Sequential Cohort Design Research Articles

Putative risk and resiliency factors after an augmented training program for preventing posttraumatic stress injuries among public safety personnel from diverse sectors

ABSTRACT Mental health disorders are particularly prevalent among public safety personnel (PSP). Emotional Resilience Skills Training (ERST) is a cognitive behavioural training program for PSP based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (i.e. Unified Protocol). The current study was designed to assess whether ERST is associated with reduced putative risk factors for mental disorders and increased individual resilience. The PSP-PTSI Study used a longitudinal prospective sequential experimental cohort design that engaged each participant for approximately 16 months. PSP from diverse sectors (i.e. firefighters, municipal police, paramedics, public safety communicators) completed self-report measures of several putative risk variables (i.e. anxiety sensitivity, fear of negative evaluation, pain anxiety, illness and injury sensitivity, intolerance of uncertainty, state anger) and resilience at three time points: pre-training (n = 191), post-training (n = 103), and 1-year follow-up (n = 41). Participant scores were statistically compared across time points. Participants reported statistically significantly lower scores on all putative risk variables except pain anxiety, and statistically significantly higher resilience from pre- to post-training. Changes were sustained at 1-year follow-up. The results indicate that ERST is associated with reductions in several putative risk variables and improvement in resilience among PSP.

Prevalence of current chronic pain in Royal Canadian Mounted Police cadets

ABSTRACT Background Nearly half of active duty Royal Canadian Mounted Police (RCMP) officers report experiencing current chronic pain (43%; i.e. pain lasting longer than 3 months). Most RCMP officers who report chronic pain indicate that the pain started after working as RCMP officers (91%). Baseline data on chronic pain prevalence among RCMP cadets has not been available. Aims The current study was designed to provide cross-sectional estimates of chronic pain prevalence among RCMP cadets starting the Cadet Training Program and to assess for sociodemographic differences among participants. Methods The RCMP Study uses a longitudinal prospective sequential experimental cohort design to create a clustered randomized trial that engages individual participants for 5.5 years. The current article provides cross-sectional associations between chronic pain prevalence and sociodemographic characteristics. Participants were RCMP cadets starting the Cadet Training Program (n = 770). Location, intensity (on a 0–10 scale and days per week experienced), and duration (number of months) of chronic pain were reported. Differences across sociodemographic characteristics were examined. Results Few RCMP cadets reported experiencing chronic pain (10%); lower back pain was rated as the most severe in terms of intensity and duration and second most frequently reported in number of days experienced per week. Prevalence of chronic pain was lower among RCMP cadets than among RCMP officers. Conclusions Chronic pain prevalence among active duty RCMP officers may result from or be moderated by operational duties, as well as routine aging. Future researchers could examine ways to mitigate chronic pain development during RCMP officer careers.

Improving post-concussion discharge education for families seeking emergency department care: intervention development.

Pediatric emergency departments (ED) are where many families receive post-concussion medical care and thus an important context for helping parents build skills to support their child after discharge. Develop a strategy for increasing parent provision of emotional and instrumental support to their child after discharge and conduct a pilot test of this strategy's acceptability. In a large pediatric ED in the United States, we partnered with parents (n = 15) and clinicians (n = 15) to understand needs and constraints related to discharge education and to operationalize a strategy to feasibly address these needs. This produced a brief daily text message intervention for parents for 10 days post-discharge. We used a sequential cohort design to assess the acceptability this intervention and its efficacy in changing parenting practices in the 2-weeks post-discharge (n = 98 parents). Parents who received the messaging intervention rated it as highly acceptable and had meaningfully higher scores for emotionally supportive communication with their child in the two weeks post-discharge than parents in the control condition (Cohen's d = 0.65, p = 0.021). This brief messaging intervention is a promising strategy for enhancing discharge education post-concussion that warrants further evaluation.

Partner engagement for planning and development of non-pharmacological care pathways in the AIM-Back trial.

