Journal of lung, pulmonary & respiratory research, 2016
The purpose of this study is to use Rasch analysis to explore the validity of considering self-re... more The purpose of this study is to use Rasch analysis to explore the validity of considering self-report scores from Wisconsin Upper Respiratory Symptom Survey (WURSS-21) as a single global illness severity domain. The WURSS-21 is a widely used questionnaire instrument that assesses symptom severity and functional impact of common cold and flu-like illness. This study applies item response theory, specifically Rasch modeling, to investigate dimensional and measurement properties of the WURSS-21, and looks at invariance over time. The data assessed represents 1167 people, each scoring the WURSS-21 once daily for up to seven consecutive days of acute upper respiratory infection (URI) illness. Rasch analysis supports a single domain WURSS-21 global symptom score. Assessment of differential item functioning across seven days of illness provides evidence for measurement invariance. While individual items rating physical symptoms were somewhat variable, items rating functional impairment and...
We reported the factor structure and psychometric properties of a new measure of early symptoms o... more We reported the factor structure and psychometric properties of a new measure of early symptoms of Post-Stroke Depression (PSD). Cross-sectional survey methods were used to administer the measure to hospitalized post-stroke patients (N=410) in southeast China, 7-30 days after mild to moderate stroke. Factor structure of the measure was evaluated using exploratory factor analysis (EFA) with first and second order confirmatory factor analysis (CFA). Measurement reliability of each factor and the total measure was assessed using Cronbach alpha coefficient, item-total correlation, item-subscale correlation and the composite coefficient. Discriminant validity was tested using the estimated correlation matrix and average variance extracted (AVE). The EFA extracted a theoretically consistent, clinically interpretable, 29-item, 6-factor model for early symptoms of PSD (dull, guilt, low, wakefulness, emotional, and nervous). A first order CFA retained the 6-factors but deleted 3 underperform...
We conducted a two-group longitudinal partially nested randomized controlled trial to examine whe... more We conducted a two-group longitudinal partially nested randomized controlled trial to examine whether young adolescent youth-parent dyads participating in Mission Possible: Parents and Kids Who Listen, in contrast to a comparison group, would demonstrate improved problem-solving skill. The intervention is based on the Circumplex Model and Social Problem-Solving Theory. The Circumplex Model posits that families who are balanced, that is characterized by high cohesion and flexibility and open communication, function best. Social Problem-Solving Theory informs the process and skills of problem solving. The Conditional Latent Growth Modeling analysis revealed no statistically significant differences in problem solving among the final sample of 127 dyads in the intervention and comparison groups. Analyses of effect sizes indicated large magnitude group effects for selected scales for youth and dyads portraying a potential for efficacy and identifying for whom the intervention may be effi...
Nurses' turnover intention is not dichotomous; it may reflect intent to leave the profession,... more Nurses' turnover intention is not dichotomous; it may reflect intent to leave the profession, intent to leave a type of facility, or intent to leave a specific workplace. In a latent class analysis (LCA) of data from 186 licensed nurses (RNs and LPNs) recruited from 25 nursing homes (NHs) in Taiwan, we classified nurses into turnover intention subgroups based on seven questionnaire items and used a multilevel contrast analysis to characterize the subgroups according to demographic and facility factors, job demand, and job satisfaction. A multilevel probit model was used to examine how job demand and job satisfaction influenced subgroup membership. Three turnover subgroups were identified: high turnover intention (12%), middle turnover intention (57%), and low turnover intention (31%). The high turnover intention subgroup comprised the youngest nurses and had the lowest percentage of registered nurses (RNs); nurses in this subgroup had worked the longest at the current NH and had...
