97 research outputs found
Patterns of Dental Service Utilization Following Nontraumatic Dental Condition Visits to the Emergency Department in Wisconsin Medicaid
No full textObjectives: To examine patterns of dental service utilization for adult Medicaid enrollees in Wisconsin following nontraumatic dental condition (NTDC) visits to the emergency department (ED).
Methods: This is a retrospective, observational study of claims for NTDC visits to the ED and dental service encounters from the Wisconsin Medicaid Evaluation and Decision Support database (2001-2009). We used competing risk models to predict probabilities of returning to the ED versus obtaining follow-up care from a dentist.
Results: We observed a 43 percent increase in the rate of NTDC visits to the ED, with most of this increase occurring from 2001 to 2005. Within 30 days of an NTDC visit to the ED, ∼29.6 percent of enrollees will first visit a dentist office, while ∼9.9 percent will return to the ED. Young to middle-aged adults (18 to \u3c50 years) and enrollees living in counties with a lower supply of dental providers were more likely to return to the ED following a NTDC visit. Among the enrollees that first visited a dental office following an ED visit, 37.6 percent had an extraction performed at this visit.
Conclusions: Almost one in five adult Medicaid enrollees will subsequently return to the ED following a previous NTDC visit. The provision of definitive care for these individuals appears to primarily consist of extractions
Abstract PR13: Availability of Patient Navigation Services at NCI Community Oncology Research Program (NCORP) Community Sites
No full textAbstract
Purpose: Patient navigation, support and guidance provided by trained culturally sensitive health care workers, has been promoted as a strategy to improve care quality and reduce cancer health disparities. Yet, the availability and extent of navigation in community oncology practices is unclear. The purpose of this analysis was to assess: 1) availability of navigation services across diverse community oncology practices and 2) characteristics of oncology practices that do and do not offer navigation.
Methods: Community oncology practices were surveyed regarding availability of cancer navigation services, cancer types served, and presence of lay and nurse navigators, as part of a larger survey of cancer care delivery research (CCDR) capacity of NCI Community Oncology Research Program (NCORP) sites. CCDR leads at practices reported navigation data, along with other information about the site.
Results: We collected data from 350 of 401 CCDR-designated NCORP oncology sites, representing 201 adult practices. The majority of the practices included a hospital-based outpatient clinic (73.6%) and were multi-specialty (76.6%). 15.9% were designated by NCORP as minority and underserved community sites and 14.4% self-identified as a safety net hospital. Navigation services were not available to cancer patients at 20.0% of practices; 45.2% of practices provided navigation to all patients and 34.8% provided it to some oncology patients. Larger practices were more likely to provide navigation to some or all patients (vs none); ORs for 5-9, 10-17, and 18+ providers (vs 1-4 providers), respectively, were 6.1, 8.9, and 3.3 (all p<. 05). Other significant predictors included multidisciplinary vs single discipline practice (OR=7.7, 95% CI 3.5-16.8), and having a hospital-based outpatient clinic (OR=4.1, 95% CI 2.0-8.6). Minority and underserved community sites were not significantly more likely to offer navigation to oncology patients (OR= 0.83, 95%CI 0.3-2.1), but if they did, they were more likely to offer it to all (vs some) patients (OR=2.9, 95%CI 1.1-7.6). Practices that were part of large regional/multisite networks with (OR= 0.4, 95% CI 0.2-0.9) or without (OR= 0.3, 95% CI 0.1-0.9) a health care plan tended to be less likely than smaller single or small regional practices to offer navigation to all patients. Nurse navigators were available at 82.6% of practices and lay navigators were available at 24.3% of sites. Navigation was most commonly provided to breast cancer patients (78.5%), followed by lung cancer (68.9%); other cancer types ranged from 53.5-63.6% of sites. Navigation was less likely to be provided prior to screening and after completion of treatment, than from screening to diagnostic resolution and during treatment.
Conclusions: Navigation is available in some capacity in a majority of community oncology practices, but variation exists in cancer types covered and integration in the care continuum. Details regarding what specific navigation activities were provided and impact on cancer disparities are not known. Practices designated as serving a larger proportion of minority and underserved patients were more likely to provide navigation to all patients, if they offered it. The widespread availability of navigation in NCORP community sites provides opportunities for observational and intervention studies to assess the impact of navigation on cancer outcomes.
