Main Dependent Measure Research Articles

Association Between Capitated Payments and Preventive Care Among U.S. Adults

There is increasing interest in using capitation rather than fee for service to promote primary care and population health. The goal of this study was to examine the association between practice reimbursement mix (majority fee for service versus majority capitation versus other) and receipt of common preventive screening examinations and health counseling from 2012 to 2018. Using the National Ambulatory Medical Care Survey, a retrospective cross-sectional study of 24,864 visits with primary care clinicians among patients aged 18-75 years without a cancer diagnosis was conducted. The main dependent measures were age- and sex-appropriate receipt of breast cancer screening, osteoporosis screening, cervical cancer screening, chlamydia testing, colon cancer screening, diabetes screening, and hyperlipidemia screening as well as 3 health counseling items. Multivariable logistic regression was performed to assess the association between reimbursement mix and receipt of preventive care, adjusted for patient, visit, and practice characteristics. Majority capitation reimbursement was associated with a greater likelihood of receiving breast cancer screening (AOR=2.11, 95% CI=1.16, 3.84, p=0.014) and osteoporosis screening (AOR=4.34, 95% CI=1.74, 10.8, p=0.0017) than majority fee-for-service or other reimbursement mixes. Reimbursement mix was not associated with the likelihood of receiving 9 other preventive care or health counseling services. Larger amounts of capitation reimbursement may improve some but not all aspects of preventive care compared with fee for service.

The impact of HDHPs on service use and spending for substance use disorders.

Although high-deductible health plans (HDHPs) reduce health care spending, higher deductibles may lead to forgone care. Our goal was to determine the effects of HDHPs on the use of and spending on substance use disorder (SUD) services. We used difference-in-differences models to compare service use and spending for treating SUD among enrollees who were newly offered an HDHP relative to enrollees offered only traditional plan options throughout the study period. We used deidentified commercial claims data from OptumLabs (2007-2017) to identify a sample of 28,717,236 person-years (2.2% with a diagnosed SUD). The main independent measure was an indicator for being offered an HDHP. The main dependent measures were the probability of (and spending associated with) using SUD services and specific treatment types. Enrollees were 6.6% (P < .001) less likely to use SUD services after being offered an HDHP relative to the comparison group. Reductions were concentrated in inpatient, intermediate, and ambulatory care, as well as medication use. Being offered an HDHP was associated with a decrease of 21% (P < .001) on health plan spending and an increase of 14% (P < .01) on out-of-pocket spending. Offering an HDHP was associated with a reduction in SUD service use and a shift in spending from the plan to the enrollee. In the context of the US drug epidemic, these study findings highlight a concern that the movement toward HDHPs may be exacerbating undertreatment of SUD.

Does learning different script systems affect configural visual processing? ERP evidence from early readers of Chinese and German.

AbstractReading is a complex cultural skill requiring considerable training, apparently affecting also the processing of non‐linguistic visual stimuli. We examined whether the different visual demands involved in reading different script systems—alphabetic German versus logographic Chinese script—would differentially influence configural visual processing. Our main dependent measure was the N170 component of the ERP, which is considered as a signature of configural processing. In the present study, German and Chinese children (N = 28 vs. 27) who had received about one year of formal instruction in their native script system, worked on a series of one‐back tasks with naturalistic faces, two‐tone Mooney faces and doodles, and on an adaptation task with pairs of faces were either identical or differed in their second‐order relations. Chinese children showed larger N170 amplitudes than German children for naturalistic and Mooney faces, specifically indicating superior holistic processing in Chinese children. In contrast, there was no superiority in Chinese children on the second‐order adaptation effect at the N170, providing no evidence for differences in second‐order relations processing of facial configurations between the groups. Given the sensitivity of the visual system to reading acquisition, these findings suggest that these group differences in holistic processing might be due to the extensive training with the highly complex logographic script system learned by Chinese children, imposing high demands on higher‐order visual perception.

Unique Internet Search Strategies of Individuals With Self-Stated Autism: Quantitative Analysis of Search Engine Users' Investigative Behaviors.