Evidence suggests that person-centered caregiving approaches may reduce dementia-related behavior... more Evidence suggests that person-centered caregiving approaches may reduce dementia-related behavioral symptoms; however, little is known about the sequential and temporal associations between specific caregiver actions and behavioral symptoms. The aim of this study was to identify sequential associations between caregiver person-centered actions, task-centered actions, and resident behavioral symptoms and the temporal variation within these associations. Videorecorded observations of naturally occurring interactions (N = 33; 724min) between 12 nursing home (NH) residents with dementia and eight certified nursing assistants were coded for caregiver person-centered actions, task-centered actions, and resident behavioral symptoms and analyzed using timed-event sequential analysis. Although caregiver actions were predominantly person-centered, we found that resident behavioral symptoms were significantly more likely to occur following task-centered caregiver actions than person-centered actions. Findings suggest that the person-centeredness of caregivers is sequentially and temporally related to behavioral symptoms in individuals with dementia. Additional research examining the temporal structure of these relationships may offer valuable insights into the utility of caregiver person-centeredness as a low-cost strategy for improving behavioral symptom management in the NH setting.
Journal of primary care & community health, Jan 28, 2015
To assess relationships between primary care work conditions, physician burnout, quality of care,... more To assess relationships between primary care work conditions, physician burnout, quality of care, and medical errors. Cross-sectional and longitudinal analyses of data from the MEMO (Minimizing Error, Maximizing Outcome) Study. Two surveys of 422 family physicians and general internists, administered 1 year apart, queried physician job satisfaction, stress and burnout, organizational culture, and intent to leave within 2 years. A chart audit of 1795 of their adult patients with diabetes and/or hypertension assessed care quality and medical errors. Women physicians were almost twice as likely as men to report burnout (36% vs 19%, P < .001). Burned out clinicians reported less satisfaction (P < .001), more job stress (P < .001), more time pressure during visits (P < .01), more chaotic work conditions (P < .001), and less work control (P < .001). Their workplaces were less likely to emphasize work-life balance (P < .001) and they noted more intent to leave the prac...
WMJ: official publication of the State Medical Society of Wisconsin
Poor mental health conditions, including stress and depression, have been recognized as a risk fa... more Poor mental health conditions, including stress and depression, have been recognized as a risk factor for the development of acute respiratory infection (ARI). Very few studies have considered the role of general mental health in ARI occurrence. The aim of this analysis is to determine if overall mental health, as assessed by the mental component of the Short Form 12 Health Survey (SF-12), predicts incidence, duration or severity of ARI. Data utilized for this analysis came from the NIH-funded MEPARI and MEPARI-2 randomized controlled trials examining the effects of meditation or exercise on ARI among adults aged >30 years in Madison, Wisconsin. A Kendall tau rank correlation compared SF-12 mental, completed by participants at baseline, with ARI incidence, duration and area-under-the-curve (global) severity, as assessed by the Wisconsin Upper Respiratory Symptom Survey (WURSS-24). Participants were recruited from Madison, Wisconsin using advertisements in local media. SF-12 menta...
The purpose of the study was to develop and test the initial psychometric properties of the ATTit... more The purpose of the study was to develop and test the initial psychometric properties of the ATTitudes and Avatars INstrument (ATTAIN). The integrated behavior model guided instrument development to measure the young adolescent boys&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; attitudes, intentions and actions to change their bodies. An adolescent health expert panel and young adolescent boys were recruited to test for content validity. Fifty-nine boys 11 to 14 years of age were recruited at a middle school in the USA during physical education class to conduct a pilot study to test for internal consistency and test-retest reliability. The ATTAIN was found to have high content validity, slightly below recommended levels for internal consistency, and varied test-retest reliability. The long-term goal of the development and testing of the ATTAIN is to make it available to researchers and professionals to screen and focus on adolescents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perceptions of their bodies and using those perceptions to attain and maintain healthy bodies. The results of this study suggest preliminarily a theoretically derived instrument with appropriate content for young adolescent boys and variable reliability. The attitudes, intentions, and actions survey items and avatars as measured by the ATTAIN, were meaningful to the boys. The ATTAIN has potential to be used as a screening instrument for young adolescents boys and understanding their attitudes toward their bodies; however, it will require continued development and testing to establish construct and discriminant validity.
