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  • 1
    Online Resource
    Online Resource
    Absence of a moderating effect of parent health literacy on Early Head Start enrollment and dental use
    Wiley ; 2018
    In:  Journal of Public Health Dentistry Vol. 78, No. 3 ( 2018-06), p. 257-265
    Details
    In: Journal of Public Health Dentistry, Wiley, Vol. 78, No. 3 ( 2018-06), p. 257-265
    Abstract: To examine the moderating effect of parents' health literacy (HL) on the effectiveness of North Carolina Early Head Start (EHS) in improving children's dental use. Methods Parents of 479 children enrolled in EHS and 699 Medicaid‐matched parent–child dyads were interviewed at baseline when children were approximately 10 months old and 24 months later. We used in‐person computer‐assisted, structured interviews to collect information on sociodemographic characteristics, dental use, and administer the Short Assessment of Health Literacy – Spanish and English (SAHL‐S & E). This quasi‐experimental study tested whether the interaction effect between EHS and parents' HL was associated with dental use. Logit (any use) and marginalized zero‐inflated negative binomial count models (number of dental visits) included random effects to account for clustering and controlled for baseline dental use, dental need, survey language, and a propensity score covariate. Results Nineteen percent of parents in EHS had low literacy compared to 12 percent of parents in the non‐EHS group ( P   〈  0.01). The interaction term between EHS and parent's HL was not significant in the adjusted logit model (ratio of aORs 0.98, 95 percent CI: 0.43‐2.20) or the adjusted count model (ratio of aRRs 0.88, 95 percent CI: 0.72‐1.09). Conclusions Parents in EHS had a higher prevalence of low HL compared to non‐EHS parents. Parents' HL did not moderate the relationship between EHS and child dental use, suggesting that EHS results in similar improvements in dental use regardless of parent's HL levels.
    Type of Medium: Online Resource
    ISSN: 0022-4006 , 1752-7325
    URL: Issue
    URL: Article
    DOI: 10.1111/jphd.2018.78.issue-3
    DOI: 10.1111/jphd.12269
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2267887-6
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  • 2
    Online Resource
    Online Resource
    Independent evidence for an association between general cognitive ability and a genetic locus for educational attainment
    Wiley ; 2015
    In:  American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Vol. 168, No. 5 ( 2015-07), p. 363-373
    Details
    In: American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, Wiley, Vol. 168, No. 5 ( 2015-07), p. 363-373
    Abstract: Cognitive deficits and reduced educational achievement are common in psychiatric illness; understanding the genetic basis of cognitive and educational deficits may be informative about the etiology of psychiatric disorders. A recent, large genome‐wide association study (GWAS) reported a genome‐wide significant locus for years of education, which subsequently demonstrated association to general cognitive ability (“ g ”) in overlapping cohorts. The current study was designed to test whether GWAS hits for educational attainment are involved in general cognitive ability in an independent, large‐scale collection of cohorts. Using cohorts in the Cognitive Genomics Consortium (COGENT; up to 20,495 healthy individuals), we examined the relationship between g and variants associated with educational attainment. We next conducted meta‐analyses with 24,189 individuals with neurocognitive data from the educational attainment studies, and then with 53,188 largely independent individuals from a recent GWAS of cognition. A SNP (rs1906252) located at chromosome 6q16.1, previously associated with years of schooling, was significantly associated with g ( P  = 1.47 × 10 −4 ) in COGENT. The first joint analysis of 43,381 non‐overlapping individuals for this a priori‐ designated locus was strongly significant ( P  = 4.94 × 10 −7 ), and the second joint analysis of 68,159 non‐overlapping individuals was even more robust ( P  = 1.65 × 10 −9 ). These results provide independent replication, in a large‐scale dataset, of a genetic locus associated with cognitive function and education. As sample sizes grow, cognitive GWAS will identify increasing numbers of associated loci, as has been accomplished in other polygenic quantitative traits, which may be relevant to psychiatric illness. © 2015 Wiley Periodicals, Inc.