BackgroundAlthough autism is often characterized in literature by the presence of repetitive behavior, in structured decision tasks, individuals with autism spectrum disorder (ASD) have been found to examine more options in a given time period than controls.ObjectiveWe aimed to examine whether this investigative tendency emerges in information searches conducted via the internet.MethodsIn total, 1746 search engine users stated that they had ASD in 2019. This group’s naturally occurring responses following 1491 unique general queries and 78 image queries were compared to those of all other users of the search engine. The main dependent measure was scrolled distance, which denoted the extent to which additional results were scanned beyond the initial results presented on-screen. Additionally, we examined the number of clicks on search results as an indicator of the degree of search outcome exploitation and assessed whether there was a trade-off between increased search range and the time invested in viewing initial search results.ResultsAfter issuing general queries, individuals with self-stated ASD scanned more results than controls. The scrolled distance in the results page of general queries was 45% larger for the group of individuals with ASD (P<.001; d=0.45). The group of individuals with ASD also made the first scroll faster than the controls (P<.001; d=0.51). The differences in scrolled distance were larger for popular queries. No group differences in scrolled distance emerged for image queries, suggesting that visual load impeded the investigative behavior of individuals with ASD. No differences emerged in the number of clicks on search results.ConclusionsIndividuals who self-stated that they had ASD scrutinized more general search results and fewer image search results than the controls. Thus, our results at least partially support the notion that individuals with ASD exhibit investigative behaviors and suggest that textual searches are an important context for expressing such tendencies.

Defending one's worldview under mortality salience: Testing the validity of an established idea

Terror management theory (TMT) posits that mortality salience (MS) leads to more negative perceptions of persons who oppose one's worldview and to more positive perceptions of persons who confirm one's worldview. Recent failed replications of classic findings have thrown into question empirical validity for this established idea. We believe, that there are crucial methodological and theoretical aspects that have been neglected in these studies which limit their explanatory power; thus, the studies of this registered report aimed to address these issues and to directly test the worldview defense hypothesis. First, we conducted two preregistered lab studies applying the classic worldview defense paradigm. The stimulus material (worldview-confirming and -opposing essays) was previously validated for students at a German university. In both studies, the MS manipulation (between-subjects) was followed by a distraction phase. Then, in Study 1 (N = 131), each participant read both essays (within-subjects). In Study 2 (N = 276), the essays were manipulated between-subjects. Credibility attribution towards the author was assessed as the dependent variable. In both studies, the expected interaction effects were not significant. In a third highly powered (registered) study (N = 1356), we used a previously validated worldview-opposing essay. The five classic worldview defense items served as the main dependent measure. The MS effect was not significant. Bayesian analyses favored the null hypothesis. An internal meta-analysis revealed a very small (Hedges' g = 0.09) but nonsignificant (p = .058) effect of MS. Altogether, the presented studies reveal challenges in providing convincing evidence for this established idea.

Development and Validation of Caregiver Risk Evaluation (CaRE): A New Algorithm to Screen for Caregiver Burden

Objective: The main objective was to develop a decision-support tool to assess the risk of caregiver burden, the Caregiver Risk Evaluation (CaRE) algorithm. Methods: Home care clients were assessed using the Resident Assessment Instrument for Home Care (RAI-HC). Their caregiver completed the 12-item Zarit Burden Interview (ZBI), the main dependent measure, which was linked to the RAI-HC. Results: In the sample (n = 344), 48% were aged 85+ years and 61.6% were female. The algorithm can be collapsed into four categories (low, moderate, high, and very high risk). Relative to the low-risk group, clients in the very high-risk group had an odds ratio of 5.16 (95% confidence interval: [2.05, 12.9]) for long-term care admission, after adjusting for client age, sex, and regional health authority. Discussion: The CaRE algorithm represents a new tool to be used by home care clinicians as they proactively plan for the needs of clients and their caregivers.