To investigate the mediating effect of work-to-family conflict on the relationship between job sa... more To investigate the mediating effect of work-to-family conflict on the relationship between job satisfaction and turnover intention among licensed nurses in long-term care settings. The considerable research on turnover in long-term care has primarily focused on the impact of job satisfaction on turnover intention. Given the well-documented high turnover rate in nursing home staffing, dissatisfaction is expected to continue. Alternatives (e.g. reduction in work-to-family conflict) for reducing turnover under the circumstance of job dissatisfaction have not been investigated extensively. A cross-sectional mailed survey. A convenience sample comprising 200 nurses from 25 private nursing homes in Central Taiwan was created. Data were collected from nurses about their level of turnover intention, job satisfaction and work-to-family conflict in 2012. A composite indicator structural equation model was used to examine the mediation model of this study. Overall, 186 nurses (93%) returned the completed questionnaires. Consistent with published research from other countries, turnover intention in our study was significantly and negatively associated with job satisfaction and significantly and positively associated with work-to-family conflict. In addition, job dissatisfaction indirectly influenced turnover intention through high work-to-family conflict. Findings from this study indicate the importance of work-to-family conflict to nurse turnover. While work setting has a strong, well-documented influence on job satisfaction, limiting job satisfaction efforts to work setting improvements may not yield the hoped-for results unless work-to-family conflict is also considered and addressed.
Cluster randomized controlled trials (CRCT) can be susceptible to a wide range of methodological ... more Cluster randomized controlled trials (CRCT) can be susceptible to a wide range of methodological problems. Many of these problems are not commonly recognized by researchers. This article is focused on one potential problem, the issue of impure clustering (multiple patient membership) within the CRCT structures and how it can lead to possible misunderstanding and bias in the results of the trial. A solution to this problem is presented using a multiple membership random effects model (MMREM). A simulated example of a three-level CRCT is presented and modeled with and without multiple patient membership data. Results indicate underestimation of higher level variances, and overestimation of lower-level variances, while also indicating underestimation of level predictors where the multiple membership occurs.
Measurement of beliefs about sexually transmitted diseases (STDs) is important to understanding s... more Measurement of beliefs about sexually transmitted diseases (STDs) is important to understanding sexual health behaviors. The purpose of this study was to develop and test the psychometric properties of the Representations of STDs (RoSTD) Scale. The RoSTD was developed to measure young women's representations of STDs, and it is intended to be used to measure beliefs about any of the seven most common STDs. Confirmatory factor analysis indicated a four-factor structure for the 40-item RoSTD: Future Perspective, Cause, Psychosocial Consequence, and Identity. Internal consistency for the subscales (measured for each of seven different STDs) ranged from .67 to .93 and 2-week test-retest correlations ranged from .69 to .90. The RoSTD shows evidence of reliability and validity in young women.
Journal of health care for the poor and underserved, 2011
Women are more likely than men to forgo, delay, and ration medical care because of medical debt. ... more Women are more likely than men to forgo, delay, and ration medical care because of medical debt. Using 2003-04 Community Tracking Study Household Survey data, this study examined gender differences in five financial hardships associated with medical debt. Regression analyses accounting for predisposing, enabling, and need factors of health services use indicated women were less likely to report being contacted by a collection agency (b=-0.15, p<.05), using savings (b=-0.23, p<.005), or having any financial hardships associated with medical debt (b=-0.24, p<.05). There were no significant gender differences in putting off major purchases, borrowing money, and problems paying for necessities. Similarly, there were positive and negative relationships between medical debt financial hardships and income, insurance, and health status. Findings suggest that making health care affordable and equitable is critically important for both men and women. Research is needed to understand ...
The major difference between cisplatin-based chemotherapy doublets for advanced non-small cell lu... more The major difference between cisplatin-based chemotherapy doublets for advanced non-small cell lung cancer (NSCLC) is not in the outcomes of their use--rather, it is in the side effects and toxicities that they cause. The degree to which oncologists involve lung cancer patients in discussions regarding the selection of chemotherapy is unknown. A questionnaire regarding patient concerns about chemotherapy and physician discussions was sent to patients registered in the Alliance for Lung Cancer Advocacy, Support, and Education (ALCASE) database from 2000--2002. About three-quarters of the respondents reported that if they were given the option, they would consider side effects important in choosing a particular regimen--and nausea was the most important side effect that would influence that decision. Female patients were more likely to worry about infection and hair loss resulting from therapy than were men. Further, about two-thirds of patients reported that they had discussed differ...