Citation Format: Kathryn E. Weaver, Lucy Gansauer, Nicholas M. Pajewski, Kathleen Castro, Ruth Carlos, Irene Prabhu Das, Marvella E. Ford, Ann M. Geiger. Availability of Patient Navigation Services at NCI Community Oncology Research Program (NCORP) Community Sites. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr PR13.</jats:p
Six degrees of epistasis: Statistical network models for GWAS
No full textThere is growing evidence that much more of the genome than previously thought is required to explain the heritability of complex phenotypes. Recent studies have demonstrated that numerous common variants from across the genome explain portions of genetic variability, with various avenues of research directed at explaining the remaining heritability. This polygenic structure is also the motivation for the growing application of pathway and gene set enrichment techniques, which have yielded promising results. These findings suggest that the coordination of genes in pathways that are known to occur at the gene regulatory level also can be detected at the population level. Although genes in these networks interact in complex ways, most population studies have focused on the additive contribution of common variants and the potential of rare variants to explain additional variation. In this brief review, we discuss the potential to explain additional genetic variation through the agglomeration of multiple gene-gene interactions as well as main effects of common variants in terms of a network paradigm. Just as is the case for single-locus contributions, we expect each gene-gene interaction edge in the network to have a small effect, but these effects may be reinforced through hubs and other connectivity structures in the network. We discuss some of the opportunities and challenges of network methods for analyzing GWAS such as the study of hubs and motifs, and integrating other types of variation and environmental interactions. Such network approaches may unveil hidden variation in GWAS, improve understanding of mechanisms of disease, and possibly fit into a network paradigm of evolutionary genetics
A method to assess linkage disequilibrium between CNVs and SNPs inside copy number variable regions
No full textSince the discovery of the ubiquitous contribution of copy number variation to genetic variability, researchers have commonly used metrics such as r-squared to quantify linkage disequilibrium (LD) between copy number variants (CNVs) and single nucleotide polymorphisms (SNPs). However, these reports have been restricted to SNPs outside copy number variable regions (CNVR) as current methods have not been adapted to account for SNPs displaying variable copy number. We show that traditional LD metrics inappropriately quantify SNP/CNV covariance when SNPs lie within copy number variable regions (CNVR). We derive a new method for measuring LD that solves this issue, and defaults to traditional metrics otherwise. Finally, we present a procedure to estimate CNV-SNP allele frequencies from unphased CNV-SNP genotypes. Our method allows researchers to include all SNPs in SNP/CNV LD measurements, regardless of copy number
A psychometric evaluation of the PedsQL™ Family Impact Module in parents of children with sickle cell disease
No full textAbstract Background Caring for a child with a chronic condition, such as sickle cell disease, can have a significant impact on parents and families. In order to provide comprehensive care and support to these families, psychometrically sound instruments are needed as an initial step in measuring the impact of chronic diseases on parents and families. We sought to evaluate the psychometric properties of the PedsQL™ Family Impact Module in populations of children with and without sickle cell disease. In addition, we sought to determine the correlation between parent's well being and their proxy report of their child's health-related quality of life (HRQL). Methods We conducted a cross-sectional study of parents of children with and without sickle cell disease who presented to an urban hospital-based sickle cell disease clinic and an urban primary care clinic. We assessed the HRQL and family functioning of both groups of parents utilizing the PedsQL™ Family Impact Module. The reliability, validity and factor structure of the instrument were determined and scores from the instrument were correlated with scores from parent-proxy report of their child's HRQL using the PedsQL™ 4.0 Generic Core Scales. Results Parents of 170 children completed the module (97 parents of children with sickle cell disease and 73 parents of children without sickle cell disease). The Family Impact Module had high ceiling effects but was reliable (Cronbach's alpha > 0.80 in all scales). The empirical factor structure was generally consistent with the theoretical factor structure and supported construct validity. The Family Impact Module discriminated between parents of children with severe sickle cell disease from parents of children with mild disease or no disease in the areas of communication and worry. There were no significant differences across any of the subscales between parents of children with mild sickle cell disease and those with no disease. Parents with higher scores, representing better HRQL and family functioning, generally reported higher HRQL scores for their children. Conclusion The PedsQL™ Family Impact module was reliable, however it displayed large ceiling effects and did not discriminate well between parents of children with and without sickle cell disease. Future research to evaluate the psychometric properties of the Family Impact Module for parents of healthy children may be helpful.</p
The effect of parental mental health on proxy reports of health-related quality of life in children with sickle cell disease
No full textRisk factors for dementia progression among community‐dwelling older adults in a longitudinal national survey
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