Adapting advertising appeals to individualism or collectivism: The role of thought activation

Research into international advertising has shown culturally adapted value appeals to be more persuasive and better liked than non-adapted value appeals, especially when they appeal to the individualism–collectivism dimension. The exception to this observation is in Europe, where, despite significant cultural differences across the continent, such effects have not been identified. This study replicates the material from a previous, highly successful study, and adds a qualitative part to the study. Dutch participants completed a cognitive response task, placed either before or after the main dependent measures, to investigate whether inviting participants to think actively about an advertisement may lead to value activation and consequently to cultural value adaptation effects. The results indicate that cultural value adaptation has no effect on liking or persuasion, even when the cognitive response task occurred before the main dependent measures. This study adds to a growing body of literature indicating that Western Europeans do not consider advertisements adapted to the individualism–collectivism dimension to be more persuasive than non-adapted advertisements; likewise, Western Europeans do not prefer them over non-adapted advertisements.

Risky drinking decisions: The influence of party music and alcohol abuse in young adult women.

To assess the impact of music listening on risky drinking decisions, the current study used visual alcohol cues paired with hypothetical risky drinking scenarios (e.g., "You do not have a safe ride home" for alcohol). Young adult women with a history of alcohol abuse (N=34) and casual-drinking control women (N=29) made hypothetical decisions about whether or not to drink alcohol, or eat food (an appetitive control condition), in risky contexts while personal "party music" (music chosen by participants for "going out") and "home music" (music chosen for "staying in") played in the background. The main dependent measure - likelihood of drinking - was reported on a 4-point scale where 1 corresponded to "very unlikely", and 4 to "very likely". Listening to party music while making decisions increased the likelihood of making risky decisions, regardless of alcohol abuse history, while other personal music did not. Further, party music specifically increased the likelihood of risky drinking decisions relative to risky eating decisions. As expected, those with a history of alcohol abuse made more risky drinking decisions in general, regardless of the type of music heard. The results suggest that party music is an important feature of the drinking environment associated with increased risky decisions about drinking alcohol in young adult women, regardless of their history of alcohol abuse. The finding that music plays an important role in risky drinking decisions indicates that further investigation into the real-world drinking environments of young adults is crucial, as it will aid in the development of a more complete picture of risky drinking decisions in young adults.

The impact of cue format and cue transparency on task switching performance.

Cues help in retrieving and implementing task-sets, that are actual representations of the to-be performed task in working memory. However, whereas previous studies revealed that the effectiveness of selecting and implementing task-sets based on cues depends on the type of cue (i.e., transparent words vs. arbitrary shapes), it is still unclear which characteristics of cues are responsible for these differences and whether the impact of the cue is bound to task-set retrieval only or also impacts task-set representations. For instance, the amount of interference during actual task performance has been reported to alter dependent on cue type as do preparation gains such as the reduction of switch cost. To investigate the effectiveness of cue characteristics (i.e., cue transparency and cue format), we manipulated those within- and between-participants in three experiments. Main dependent measures were switch costs in reaction times and error rates that occur when participants have to switch task-sets, and thus update working memory content. Our results consistently show beneficial effects of transparent cues for the reduction of switch cost. The influence of cue format was manifest in within-participants manipulation only and was mainly found in error rates. Overall, our data suggest that the amount of interference experienced in actual task performance can be significantly modulated dependent on cue type, suggesting flexible adaptation of the cognitive system to contextual information.

Spatial Learning and Memory Using a Radial Arm Maze with a Head-Mounted Display.

ObjectiveA radial arm maze (RAM) is an essential tool for assessing spatial learning and memory. Although this tool is widely used to study deficits in spatial memory in animal models, it has several restrictions that prevent its adaptation to human research and training. Therefore, we developed a head-mounted-display RAM (HMD-RAM) program for humans and verified its validity by comparing it to the results obtained by previous RAM studies. We also compared the HMD and a flat monitor as experimental devices. MethodsForty participants were recruited for the current study (Study 1: 20 participants with the HMD device; Study 2: 20 participants with the flat monitor). They navigated a virtual room as a first-person viewer and used environmental landmarks to remember their spatial position and orientation. The main dependent measures were working memory error, reference memory error, detection time, travel distance, and participant’s head movements. To validate the program, participants also conducted neuropsychological assessments and self-reported measures. ResultsThe results for HMD-RAM tasks were consistent with the results of previous research conducted on animals, and the HMD elicited a higher sense of presence, immersion, and simulator sickness than the flat monitor. According to post-experiment questions on navigation strategy, creating landmarks was important when people were discovering locations in their environment, and an HMD was beneficial for better navigation strategy. ConclusionThese results suggest that the HMD-RAM is valuable for estimating spatial learning and memory in humans and may be a useful tool for early diagnosis of deficits in spatial learning and memory, including amnestic mild cognitive impairment and Alzheimer’s disease.