    Type of Medium: Online Resource
    ISSN: 1552-4841 , 1552-485X
    URL: Issue
    URL: Article
    DOI: 10.1002/ajmg.b.v168.5
    DOI: 10.1002/ajmg.b.32319
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 2143866-3
    SSG: 12
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  • 3
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    Online Resource
    Medicare Shared Savings ACOs and Hospice Care for Ischemic Stroke Patients
    Wiley ; 2019
    In:  Journal of the American Geriatrics Society Vol. 67, No. 7 ( 2019-07), p. 1402-1409
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 67, No. 7 ( 2019-07), p. 1402-1409
    Abstract: Palliative care services have the potential to improve the quality of end‐of‐life care and reduce cost. Services such as the Medicare hospice benefit, however, are often underutilized among stroke patients with a poor prognosis. We tested the hypothesis that the Medicare Shared Savings Program (MSSP) is associated with increased hospice enrollment and inpatient comfort measures only among incident ischemic stroke patients with a high mortality risk. DESIGN A difference‐in‐differences design was used to compare outcomes before and after hospital participation in the MSSP for patients discharged from MSSP hospitals (N = 273) vs non‐MSSP hospitals (N = 1490). SETTING Records from a national registry, Get with the Guidelines (GWTG)‐Stroke, were linked to Medicare hospice claims (2010‐2015). PARTICIPANTS Fee‐for‐service Medicare beneficiaries age 65 and older hospitalized for incident ischemic stroke at a GWTG‐Stroke hospital from January 2010 to December 2014 (N = 324 959). INTERVENTION Discharge from an MSSP hospital or beneficiary alignment with an MSSP Accountable Care Organization (ACO). MEASUREMENTS Hospice enrollment in the year following stroke. RESULTS Among patients with high mortality risk, ACO alignment was associated with a 16% increase in odds of hospice enrollment (adjusted odds ratio [OR] = 1.16; 95% confidence interval [CI]  = 1.06‐1.26), increasing the probability of hospice enrollment from 20% to 22%. In the low mortality risk group, discharge from an MSSP vs non‐MSSP hospital was associated with a decrease in the predicted probability of inpatient comfort measures or discharge to hospice from 9% to 8% (OR = .82; CI = .74‐.91), and ACO alignment was associated with reduced odds of a short stay ( 〈 7 days) (OR = .86; CI = .77‐.96). CONCLUSION Among ischemic stroke patients with severe stroke or indicators of high mortality risk, MSSP was associated with increased hospice enrollment. MSSP contract incentives may motivate improved end‐of‐life care among the subgroups most likely to benefit.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.2019.67.issue-7
    DOI: 10.1111/jgs.15852
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2040494-3
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  • 4
    Online Resource
    Online Resource
    Rural–Urban Differences in the Effect of Follow‐Up Care on Postdischarge Outcomes
    Wiley ; 2017
    In:  Health Services Research Vol. 52, No. 4 ( 2017-08), p. 1473-1493
    Details
    In: Health Services Research, Wiley, Vol. 52, No. 4 ( 2017-08), p. 1473-1493
    Abstract: To assess rural–urban differences in quality of postdischarge care among Medicare beneficiaries, controlling for selection bias of postdischarge services. Data Sources The Medicare Current Beneficiary Survey ( MCBS ), Cost and Use Files from 2000 to 2010, the Area Resource File, Provider of Services File, and the Dartmouth Atlas of Health Care. Study Design Retrospective analysis of 30‐ and 60‐day hospital readmission, emergency department ( ED ) use, and mortality using two‐stage residual inclusion; receipt of 14‐day follow‐up care was the main independent variable. Data Extraction Method We defined index admission from the MCBS as any admission without a previous admission within 60 days. Principal Findings Noninstrumental variables estimation was the preferred estimation strategy. Fourteen‐day follow‐up care reduced the risk of readmission, ED use, and mortality. There were no rural– urban differences in the effect of 14‐day follow‐up care on readmission and mortality. Rural beneficiaries experienced a greater effect of 14‐day follow‐up care on reducing 30‐day ED use compared to urban beneficiaries. Conclusions Follow‐up care reduces 30‐ and 60‐day readmission, ED use, and mortality. Rural and urban Medicare beneficiaries experience similar beneficial effects of follow‐up care on the outcomes. Policies that improve follow‐up care in rural settings may be beneficial.
    Type of Medium: Online Resource
    ISSN: 0017-9124 , 1475-6773
    URL: Issue
    URL: Article
    DOI: 10.1111/hesr.2017.52.issue-4
    DOI: 10.1111/1475-6773.12543
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2078493-4
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