An improved comorbidity summary score for measuring disease burden and predicting mortality with applications to two national cohorts

Abstract

Research involving administrative healthcare data to study patient outcomes requires the investigator to account for the patient’s disease burden in order to reduce the potential for biased results. Here we develop a comorbidity summary score based on variable importance measures derived from several statistical and machine learning methods and show it has superior predictive performance to the Elixhauser and Charlson indices when used to predict 1-year, 5-year, and 10-year mortality. We used two large Veterans Administration cohorts to develop and validate the summary score and compared predictive performance using the area under ROC curve (AUC) and the Brier score.     

Some efficient random imputation methods

Imputation methods that assign a selection of respondents’ values for missing i tern nonresponses give rise to an addd,tional source of sampling variation, which we term imputation varLance , We examine the effect of imputation variance on the precision of the mean, and propose four procedures for sampling the rEespondents that reduce this additional variance. Two of the procedures employ improved sample designs through selection of respc,ndents by sampling without replacement and by stratified sampl;lng. The other two increase the sample base by the use of multiple imputations.     

A midwife program of newborn resuscitation

A very small proportion of newborns fail to establish a normal respiratory pattern without some assistance at birth and newborns requiring resuscitative measures at birth should have a skilled practitioner able to provide it. In this small hospital midwives felt unskilled in newborn resuscitation and paediatricians were not always immediately available. A stakeholder group gathered to discuss the problem. A training program was implemented that improved the skills, confidence and support of the attending midwife to resuscitate the newborn effectively. The aim was to improve the outcome for the infant whilst maintaining the mother's choice of birthing in a small local hospital close to family and friends.     

Rural Appalachian High School Students’ College‐Going and STEMM Perceptions

The authors examined perceptions of key social cognitive career theory (Lent, Brown, & Hackett, 1994) variables related to college‐going and science, technology, engineering, math, and medical (STEMM) careers in 10th and 11th graders (N = 892) attending 3 rural Appalachian high schools. The authors examined differences in perceptions related to gender, prospective 1st‐generation college student status, and the presence or absence of aspirations to pursue a STEMM career. Young women and young men scored similarly on all but 1 dependent variable, college‐going self‐efficacy (young women scored higher). Students who had STEMM career aspirations had higher scores on every measure than those who did not. Results suggest examining a 3rd prospective 1st‐generation college student status group—students who are unsure of their parents’ education level—as a distinct group in future research. By examining the college‐going and STEMM attitudes of rural Appalachian high school students, this study advances the literature and informs practitioners on reducing educational and vocational inequalities in this region.     

The female aging body: A systematic review of female perspectives on aging,health, and body image

While most body image research has focused on young female populations, evidence has shown that as few as 12% of older women are satisfied with their body size. Recent studies have also highlighted how anti-aging discourses are promoting unrealistic body norms, which have shown to contribute to poor body image and altered health behaviors. A systematic review of empirical studies focused on older women’s perspectives of health, body image, and the aging body is presented. Findings support that body image is a persistent, lifelong issue for women and should be considered when implementing healthy aging policies and practices.     

Modeling population and subject-specific growth in a latent trait measured by multiple instruments over time using a hierarchical Bayesian framework

Psychometric growth curve modeling techniques are used to describe a person’s latent ability and how that ability changes over time based on a specific measurement instrument. However, the same instrument cannot always be used over a period of time to measure that latent ability. This is often the case when measuring traits longitudinally in children. Reasons may be that over time some measurement tools that were difficult for young children become too easy as they age resulting in floor effects or ceiling effects or both. We propose a Bayesian hierarchical model for such a scenario. Within the Bayesian model we combine information from multiple instruments used at different age ranges and having different scoring schemes to examine growth in latent ability over time. The model includes between-subject variance and within-subject variance and does not require linking item specific difficulty between the measurement tools. The model’s utility is demonstrated on a study of language ability in children from ages one to ten who are hard of hearing where measurement tool specific growth and subject-specific growth are shown in addition to a group level latent growth curve comparing the hard of hearing children to children with normal hearing.KEYWORDS: Bayesian hierarchical models, psychometric modeling, language ability, growth curve modeling, longitudinal analysis     

Do Associations Between Pleasure Ratings and Condom Use During Penile–Vaginal Intercourse Vary by Relationship Type?: A Study of Canadian University Students

Research suggests the relationship between pleasure and condom use during penile–vaginal intercourse (PVI) is associated with relationship status. This online study examined pleasure ratings and condom use at last PVI, stratifying by partner type, among a national sample of Canadian university students. Participants were 715 undergraduates (60.7% women, 39.3% men) who reported on their most recent sexual experience. Condom use decreased with level of relationship commitment, whereas ratings of pleasure increased. Overall, participants were more likely to rate their most recent PVI as Very pleasurable when condoms were not used compared to when condoms were used. However, when stratified by partner type, these differences largely disappeared. For women, with one exception, there were no differences in pleasure between PVI with and without condoms across most partner-type categories. Women in committed dating relationships were more likely to report their last PVI as very pleasurable if condoms were not used than women in these same relationships who had used condoms. Across relationship categories, men who did and did not use condoms did not differ in terms of their pleasure ratings. The results of this study suggest relationship context should be taken into account when assessing condom use experiences.     

Sexuality in Older Adults (65+)—An Overview of the Literature,Part 1: Sexual Function and its Difficulties

Objectives: The aim of the current article was to provide an overview of literature on sexual function and sexual difficulties in older adults. Method: The authors conducted a narrative review of papers published in English between January 2005 and July 2015 based on an extensive search in PsycINFO. Results: The review showed that although common biological changes may adversely affect sexual function in old age, sexual experience seems to also be affected by psychological and interpersonal factors. Conclusions: Greater life expectancy and better medical care will result in older individuals with chronic diseases living longer. The need for help to cope with changes in sexual health is likely to increase in older adults, as sexuality may be negatively affected through several pathways.     

Challenging the Myth of Urban Regeneration: Raising the Profile of Problem Gambling with a Media Campaign

This paper is an examination of discourses challenging the myth of ‘gambling’ as a form of urban regeneration in Great Britain. The focus is primarily on the Daily Mail, which has continually waged a successful media campaign to “Kill the Casino Bill” and constructed a powerful public condemnation of gambling as regenerative. From an analysis of 156 gambling articles from January 2004 to December 2010 common and recurring themes emerged to dismiss gambling as a form of regeneration. These were gambling as immoral, criminal and pathological. These helped shaped discourses around which the debate on gambling was framed and structured.