Automatic social comparison: Cognitive load facilitates an increase in negative thought accessibility after thin ideal exposure among women.

Women are routinely exposed to images of extremely slim female bodies (the thin ideal) in advertisements, even if they do not necessarily pay much attention to these images. We hypothesized that paradoxically, it is precisely in such conditions of low attention that the impact of the social comparison with the thin ideal might be the most pronounced. To test this prediction, one hundred and seventy-three young female participants were exposed to images of the thin ideal or of women’s fashion accessories. They were allocated to either a condition of high (memorizing 10 digits) or low cognitive load (memorizing 4 digits). The main dependent measure was implicit: mean recognition latency of negative words, relative to neutral words, as assessed by a lexical decision task. The results showed that thin-ideal exposure did not affect negative word accessibility under low cognitive load but that it increased it under high cognitive load. These findings are consistent with the hypothesis that social comparison with the thin ideal is an automatic process, and contribute to explain why some strategies to prevent negative effects of thin-ideal exposure are inefficient.

Optimization of the dependability and performance measures of a generic model for multi-state deteriorating systems under maintenance

In this paper, a general model for multi-state deteriorating systems with condition based preventive maintenance is introduced and analyzed extensively. The system experiences various levels of deterioration and at each stage, an inspection is carried out at constant time intervals in order to identify what kind of preventive maintenance, the system should undergo. When the system fails, despite preventive maintenance, a repair procedure is carried out and the system is restored to its initial fully operational state. The proposed model incorporates also imperfect maintenance, either minimal or major, failed maintenance and sudden failures that may occur mostly due to external factors at any deterioration state as well. Moreover, the sojourn times are assumed to be generally distributed. The main dependability and performance measures of the proposed model are computed while the corresponding transient measures are estimated using Monte Carlo simulation. Our endmost aim is to distinguish inspection and consequently maintenance policies that optimize multi-state deteriorating system's dependability and/or performance. Additionally, multi-objective optimization problems are formulated and solve in order to distinguish preventive maintenance policies that optimize simultaneously both the dependability and performance measures.

Increased cognitive problem reporting after information about chemotherapy-induced cognitive decline: The moderating role of stigma consciousness

Objective: Information about treatment side effects can increase their occurrence; breast cancer (BC) patients showed increased cognitive problem reporting (CPR) and decreased memory performance after information about cognitive side effects. The current study extends previous research on adverse information effects (AIE) by investigating (a) risk factors, (b) underlying mechanisms and (c) an intervention to reduce AIE.Design: In an online experiment, 175 female BC patients were randomly assigned to one of three conditions. In the two experimental groups, patients were informed about the possible occurrence of cognitive problems after chemotherapy with (intervention group) or without (experimental group) reassuring information that ‘there are still patients who score well on memory tests’. In the control group, no reference to chemotherapy-related cognitive problems was made.Main outcome measures: Main dependent measure was CPR. Four moderating and five mediating processes were examined.Results: CPR increased with higher levels of stigma consciousness in the two experimental groups, but not in the no-information control group.Conclusion: Merely informing patients about cognitive side effects may increase their occurrence, especially among individuals vulnerable to patient stereotypes. Adding reassuring information is not sufficient to reduce AIE.

Racial Resentment and Attitudes Toward the Use of Force by Police: An Over‐Time Trend Analysis

On the heels of recent police shootings of an unarmed Michael Brown in Ferguson, Missouri, Walter Scott in North Charleston, South Carolina, and the death of Freddy Gray in Baltimore, Maryland, that stoked racial tensions, this article examines how beliefs about race and racial inequality influence whites’ attitudes toward the use of force by the police since the mid‐1980s. Our main dependent measure is a composite index (“Police Force Index”) constructed from four survey items from the 1986–2012 National Opinion Research Center's General Social Survey (GSS). Results show that (1) beliefs about race do indeed significantly predict whites’ attitudes toward police use of force, and more importantly, (2) this effect has remained constant since the mid‐1980s. We discuss theoretical and practical implications of these findings and suggestions for future research.