Journal of Verbal Learning and Verbal Behavior, 1963
The familiar assertion that, in language development, understanding precedes production was teste... more The familiar assertion that, in language development, understanding precedes production was tested for 10 grammatical contrasts with 12 3-year-old children. Understanding was operationalized as the correct identification of pictures named by contrasting sentences. Production was ...
Unstructured data encountered during retrospective electronic medical record (EMR) abstraction ha... more Unstructured data encountered during retrospective electronic medical record (EMR) abstraction has routinely been identified as challenging to reliably abstract, as these data are often recorded as free text, without limitations to format or structure. There is increased interest in reliably abstracting this type of data given its prominent role in care coordination and communication, yet limited methodological guidance exists. As standard abstraction approaches resulted in substandard data reliability for unstructured data elements collected as part of a multisite, retrospective EMR study of hospital discharge communication quality, our goal was to develop, apply and examine the utility of a phase-based approach to reliably abstract unstructured data. This approach is examined using the specific example of discharge communication for warfarin management. We adopted a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;fit-for-use&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; framework to guide the development and evaluation of abstraction methods using a 4-step, phase-based approach including (1) team building; (2) identification of challenges; (3) adaptation of abstraction methods; and (4) systematic data quality monitoring. Unstructured data elements were the focus of this study, including elements communicating steps in warfarin management (eg, warfarin initiation) and medical follow-up (eg, timeframe for follow-up). After implementation of the phase-based approach, interrater reliability for all unstructured data elements demonstrated κ&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s of ≥0.89-an average increase of +0.25 for each unstructured data element. As compared with standard abstraction methodologies, this phase-based approach was more time intensive, but did markedly increase abstraction reliability for unstructured data elements within multisite EMR documentation.
Journal of lung, pulmonary & respiratory research, 2016
The purpose of this study is to use Rasch analysis to explore the validity of considering self-re... more The purpose of this study is to use Rasch analysis to explore the validity of considering self-report scores from Wisconsin Upper Respiratory Symptom Survey (WURSS-21) as a single global illness severity domain. The WURSS-21 is a widely used questionnaire instrument that assesses symptom severity and functional impact of common cold and flu-like illness. This study applies item response theory, specifically Rasch modeling, to investigate dimensional and measurement properties of the WURSS-21, and looks at invariance over time. The data assessed represents 1167 people, each scoring the WURSS-21 once daily for up to seven consecutive days of acute upper respiratory infection (URI) illness. Rasch analysis supports a single domain WURSS-21 global symptom score. Assessment of differential item functioning across seven days of illness provides evidence for measurement invariance. While individual items rating physical symptoms were somewhat variable, items rating functional impairment and...
We reported the factor structure and psychometric properties of a new measure of early symptoms o... more We reported the factor structure and psychometric properties of a new measure of early symptoms of Post-Stroke Depression (PSD). Cross-sectional survey methods were used to administer the measure to hospitalized post-stroke patients (N=410) in southeast China, 7-30 days after mild to moderate stroke. Factor structure of the measure was evaluated using exploratory factor analysis (EFA) with first and second order confirmatory factor analysis (CFA). Measurement reliability of each factor and the total measure was assessed using Cronbach alpha coefficient, item-total correlation, item-subscale correlation and the composite coefficient. Discriminant validity was tested using the estimated correlation matrix and average variance extracted (AVE). The EFA extracted a theoretically consistent, clinically interpretable, 29-item, 6-factor model for early symptoms of PSD (dull, guilt, low, wakefulness, emotional, and nervous). A first order CFA retained the 6-factors but deleted 3 underperform...
