Ranking sires using genetic selection indices based on financial investment methods versus lifetime net merit.

Current USDA selection indices such as lifetime net merit (NM$) estimate lifetime profit differences, which are accurately approximated by a linear combination of 13 traits. In these indices, every animal gets credit for 2.78 lactations of the traits expressed per lactation, such as fat and protein, independent of its productive life (PL). This formulation may over- or underestimate the net revenue from traits expressed per lactation depending on PL. The objectives were to develop 2 genetic selection indices using financial investment methods to account for differences in PL and to compare them with the 2017 NM$ for marketed Holstein sires. Selection among animals with different PL is an example of investment in mutually exclusive projects that have unequal duration. Financial investment theory says that such projects are best compared with the annualized net present value (ANPV) method when replacement occurs with technologically equal assets. However, genetic progress implies that future available replacement animals are technologically improved assets. Asset replacement theory with improved assets results in an annualized value including genetic opportunity cost (AVOC) for each animal. We developed the ANPV and AVOC and compared these with the NM$ for 1,500 marketed Holstein sires from the December 2017 genetic evaluation. The lowest Pearson correlation coefficient was 0.980 between AVOC and NM$, whereas the highest was 0.999 between ANPV and NM$ among the 1,500 sires. Correlations for the top 300 sires were lower. Although we found high correlations between indices, the 95th and 5th percentiles of individual rank changes between AVOC and NM$ were +131 and -163 positions, respectively, whereas these changes between ANPV and NM$ were +27 and -45 positions, respectively. The relative emphasis of PL in the AVOC index was half of the relative emphasis in NM$. These results show that applying financial investment methods to value differences in genetic merit of animals changes their rankings compared with the NM$ formulation. Rank changes were meaningful enough that the new indices warrant consideration for use in practice.

Assessing readability formula differences with written health information materials: application, results, and recommendations.

BACKGROUND: Readability formulas are often used to guide the development and evaluation of literacy-sensitive written health information. However, readability formula results may vary considerably as a result of differences in software processing algorithms and how each formula is applied. These variations complicate interpretations of reading grade level estimates, particularly without a uniform guideline for applying and interpreting readability formulas. OBJECTIVES: This research sought to (1) identify commonly used readability formulas reported in the health care literature, (2) demonstrate the use of the most commonly used readability formulas on written health information, (3) compare and contrast the differences when applying common readability formulas to identical selections of written health information, and (4) provide recommendations for choosing an appropriate readability formula for written health-related materials to optimize their use. METHODS: A literature search was conducted to identify the most commonly used readability formulas in health care literature. Each of the identified formulas was subsequently applied to word samples from 15 unique examples of written health information about the topic of depression and its treatment. Readability estimates from common readability formulas were compared based on text sample size, selection, formatting, software type, and/or hand calculations. Recommendations for their use were provided. RESULTS: The Flesch-Kincaid formula was most commonly used (57.42%). Readability formulas demonstrated variability up to 5 reading grade levels on the same text. The Simple Measure of Gobbledygook (SMOG) readability formula performed most consistently. Depending on the text sample size, selection, formatting, software, and/or hand calculations, the individual readability formula estimated up to 6 reading grade levels of variability. CONCLUSIONS: The SMOG formula appears best suited for health care applications because of its consistency of results, higher level of expected comprehension, use of more recent validation criteria for determining reading grade level estimates, and simplicity of use. To improve interpretation of readability results, reporting reading grade level estimates from any formula should be accompanied with information about word sample size, location of word sampling in the text, formatting, and method of calculation.

Communicating non-steroidal anti-inflammatory drug risks: verbal counseling, written medicine information, and patients' risk awareness.

OBJECTIVE: To assess potential associations among physician counseling, pharmacist counseling, written medicine information (WMI) and patient awareness of non-steroidal anti-inflammatory drug (NSAID) risks. METHODS: Three-hundred and eighty-two older, white and African American patients prescribed NSAIDs were surveyed regarding their NSAID risk awareness defined as an index score ranging from zero to four correctly identified risks (i.e., gastrointestinal bleeding, heart attack, hypertension, and kidney disease). Associations among NSAID risk awareness and patient-reported physician counseling, pharmacist counseling, and reading of WMI were evaluated in multivariable ordered logistic regression models and confirmed using path analysis. RESULTS: Physician counseling was positively associated with reading WMI (p<0.001) and NSAID risk awareness (p<0.001). Pharmacist counseling was not associated with reading WMI (p=0.622) and neither pharmacist counseling (p=0.366) nor reading WMI (p=0.916) was associated with NSAID risk awareness. CONCLUSIONS: Physicians play a prominent role in facilitating NSAID risk awareness whereas pharmacist counseling and WMI may have limited impact. PRACTICE IMPLICATIONS: The lack of significant associations among pharmacist counseling and reading WMI with NSAID risk awareness suggests a missed opportunity to improve patient understanding. There is a need for coordinated and effective strategies to communicate risk information among physicians and pharmacists and to better integrate WMI into this process.

Relationship of depression screening and physician office visit duration in a national sample.