Focusing attention on circular pedaling reduces movement economy in cycling

Previous research has shown that focus of attention affects movement economy in endurance tasks. This experimental study was designed to take a closer look at how focusing attention on special characteristics of endurance cycling actions can influence metabolic energy costs. Twenty-five trained cyclists completed 4 × 6 min time trials at submaximal intensity on a cycling ergometer. For each of the four time trials, they were instructed to adopt a different focus of attention: (1) circular pedaling, (2) force production of quad muscles, (3) head position, (4) stimuli in a cycling video. The order of conditions was counterbalanced. The main dependent measure was movement economy (i.e., oxygen consumption at a given workload). The results show that a focus on the circular pedaling action leads to reduced economy than a focus on the video (p = 0.001). Focusing on smooth and circular pedaling includes a continuous monitoring of the cycling action, which could disturb the rhythmical nature of movement execution, thereby leading to detriments in movement economy.

Saccade latency indexes exogenous and endogenous object-based attention

Classic studies of object-based attention have utilized keypress responses as the main dependent measure. However, people typically make saccades to fixate important objects. Recent work has shown that attention may act differently when it is deployed covertly versus in advance of a saccade. We further investigated the link between saccades and attention by examining whether object-based effects can be observed for saccades. We adapted the classical double-rectangle cueing paradigm of Egly, Driver, and Rafal (1994), and measured both the first saccade latency and the keypress reaction time (RT) to a target that appeared at the end of one of the two rectangles. Our results showed that saccade latencies exhibited higher sensitivity than did RTs for detecting effects of attention. We also assessed the generality of the attention effects by testing three types of cues: hybrid (predictive and peripheral), exogenous (nonpredictive and peripheral), and endogenous (predictive and central). We found that both RTs and saccade latencies exhibited effects of both space-based and object-based attentional selection. However, saccade latencies showed a more robust attentional modulation than RTs. For the exogenous cues, we observed a spatial inhibition of return along with an object-based effect, implying that object-based attention is independent of space-based attention. Overall, our results revealed an oculomotor correlate of object-based attention, suggesting that, in addition to spatial priority, object-level priority also affects saccade planning.

Adult Intake of Minimally Processed Fruits and Vegetables: Associations with Cardiometabolic Disease Risk Factors

BackgroundThe US Department of Agriculture launched ChooseMyPlate.gov nutrition recommendations designed to encourage increased fruit and vegetable intake, in part, as a strategy for improving weight control through the consumption of high-satiation foods. ObjectiveThe purpose of this cross-sectional study was to assess the relationship between adults’ reported daily intake of fruits and nonstarchy vegetables (ie, those thought to have the lowest energy density) expressed as a proportion of their total daily food intake and objectively measured cardiovascular and metabolic disease risk factors using data from the 2009-2010 National Health and Nutrition Examination Survey (NHANES). Physical activity was included as a moderator variable. DesignThis study employed a cross-sectional examination of 2009-2010 NHANES data to assess how daily fruit and nonstarchy vegetable intake was associated with anthropometric measures and cardiometabolic blood chemistry markers. Participants/settingAdults free of cardiac or metabolic disease (n=1,197) participated in 24-hour dietary recalls; a variety of cardiometabolic biomarkers and anthropometric measures were also collected from participants. Main outcome measuresAmong participants with complete data on all variables, the ratio of the combined cup-equivalents of fruit and nonstarchy vegetable intake to the total gram weight of all foods consumed daily (F/V ratio) served as the primary independent variable. Main dependent measures included fasting glucose, insulin, glycosylated hemoglobin, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, total cholesterol, waist circumference, and body mass index. Statistical analyses performedDemographic and behavioral predictors of the F/V ratio and the association between the F/V ratio and cardiometabolic disease risk factors were examined using multivariate regression. ResultsBody mass index (β=−2.58; 95% CI −3.88 to −1.28), waist circumference (β=−6.33; 95% CI −9.81 to −2.84), and insulin (β=−0.21; 95% CI −0.37 to −0.05) were inversely associated with the F/V ratio. These associations were weakened for the subset that adhered to federal physical activity recommendations. No other statistically significant associations were found between F/V ratio and main dependent measures. ConclusionsIn this nationally representative sample, predicted inverse associations between the proportion of daily fruit and nonstarchy vegetable intake relative to total intake and measures reflective of body fat composition and fasting insulin were confirmed. Future research should examine whether a similar association is observed for other sources of resistant starch, such as whole grains, which are arguably more strongly linked with satiety and host insulin levels.