Embedded pragmatic clinical trials are increasingly recommended for non-pharmacological pain care research due to their focus on examining intervention effectiveness within real-world settings. Engagement with patients, health care providers, and other partners is essential, yet there is limited guidance for how to use engagement to meaningfully inform the design of interventions to be tested in pain-related pragmatic clinical trials. This manuscript aims to describe the process and impacts of partner input on the design of two interventions (care pathways) for low back pain currently being tested in an embedded pragmatic trial in the Veterans Affairs health care system. Sequential cohort design for intervention development was followed. Engagement activities were conducted with 25 participants between November 2017 and June 2018. Participants included representatives from multiple groups: clinicians, administrative leadership, patients, and caregivers. Partner feedback led to several changes in each of the care pathways to improve patient experience and usability. Major changes to the sequenced care pathway included transitioning from telephone-based delivery to a flexible telehealth model, increased specificity about pain modulation activities, and reduction of physical therapy visits. Major changes to the pain navigator pathway included transitioning from a traditional stepped care model to one that offers care in a feedback loop, increased flexibility regarding pain navigator provider type, and increased specificity for patient discharge criteria. Centering patient experience emerged as a key consideration from all partner groups. Diverse input is important to consider before implementing new interventions in embedded pragmatic trials. Partner engagement can increase acceptability of new care pathways to patients and providers and enhance uptake of effective interventions by health systems. NCT#04411420. Registered on 2 June 2020.

Actual and Perceived Motor Competence in Chilean Schoolchildren before and after COVID-19 Lockdowns: A Cohort Comparison.

(1) Background: the measures applied in Chile to reduce COVID-19 infections have been very strict, mainly for children who have experienced lockdowns and school closures for almost two years. Emerging evidence indicates that lockdowns have had several negative effects on children; therefore, the present study seeks to analyze the secular effects of COVID-19 lockdowns on Chilean students' actual motor competence (AMC) and perceived motor competence (PMC). (2) Methods: using a sequential cohort design, data from 523 fifth-grade students at nine elementary schools (46.8% girls, age M = 11.11, SD = 0.66) were assessed in 2018-19 (pre-lockdown) (n = 265) and 2022 (post-lockdown) (n = 258). (3) Results: in the domain of object control (AMC and PMC), no significant differences were found (AMC p = 0.559; PMC p = 0.682). In the self-movement domain of AMC and PMC, the significant differences found presented a small effect size (AMC p = 0.044, ηp2 = 0.01; PMC p = 0.001, ηp2 = 0.03). (4) Conclusions: although the differences encountered were not drastic, self-movement skills tended to be greatly affected by the lockdowns resulting from the COVID-19 pandemic. These findings broaden information on the negative consequences of the pandemic on students in aspects related to an active and healthy life.

Safety, Pharmacokinetics and Pharmacodynamics of DS-1040, in Combination with Thrombectomy, in Japanese Patients with Acute Ischemic Stroke.

Background and ObjectivesDS-1040 is a novel inhibitor of the activated form of thrombin-activatable fibrinolysis inhibitor that may have therapeutic potential in thromboembolic diseases, such as acute ischemic stroke (AIS) or pulmonary embolism. We undertook a Phase I clinical trial to investigate the safety, pharmacokinetics, and pharmacodynamics of DS-1040 in Japanese patients who were eligible for thrombectomy following AIS.MethodsThe trial enrolled patients with AIS due to large vessel occlusion, who were planned for thrombectomy within 8 h of symptom onset. Subjects were randomized to receive a single intravenous infusion of placebo or DS-1040 (0.6, 1.2, 2.4 or 4.8 mg) in a sequential-cohort design. The primary endpoints were the incidence of intracranial hemorrhage (ICH) and major extracranial bleeding within 36 and 96 h, respectively, of treatment initiation. Treatment-emergent adverse events (TEAEs) and pharmacokinetic/pharmacodynamic parameters were also assessed.ResultsNine patients received placebo and 32 patients received DS-1040. There were no cases of symptomatic ICH or major extracranial bleeding with either placebo or DS-1040 after 36 and 96 h. One patient, who received DS-1040 0.6 mg, experienced a subarachnoid hemorrhage that was considered to be drug-related. Three patients died (2 placebo, 1 DS-1040), but no deaths were adjudicated as study drug-related. In vivo exposure to DS-1040 increased in proportion to dosage, but no clear dose-response relationship was seen for D-dimer levels and thrombin-activatable fibrinolysis inhibitor activity.ConclusionsSingle doses of DS-1040 0.6–4.8 mg were well tolerated in Japanese patients with AIS undergoing thrombectomy.Clinical trial registration numberNCT03198715; JapicCTI-163164.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40261-021-01112-8.

Brick-by-brick inequality. Homeownership in Italy, employment instability and wealth transmission.

