20574879

ABSTRACT

Our goal was to assess the relationships between single-item health literacy screening questions and reading prescription nonsteroidal anti-inflammatory drug (NSAID) written medicine information (WMI) provided at pharmacies. The health literacy of 382 patients from primary care physician practices in Alabama was estimated using validated health literacy screening questions related to understanding written medical information (SQ1); confidence in completing medical forms alone (SQ2); and need for assistance in reading hospital materials (SQ3). Reading WMI was measured by a "Yes" response to the question, "Often the drug store gives you written information such as pamphlets or handouts along with your prescription. Have you read about the risks of NSAIDs in this written material provided by the drug store?" Relationships were assessed using generalized linear latent and mixed models. Two-thirds (67.6%) of patients read WMI. Higher estimated health literacy was associated with increased odds of reading WMI. Adjusted odds ratios (95% CI) were 2.08 (1.08-4.03); 2.09 (1.12-3.91); and 1.98 (1.04-3.77) using SQ1-SQ3. Current WMI may be unable to meet the needs of those with inadequate health literacy. Health literacy screening questions can be used to triage patients at risk for not reading WMI so they can be assisted with supplemental educational strategies.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal , Drug Labeling , Health Literacy , Patient Education as Topic , Reading , Age Factors , Aged , Alabama , Cross-Sectional Studies , Educational Status , Female , Humans , Interviews as Topic , Linear Models , Male , Middle Aged , Multivariate Analysis , Pharmacies , Prescriptions
7.
J Clin Epidemiol ; 57(7): 721-9, 2004 Jul.
Article in English | MEDLINE | ID: mdl-15358400

ABSTRACT

OBJECTIVE: The purpose of this study was to examine the proportion of men who died from prostate cancer (PrCa) vs. with PrCa and assess the comorbid conditions associated with other-cause deaths. STUDY DESIGN AND SETTING: We identified all male decedents aged >/=65 years in Jefferson County, AL, in 1993-1995. By crosslinking three databases (death certificate, Medicare, and Veteran's Administration), we identified men whose deaths might have been caused by PrCa. We abstracted and reviewed medical records to rate comorbid conditions and determine whether or not death was due to PrCa. RESULTS: Of 561 men with a premortem diagnosis of PrCa, 42% died from PrCa and 53% died with PrCA; 50.2% of blacks died from PrCa vs. 36.9% of Whites. Other factors related to dying with PrCa included older age at death and a serious, or very serious, comorbid condition. Treatment did not have an independent effect on cause of death (i.e., death with vs. from PrCa). CONCLUSIONS: Comorbidity was an independent predictor of dying with PrCa, even after adjustment for ethnicity, age, and treatment. Given the as yet unproven benefit of PrCa screening, our results extend the body of information relevant to the screening decision; among men dying with a diagnosis of PrCa, only about 1/3 to 1/2 died from the disease.


Subject(s)
Prostatic Neoplasms/mortality , Age Distribution , Aged , Aged, 80 and over , Alabama/epidemiology , Black People/statistics & numerical data , Cardiovascular Diseases/mortality , Cause of Death , Comorbidity , Humans , Male , Neoplasms/mortality , Pulmonary Disease, Chronic Obstructive/mortality , Retrospective Studies , Severity of Illness Index , White People/statistics & numerical data
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