The separate and combined effects of drinking and smoking upon everyday prospective memory

Introduction Prospective memory (PM) refers to memory for future plans/actions; such as remembering to meet with friends or to perform a task at a specific time. Independent research has demonstrated that smoking and excessive alcohol consumption produce PM deficits on both self-reported and objective measures of PM. Objectives No research to date has looked at the combined use of excessive alcohol and tobacco smoking upon PM, which is the focus of this study. Aims The present study aimed to provide compare a group of excessive drinkers, a group of smokers (not excessively drinking) and a poly-drug excessive drinking and smoking group, on an objective measure of PM. Methods A between-subjects design will be used to compare three groups: (1) a group of excessive drinkers who do not smoke; (2) a group of smokers who do not drink excessively and (3) a group of excessive drinkers who also smoke. The Cambridge Prospective Memory Task will measure both time and event based PM; and two self-reports will measure covariates of substance use and everyday mood (since these can impact upon PM independent of smoking/drinking status). Results Descriptive statistics will be applied to observe the trends across all three groups with regards the covariates and main dependent measures of time and event based PM. A series of ANOVAs will be applied to determine significance across the groups on the covariates and on the main dependent measures. Conclusions The conclusions and implications will be presented at the conference, along with suggestions for future research.

How can technology help intergenerational reminiscence? A pilot study

The goal of this study was to test the usability and efficacy of a website designed to support intergenerational reminiscence. The website allows older persons to capture, digitally archive, and share their memories encapsulated in letters, newspaper clippings, postcards, photos and videos. The evaluation involved 44 seniors and 176 children and consisted in two main phases. In the first phase, the usability of the website was assessed in a sample of elderly participants. In the second phase, the efficacy of online reminiscence was tested against a control condition, in which elderly people shared personal memories with children without the support of technology. Main dependent measures included self-esteem, loneliness and enjoyment/engagement with the activity flow. Findings showed that the website was usable and well-accepted. However, the use of the platform did not significantly improve the effects of intergenerational reminiscence, which is an activity that participants enjoyed in itself.

Working Memory Deficits in Dynamic Sport Athletes with a History of Concussion Revealed by A Visual-Auditory Dual-Task Paradigm

Processing and integrating multiple sensory inputs simultaneously plays a vital role in an athlete's ability to plan and execute appropriate actions in dynamic environments. Previous research has shown that concussions affect an athlete's processing capacity and ability to process multiple sensory inputs simultaneously. Few studies to date have considered the impact of previous concussions on information processing of visual and auditory input. It is important to understand information processing capacity in dynamic sports because athletes must divide their attention between visual and auditory stimuli and hold that information in memory to guide actions. We developed a study to examine processing capacity by using a visuospatial working memory test to exhaust attentional resources. We hypothesize that athletes with a history of concussion will have more difficulty allocating attentional resources to each task and thus, will perform significantly worse on a visual-auditory test. Participants were varsity hockey players (n=28; 15 females) 17 of whom had suffered at least one concussion. They completed 2 tasks: a visual working memory task (Corsi block test [CBT]) and an auditory task (tone discrimination). The computerized CBT was an 8-target serial recall test that involved encoding and recalling the location of targets in the order of presentation. The auditory task involved discriminating high (1000 Hz) and low (375 Hz) tones using a computer mouse. Each task was completed individually and then simultaneously with primary focus on the visual task. The main dependent measure was the auditory task cost associated with the dual-task performance. We found that auditory cost was significantly higher in participants with a history of concussion. These results indicate that athletes with a history of concussion have more difficulty with processing multiple sensory inputs simultaneously. This evidence suggests that a history of concussion may produce long-term effects that make an athlete susceptible to further injury. Meeting abstract presented at VSS 2015. Language: en