This paper investigates changes between, and inequalities within, birth-cohorts in Italy, surrounding homeownership. Italy is a homeownership and familialistic society, where in recent decades an increasing 'generational divide' in employment prospects has opened up, as a side-effect of a partial and targeted labour market deregulation. Drawing on the interplay of macro-level constraints with micro-level factors, we discuss patterns of inequality in attaining homeownership between cohorts, arising from greater instability of employment for young adults, and within cohorts, stemming from class-based patterns of intergenerational wealth transmission. Our analytical strategy combines a sequential cohort design with two levels of analysis that simultaneously consider young people around the normative age of housing independence and wealth transmission from their families triggered by their leaving the nest. Longitudinal analyses apply random-effects probit models and linear probability distributed fixed-effects to panel data from the Bank of Italy (SHIW 1989-2016). Results show a decrease in homeownership attainment across cohorts, which can be partially ascribed to employment disadvantages faced by younger cohorts. On top of this, class-specific patterns of intergenerational transmission are in place: lower classes rely on timely housing wealth transfers, whereas upper classes are prepared to provide their children with an extended stream of financial transfers.

Safety, Pharmacokinetics, and Pharmacodynamics of Oral Venglustat in Patients With Parkinson's Disease and a <i>GBA</i> Mutation: Results From Part 1 of the Randomised, Double-Blinded, Placebo-Controlled MOVES-PD Trial

Safety, Pharmacokinetics, and Pharmacodynamics of Oral Venglustat in Patients With Parkinson's Disease and a <i>GBA</i> Mutation: Results From Part 1 of the Randomised, Double-Blinded, Placebo-Controlled MOVES-PD Trial

Quality of life of patients with Hirschsprung disease after Duhamel and Soave pull-through procedures: A mixed-methods sequential explanatory cohort study

BackgroundQuality of life (QoL) is one of the important outcomes for patients with Hirschsprung disease (HSCR) after pull-through that provides qualitative data concerning the long-term outcomes, however, it has not been well-studied. The HSCR/anorectal malformation quality of life questionnaire (HAQL) is considered valid and reliable to evaluate the QoL of HSCR patients. Material and methodsA mixed-method sequential explanatory cohort study was conducted to compare the QoL of HSCR patients after Duhamel and Soave pull-through at Dr. Sardjito Hospital between 2013 and 2018 using an Indonesian adaptation of the HAQL, followed by a qualitative study. ResultsWe ascertained eleven HSCR patients (Duhamel: five HAQL parents and one HAQL adolescent vs. Soave: four HAQL parents and one HAQL adult). For the quantitative study, the mean HAQL score was 2.50 and 2.79 for the Duhamel and Soave groups, respectively. For the qualitative study, interviewed patients' parents expressed how their child's life had improved after surgery. However, frequent bloating was a major complaint following Soave surgery, whereas hardened stools were a major problem after Duhamel procedure. ConclusionHere, for the first time using a mixed-method sequential explanatory cohort design, we show that patients with HSCR after Soave tended to have a higher overall QoL score compared to the Duhamel group. Further multicenter study with a larger sample size is mandatory to give better understanding about QoL of HSCR patients following pull-through.

Evidence Basis for a Point-of-Care Ultrasound Examination to Refine Referral for Outpatient Echocardiography

Few data exist on the potential utility of a cardiac point-of-care ultrasound (POCUS) examination in the outpatient setting to assist diagnosis of significant cardiac disease. Using a retrospective sequential cohort design, we sought to derive and then validate a POCUS examination for cardiac application and model its potential use for prognostication and cost-effective echo referral. For POCUS examination derivation, we reviewed 233 consecutive outpatient echo studies for 4 specific POCUS "signs" contained therein representing left ventricular systolic dysfunction, left atrial enlargement, inferior vena cava plethora, and lung apical B-lines. The corresponding formal echo reports were then queried for any significant abnormality. The optimal POCUS examination for identifying an abnormal echo was determined. We then reviewed 244 consecutive outpatient echo studies from another institution for associations between the optimal POCUS examination, clinical variables, and referral source with major adverse cardiac events and all-cause mortality in univariate and multivariate models. Assuming a referral model where the absence of POCUS signs or variables would negate initial echo referral, theoretical cost savings were expressed as a percentage in reduction of echo studies. In the derivation cohort, the combination of two signs, denoting left atrial enlargement and inferior vena cava plethora resulted in the highest accuracy of 72% [95% CI: 65%, 78%] in detecting an abnormal echocardiogram. In the validation cohort, mortality at 5.5 years was 14.6% overall, 23% in patients with the left atrial enlargement sign (OR 3.5 [1.6, 7.6]), 25% with inferior vena cava plethora sign (OR 2.2 [0.8, 6.0]), and 8.0% (OR 0.3 [0.2, 0.7]) in those lacking both signs. After adjusting for age, both diabetes (OR 4.8 [2.0, 11.6]), and the left atrial enlargement sign (OR 2.4 [1.1, 5.4]) remained independently associated with mortality (p<0.05). In the referral model, patients younger than 65 years of age without diabetes and without the left atrial enlargement sign would not have received echo referral, resulting in a 33% reduction in total echo cost and would have constituted a low-risk group with a 1.2% 5.5-year mortality. A quick-look sign for left atrial enlargement is associated with 5-year mortality and could function as an easily obtained outpatient POCUS examination to help in identifying patients in need of echo referral.