We conducted a two-group longitudinal partially nested randomized controlled trial to examine whe... more We conducted a two-group longitudinal partially nested randomized controlled trial to examine whether young adolescent youth-parent dyads participating in Mission Possible: Parents and Kids Who Listen, in contrast to a comparison group, would demonstrate improved problem-solving skill. The intervention is based on the Circumplex Model and Social Problem-Solving Theory. The Circumplex Model posits that families who are balanced, that is characterized by high cohesion and flexibility and open communication, function best. Social Problem-Solving Theory informs the process and skills of problem solving. The Conditional Latent Growth Modeling analysis revealed no statistically significant differences in problem solving among the final sample of 127 dyads in the intervention and comparison groups. Analyses of effect sizes indicated large magnitude group effects for selected scales for youth and dyads portraying a potential for efficacy and identifying for whom the intervention may be effi...
Nurses' turnover intention is not dichotomous; it may reflect intent to leave the profession,... more Nurses' turnover intention is not dichotomous; it may reflect intent to leave the profession, intent to leave a type of facility, or intent to leave a specific workplace. In a latent class analysis (LCA) of data from 186 licensed nurses (RNs and LPNs) recruited from 25 nursing homes (NHs) in Taiwan, we classified nurses into turnover intention subgroups based on seven questionnaire items and used a multilevel contrast analysis to characterize the subgroups according to demographic and facility factors, job demand, and job satisfaction. A multilevel probit model was used to examine how job demand and job satisfaction influenced subgroup membership. Three turnover subgroups were identified: high turnover intention (12%), middle turnover intention (57%), and low turnover intention (31%). The high turnover intention subgroup comprised the youngest nurses and had the lowest percentage of registered nurses (RNs); nurses in this subgroup had worked the longest at the current NH and had...
Evidence suggests that person-centered caregiving approaches may reduce dementia-related behavior... more Evidence suggests that person-centered caregiving approaches may reduce dementia-related behavioral symptoms; however, little is known about the sequential and temporal associations between specific caregiver actions and behavioral symptoms. The aim of this study was to identify sequential associations between caregiver person-centered actions, task-centered actions, and resident behavioral symptoms and the temporal variation within these associations. Videorecorded observations of naturally occurring interactions (N = 33; 724min) between 12 nursing home (NH) residents with dementia and eight certified nursing assistants were coded for caregiver person-centered actions, task-centered actions, and resident behavioral symptoms and analyzed using timed-event sequential analysis. Although caregiver actions were predominantly person-centered, we found that resident behavioral symptoms were significantly more likely to occur following task-centered caregiver actions than person-centered actions. Findings suggest that the person-centeredness of caregivers is sequentially and temporally related to behavioral symptoms in individuals with dementia. Additional research examining the temporal structure of these relationships may offer valuable insights into the utility of caregiver person-centeredness as a low-cost strategy for improving behavioral symptom management in the NH setting.
Journal of primary care & community health, Jan 28, 2015
To assess relationships between primary care work conditions, physician burnout, quality of care,... more To assess relationships between primary care work conditions, physician burnout, quality of care, and medical errors. Cross-sectional and longitudinal analyses of data from the MEMO (Minimizing Error, Maximizing Outcome) Study. Two surveys of 422 family physicians and general internists, administered 1 year apart, queried physician job satisfaction, stress and burnout, organizational culture, and intent to leave within 2 years. A chart audit of 1795 of their adult patients with diabetes and/or hypertension assessed care quality and medical errors. Women physicians were almost twice as likely as men to report burnout (36% vs 19%, P < .001). Burned out clinicians reported less satisfaction (P < .001), more job stress (P < .001), more time pressure during visits (P < .01), more chaotic work conditions (P < .001), and less work control (P < .001). Their workplaces were less likely to emphasize work-life balance (P < .001) and they noted more intent to leave the prac...