OBJECTIVE: Although depression screening in primary care is recommended by the U.S. Preventive Services Task Force, it may increase the duration of primary care physician visits that are often at or exceeding capacity. This study was conducted to evaluate the relationship between depression screening and physician visit duration in community-based, primary care physician office visits while controlling for important covariates. METHODS: Cross-sectional data from the 2005-2007 National Ambulatory Medical Care Survey were used to examine the relationship between physician-indicated depression screening and office visit duration among adults (≥18 years of age) with multivariable, ordered logistic regression. Predicted probabilities of visit duration (by 15-minute increments of one to 15, 16-30, 31-45, and 46-60 minutes) were estimated for visits where depression screening was and was not documented. RESULTS: In a sample of 14,736 physician office visits, representing an estimated population of more than 641 million visits, depression screening was significantly associated with increased visit duration (adjusted odds ratio=3.66, 95% confidence interval=2.25-5.95). A prominent shift in the proportion of visits that were from one to 15 minutes long to visits that were at least 16-30 minutes long was observed when depression screening was documented. CONCLUSIONS: Depression screening may increase the duration of physician visits. Given demands on physicians' time, the impact of increased depression screening, including the costs and benefits of using alternative methods and technologies to reduce physician time burden associated with depression screening, should be evaluated.

Using single-item health literacy screening questions to identify patients who read written nonsteroidal anti-inflammatory medicine information provided at pharmacies.

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.

The role of health literacy and written medicine information in nonsteroidal antiinflammatory drug risk awareness.

BACKGROUND: Despite widespread use of prescription nonsteroidal antiinflammatory drugs (NSAIDs), patients are commonly unaware of their risks. Pharmacies regularly distribute written medicine information (WMI) describing the risks and benefits of NSAID therapy at the time of dispensing. OBJECTIVE: To clarify the relationship among common sociodemographic factors, education, health literacy, reading of WMI routinely distributed at pharmacies, and NSAID risk awareness. METHODS: Generalized linear latent and mixed models (GLLAMM) ordered logistic regression and confirmatory path analysis were used to evaluate multivariable relationships in a cross-sectional dataset of 382 patients in the second phase of the Alabama NSAID Patient Safety Study. RESULTS: The majority of the analytical sample was female (72.0%) with 38.7% African American, 38.1% age 65 years or older, and 43.3% reporting at least some college education. Health literacy was positively associated with reading of WMI (p = 0.001) and NSAID risk awareness (p = 0.025), while age was negatively associated with reading WMI (p = 0.001) and NSAID risk awareness (p = 0.005). Medicaid/uninsured status was negatively associated with risk awareness (p = 0.013). Reading of WMI was not associated with NSAID risk awareness (p = 0.659). The final path model demonstrated excellent fit. CONCLUSIONS: The lack of relationship between reading of WMI and NSAID risk awareness questions the current strategy of distribution of patient-targeted print education materials at pharmacies. To maximize limited resources, future research should identify more effective strategies to deliver risk information to patients and ensure its retention, especially in high-risk groups such as the elderly, the indigent, and those with inadequate health literacy.

Variations in the probability of depression screening at community-based physician practice visits.

BACKGROUND: Despite depression screening being a US Preventive Services Task Force-recommended practice in primary care, little is known about the degree to which it is performed and the factors associated with its conduct. METHOD: Using a nationally representative sample (National Ambulatory Medical Care Survey) of adult, community-based physician practice visits during the survey years 2005 to 2007 (total = 55,143; representing approximately 1.7 billion visits nationally), we estimated the probability of depression screening and variation by visit characteristics. RESULTS: Depression screening occurred at 2.29% of adult, community-based physician practice visits. Visits with primary care physicians were more likely to include depression screening (AOR = 2.19; 95% CI, 1.31-3.65), as were visits for preventive (AOR = 4.09; 95% CI, 2.55-6.57) and chronic care (AOR = 2.00; 95% CI, 1.44-2.80) compared to visits for acute care. Compared to the Northeast, visits in the West were less likely to include depression screening (AOR = 0.27; 95% CI, 0.13-0.57), as were visits for patients having ≥ 6 visits within the past 12 months (AOR = 0.65; 95% CI, 0.42-1.00) when compared to visits for new patients. Depression screening was more common at visits for patients with ICD-9-diagnosed depression (AOR = 7.51; 95% CI, 5.38-10.50) and for females (AOR = 1.26; 95% CI, 1.00-1.57). Bivariate analyses revealed that depression screening was more common at visits for patients with hyperlipidemia (3.21% vs 2.09%, P = .0086), obesity (4.59% vs 2.08%, P < .0001), and osteoporosis (4.46% vs 2.21%, P = .0002) and less common at visits for patients with diabetes (1.58% vs 2.39%, P = .0102). CONCLUSIONS: Depression screening at community-based physician practice visits in the United States appears to be low (2.29%) and may reflect an undefined optimal screening interval or strategy in published guidelines, lack of reimbursement incentives, or incomplete documentation in the medical record. Opportunities exist to improve depression screening in males, patients with chronic disease (especially diabetes), and the western region of the United States.