Improving Patient Safety Through Video Monitoring

Abstract Purpose: Falls are a major safety issue in rehabilitation settings. Patients receive mixed messages—try to be as independent as possible, but don’t do anything in your room without calling for assistance. Despite the use of multiple falls interventions at this facility, the fall rate remained high. To impact this rate, the facility implemented a video monitoring system. This system allows for patients at risk for falling to be monitored from a remote location. The monitor technician is able to speak to the patient directly and/or contact staff members to respond to the room, preventing a fall. Design: Sequential cohort design. Method: Fifteen video monitoring units were installed on high-risk units in a 115-bed inpatient rehabilitation facility. Total falls and falls rates were tracked and reported pre- and postimplementation. Findings: Over a 21-month period prior to implementing the video monitoring system, the average hospital-wide rate of falls was 6.34 per 1,000 patient-days (SD = 1.7488). After a year of usage, that average has decreased to 5.099 falls per 1,000 patient-days (SD = 1.524). The reduction in falls was statistically significant. In addition, there have been significant cost savings by reducing sitter usage. Conclusions: Video monitoring can improve patient safety by decreasing falls; decreasing sitter usage and cost; and improving patient, family, and staff satisfaction. Clinical Relevance: Falls are a significant issue in rehabilitation settings, and current fall prevention strategies fall short of reducing fall rates. Implementation of new video monitoring technology can help reduce fall rates in inpatient rehabilitation settings.

Pathogen Inactivated Platelet Components Used without Leukofiltration, or Gamma Irradiation Show Comparable Therapeutic Efficacy and Safety to Gamma Irradiated and Non-Leukofiltered Conventional Products for the Support of HSCT Patients in Hong Kong