WMJ: official publication of the State Medical Society of Wisconsin
Poor mental health conditions, including stress and depression, have been recognized as a risk fa... more Poor mental health conditions, including stress and depression, have been recognized as a risk factor for the development of acute respiratory infection (ARI). Very few studies have considered the role of general mental health in ARI occurrence. The aim of this analysis is to determine if overall mental health, as assessed by the mental component of the Short Form 12 Health Survey (SF-12), predicts incidence, duration or severity of ARI. Data utilized for this analysis came from the NIH-funded MEPARI and MEPARI-2 randomized controlled trials examining the effects of meditation or exercise on ARI among adults aged >30 years in Madison, Wisconsin. A Kendall tau rank correlation compared SF-12 mental, completed by participants at baseline, with ARI incidence, duration and area-under-the-curve (global) severity, as assessed by the Wisconsin Upper Respiratory Symptom Survey (WURSS-24). Participants were recruited from Madison, Wisconsin using advertisements in local media. SF-12 menta...
The purpose of the study was to develop and test the initial psychometric properties of the ATTit... more The purpose of the study was to develop and test the initial psychometric properties of the ATTitudes and Avatars INstrument (ATTAIN). The integrated behavior model guided instrument development to measure the young adolescent boys&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; attitudes, intentions and actions to change their bodies. An adolescent health expert panel and young adolescent boys were recruited to test for content validity. Fifty-nine boys 11 to 14 years of age were recruited at a middle school in the USA during physical education class to conduct a pilot study to test for internal consistency and test-retest reliability. The ATTAIN was found to have high content validity, slightly below recommended levels for internal consistency, and varied test-retest reliability. The long-term goal of the development and testing of the ATTAIN is to make it available to researchers and professionals to screen and focus on adolescents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perceptions of their bodies and using those perceptions to attain and maintain healthy bodies. The results of this study suggest preliminarily a theoretically derived instrument with appropriate content for young adolescent boys and variable reliability. The attitudes, intentions, and actions survey items and avatars as measured by the ATTAIN, were meaningful to the boys. The ATTAIN has potential to be used as a screening instrument for young adolescents boys and understanding their attitudes toward their bodies; however, it will require continued development and testing to establish construct and discriminant validity.
To investigate the mediating effect of work-to-family conflict on the relationship between job sa... more To investigate the mediating effect of work-to-family conflict on the relationship between job satisfaction and turnover intention among licensed nurses in long-term care settings. The considerable research on turnover in long-term care has primarily focused on the impact of job satisfaction on turnover intention. Given the well-documented high turnover rate in nursing home staffing, dissatisfaction is expected to continue. Alternatives (e.g. reduction in work-to-family conflict) for reducing turnover under the circumstance of job dissatisfaction have not been investigated extensively. A cross-sectional mailed survey. A convenience sample comprising 200 nurses from 25 private nursing homes in Central Taiwan was created. Data were collected from nurses about their level of turnover intention, job satisfaction and work-to-family conflict in 2012. A composite indicator structural equation model was used to examine the mediation model of this study. Overall, 186 nurses (93%) returned the completed questionnaires. Consistent with published research from other countries, turnover intention in our study was significantly and negatively associated with job satisfaction and significantly and positively associated with work-to-family conflict. In addition, job dissatisfaction indirectly influenced turnover intention through high work-to-family conflict. Findings from this study indicate the importance of work-to-family conflict to nurse turnover. While work setting has a strong, well-documented influence on job satisfaction, limiting job satisfaction efforts to work setting improvements may not yield the hoped-for results unless work-to-family conflict is also considered and addressed.
Cluster randomized controlled trials (CRCT) can be susceptible to a wide range of methodological ... more Cluster randomized controlled trials (CRCT) can be susceptible to a wide range of methodological problems. Many of these problems are not commonly recognized by researchers. This article is focused on one potential problem, the issue of impure clustering (multiple patient membership) within the CRCT structures and how it can lead to possible misunderstanding and bias in the results of the trial. A solution to this problem is presented using a multiple membership random effects model (MMREM). A simulated example of a three-level CRCT is presented and modeled with and without multiple patient membership data. Results indicate underestimation of higher level variances, and overestimation of lower-level variances, while also indicating underestimation of level predictors where the multiple membership occurs.