▪Introduction: Depending on the conditioning intensity and graft source, mosthematopoietic stem cell transplant(HSCT) patients invariably experience a cytopenic phase of at least 2-3 weeks and require transfusion support until engraftment. All transfused blood components post-transplant need to be gamma irradiated to prevent transfusion associated graft versus host disease (TA-GVHD). Platelet component (PC) manufacturing methodologies differ around the globe. Currently, Hong Kong HSCT patients are supported with individual platelet rich plasma (PRP) PCs without leukocyte filtration (NLF), tested by short-term aerobic cultures for bacterial contamination (STABC), and gamma irradiated. When new PC manufacturing methodologies are considered for adoption, it is important to assess the immediate and longer term effects on transfused patients. Amotosalen+UVA light (A-UVA) pathogen reduction technology (INTERCEPT™ Blood System, Cerus Corporation, Concord, CA) inactivates bacteria, viruses, parasites and leukocytes by efficient covalent adduct modification of DNA and RNA. Treatment with A-UVA prevents TA- GVHD in an animal model, inhibits clonal T cell proliferation, prevents allogeneic antigen stimulation in mixed lymphocyte reactions, and inhibits transcription mediated cytokine production and early activation antigen expression (Corash et al, BMT 2004). The common strategy of prescribing gamma irradiated PC only for suspected "high risk" patients is sub-optimal, as failure to identify recipients at risk for TA-GVHD was responsible for 50% of reported cases (Kopolovic et al. Blood 2016). Treatment of PC with A-UVA addresses two key issues for HSCT patients: bacterial contamination, and universal prevention of TA-GVHD. Here, we compared the clinical support of HSCT patients with conventional PCs (C-PC) vs. an equivalent HSCT group supported with A-UVA PCs (I-PC) using a sequential patient cohort design within a single HSCT clinical center.Methods: I-PCs were prepared from 5 pooled ABO-matched, NLF buffy coat PCs in platelet additive solution and treated with A-UVA replacing gamma irradiation and bacterial detection. C-PCs were prepared from 5 ABO-matched, STABC-negative, NLF PRP PCs, and treated with gamma irradiation. Each patient could receive up to 5 PC transfusions. The primary efficacy endpoint was the 1-hour corrected count increment (CCI) and the primary safety endpoint was the proportion of patients (P) with acute transfusion reactions (ATR). Follow-up data on mortality, hematopoiesis engraftment, and immune status were collected up to 100 days post HSCT.Results: Patient demographics and type of HSCT were similar between patient cohorts. 33 patients received 76 A-UVA PCs and 31 patients received 89 C-PCs. The mean days of platelet support (p=0.618) and mean 1-hour CCIs per patient averaged for all transfusions were comparable (p=0.296) between the I- PC and conventional C-PC cohorts (Table). The proportion of patients with AEs was lower (p=0.021) for the I-PC group (Table), and no related SAEs were observed during the entirety of trial. Survival at 100 days post HSCT and rates of remission were similar between the cohorts (Table). The ATR rate trended lower, although not significantly different (p=0.296), in the I- PC group (Table). Follow-up data showed that the patients had comparable neutrophil and platelet engraftment (Table) with comparable immune system reconstitution by 100 days post HSCT. No cases of TA-GVHD were observed in either cohort.Conclusions: A-UVA-treated PCs prepared without LF, gamma irradiation, and bacterial detection can replace C-PCs for support of HSCT patients resulting in comparable post transfusion CCI responses and short and intermediate term clinical outcomes, while offering additional protection against transfusion transmitted bacteria and emerging or untested pathogens. [Display omitted] DisclosuresSim Pui Yin:Cerus Corporation: Other: Investigator sponsored trial. Leung Yuk Yan:Cerus Corporation: Other: Investigator sponsored trial. Lam Chun Kit:Cerus Corporation: Other: Investigator sponsored trial. Tsoi Wai:Cerus Corporation: Other: Investigator sponsored trial. Lee Cheuk:Cerus Corporation: Other: Investigator sponsored trial. Lie Kwok Wai:Cerus Corporation: Other: Investigator sponsored trial. Huang:Cerus Corporation: Employment. Rico:Cerus Corporation: Employment. Lin:Cerus corp: Employment. Corash:Cerus Corporation: Employment. Stassinopoulos:Cerus Corporation: Employment.

Development and implementation of a comprehensive psychosocial screening program in a Brazilian cancer center.

International guidelines recommend routine screening for distress as part of care practices. Accordingly, a Brazilian cancer center developed and implemented a distress screening program (DS) in 2007, which was enhanced in 2009 through the inclusion of a psychosocial care meeting group (DS+PCM) regarding patients' psychosocial needs. The current paper will provide an overview of the development and pilot implementation of this program and initial analyses to assess patient outcomes and report initial results to extend international research on this key aspect of cancer care. Patients were assessed for distress, anxiety and depression, and in the DS+PCM phase for quality of life at the first day of chemotherapy infusion, at midpoint, and at treatment end. We compared data from program phases (DS vs DS+PCM), with a sequential cohort design and mixed effects modeling. Clinical and demographic characteristics were similar between groups. Patients receiving DS+PCM showed significantly lower distress and depression/anxiety upon chemotherapy initiation (Ps<.001). While both groups reported significantly lowered distress and total depression/anxiety scores across time (Ps<.003), patients receiving DS+PCM maintained the lowest distress and total anxiety/depression at all assessments. Patients from DS+PCM group also reported improvements in quality of life over time. The current study provides preliminary evidence that a multidisciplinary structured screening program utilizing validated measures and team meetings is associated with reduced impairment in patients' psychological well being. This program provided more opportunities for collaboration among providers with increased multidisciplinary meetings, enabled patients to more easily report problems, and ensured rapid access to relevant resources.

Implementing a central venous catheter self-management education program for patients with cancer.

To evaluate the effects of the central venous catheter self-management education program (CVC S-MEP) in improving knowledge, attitude, and behavior regarding CVC and in decreasing CVC-related complications in patients with cancer during homecare service. A quasi-experimental, sequential cohort design study of patients with cancer and who have CVCs was performed to compare the effect of CVC S-MEP with usual care. The study group consisted of 45 participants (26 male and 19 female), and the mean age was 46.1 (SD, 10.5) years. The subjects of the CVC S-MEP had significantly high mean levels of self-management knowledge (p=0.007), attitude (p<0.001), and behavior (p=0.002). Also, the participants in the CVC S-MEP had significantly lower frequency of catheter-related complications (p=0.030). The CVC S-MEP helped improve patients' ability to resolve problems and adequately respond to CVC-related emergency situations by fostering greater self-care ability. Additionally, providing practical information for CVC self-management in a gradual and repetitive manner had a notable positive effect on patients.