Measurement of beliefs about sexually transmitted diseases (STDs) is important to understanding s... more Measurement of beliefs about sexually transmitted diseases (STDs) is important to understanding sexual health behaviors. The purpose of this study was to develop and test the psychometric properties of the Representations of STDs (RoSTD) Scale. The RoSTD was developed to measure young women's representations of STDs, and it is intended to be used to measure beliefs about any of the seven most common STDs. Confirmatory factor analysis indicated a four-factor structure for the 40-item RoSTD: Future Perspective, Cause, Psychosocial Consequence, and Identity. Internal consistency for the subscales (measured for each of seven different STDs) ranged from .67 to .93 and 2-week test-retest correlations ranged from .69 to .90. The RoSTD shows evidence of reliability and validity in young women.
Journal of health care for the poor and underserved, 2011
Women are more likely than men to forgo, delay, and ration medical care because of medical debt. ... more Women are more likely than men to forgo, delay, and ration medical care because of medical debt. Using 2003-04 Community Tracking Study Household Survey data, this study examined gender differences in five financial hardships associated with medical debt. Regression analyses accounting for predisposing, enabling, and need factors of health services use indicated women were less likely to report being contacted by a collection agency (b=-0.15, p<.05), using savings (b=-0.23, p<.005), or having any financial hardships associated with medical debt (b=-0.24, p<.05). There were no significant gender differences in putting off major purchases, borrowing money, and problems paying for necessities. Similarly, there were positive and negative relationships between medical debt financial hardships and income, insurance, and health status. Findings suggest that making health care affordable and equitable is critically important for both men and women. Research is needed to understand ...
The major difference between cisplatin-based chemotherapy doublets for advanced non-small cell lu... more The major difference between cisplatin-based chemotherapy doublets for advanced non-small cell lung cancer (NSCLC) is not in the outcomes of their use--rather, it is in the side effects and toxicities that they cause. The degree to which oncologists involve lung cancer patients in discussions regarding the selection of chemotherapy is unknown. A questionnaire regarding patient concerns about chemotherapy and physician discussions was sent to patients registered in the Alliance for Lung Cancer Advocacy, Support, and Education (ALCASE) database from 2000--2002. About three-quarters of the respondents reported that if they were given the option, they would consider side effects important in choosing a particular regimen--and nausea was the most important side effect that would influence that decision. Female patients were more likely to worry about infection and hair loss resulting from therapy than were men. Further, about two-thirds of patients reported that they had discussed differ...
Journal of Verbal Learning and Verbal Behavior, 1963
The familiar assertion that, in language development, understanding precedes production was teste... more The familiar assertion that, in language development, understanding precedes production was tested for 10 grammatical contrasts with 12 3-year-old children. Understanding was operationalized as the correct identification of pictures named by contrasting sentences. Production was ...
Unstructured data encountered during retrospective electronic medical record (EMR) abstraction ha... more Unstructured data encountered during retrospective electronic medical record (EMR) abstraction has routinely been identified as challenging to reliably abstract, as these data are often recorded as free text, without limitations to format or structure. There is increased interest in reliably abstracting this type of data given its prominent role in care coordination and communication, yet limited methodological guidance exists. As standard abstraction approaches resulted in substandard data reliability for unstructured data elements collected as part of a multisite, retrospective EMR study of hospital discharge communication quality, our goal was to develop, apply and examine the utility of a phase-based approach to reliably abstract unstructured data. This approach is examined using the specific example of discharge communication for warfarin management. We adopted a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;fit-for-use&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; framework to guide the development and evaluation of abstraction methods using a 4-step, phase-based approach including (1) team building; (2) identification of challenges; (3) adaptation of abstraction methods; and (4) systematic data quality monitoring. Unstructured data elements were the focus of this study, including elements communicating steps in warfarin management (eg, warfarin initiation) and medical follow-up (eg, timeframe for follow-up). After implementation of the phase-based approach, interrater reliability for all unstructured data elements demonstrated κ&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s of ≥0.89-an average increase of +0.25 for each unstructured data element. As compared with standard abstraction methodologies, this phase-based approach was more time intensive, but did markedly increase abstraction reliability for unstructured data elements within multisite EMR documentation.
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