Authentic leadership and mindfulness development through action learning

Purpose– The purpose of this paper is to evaluate a three-year training program based on action learning principles with regard to its effectiveness in fostering authentic leadership (AL) and mindfulness among the participants.Design/methodology/approach– Data were obtained using a mixed-method design. Quantitative data were collected using a quasi-experimental sequential cohort design with comparison group, in which 143 participants responded to a self-evaluation questionnaire up to six times over a three-year period. Semi-structured interviews were also conducted with 24 managers.Findings– The results indicate that, as participants evolved through the leadership development program, self-reports of AL and mindfulness increased significantly and linearly as determined using repeated measures ANOVA, pairedt-tests, and content analysis of interviews.Practical implications– The results suggest that a leadership development program based on action learning principles can foster the development of AL and mindfulness. The core elements of action learning (i.e. working on real problems, gaining new insights in a supportive and confrontational environment of one’s peer) appear to be key to bringing about real changes in the behavior of participating managers and maximizing the chances of generating lasting effects.Originality/value– This is the first longitudinal study to demonstrate that the development of mindfulness and AL – which calls for internalization of attitudes and behaviors – can be fostered by a leadership development program. The question of whether AL can be developed through planned interventions is paramount for advancing theory and research on AL.

Advancing the science of child and adolescent development: Do we need a new household panel survey?

This paper examines the extent to which a new nationally representative household panel survey could bring children and adolescents to the forefront of its design. We begin by discussing how major demographic shifts, such as reduced social mobility and transformations in family structure, may affect children and adolescent development through individual, family, and sociocultural processes. We then review the existing household surveys in the United States and highlight the strengths and weaknesses for studying how major societal trends and changes affect child and adolescent development. We then debate several different design approaches for a new study and recommend either a longitudinal panel design, which includes all children in the panel survey, or a sequential cohort design, that includes a subsample of children and embedded birth cohort study. We highlight that a large, nationally representative dataset cannot replace standalone, more in-depth developmental studies of children and adolescents with high-fidelity measurement of processes. Instead, we argue that a new panel survey could take a more targeted approach and measure the major constructs of children's development as well as select family and sociocultural processes by drawing on recent advances in survey measurement techniques. We conclude by affirming that new household survey has the potential to contribute greatly to our understanding of the developmental origins of life long wellbeing as well as the effects of major demographic shifts in the 21st century on child and adolescent development.

Acceptability, Feasibility, and Efficacy of a Supportive Group Intervention for Caregivers of Newly Diagnosed Leukemia Patients

This study describes the development of a supportive group-based intervention for family caregivers of newly diagnosed leukemia patients. We assessed the feasibility, acceptability, and efficacy of the group on caregiver distress and quality of life, as well as patient distress utilizing a sequential cohort design comparing a pre-intervention control group with the intervention group. Patients and caregiver dyads completed measures at 4 time points: within 1 week of diagnosis (T1), 2-week follow-up (T2), 6-week follow-up (T3), and 12-week follow-up (T4). Significant interaction effects were observed for both caregiver distress and quality of life, whereby those receiving the intervention demonstrated improved quality of life and reduced distress over time. Overall, results support the acceptability, feasibility, and preliminary efficacy of the group intervention.

Correction: Sequential Cohort Design Applying Propensity Score Matching to Analyze the Comparative Effectiveness of Atorvastatin and Simvastatin in Preventing Cardiovascular Events

Correction: Sequential Cohort Design Applying Propensity Score Matching to Analyze the Comparative Effectiveness of Atorvastatin and Simvastatin in Preventing Cardiovascular Events

Variation in trajectories of women’s marital quality

I examine variation in trajectories of women’s marital quality across the life course. The analysis improves upon earlier research in three ways: (1) the analysis uses a sequential cohort design and data from the first 35years of marriage; (2) I analyze rich data from a national sample; (3) I examine multiple dimensions of marital quality. Latent class growth analyses estimated on data from women in the National Longitudinal Survey of Youth-1979 (N=2604) suggest multiple trajectories for each of three dimensions of marital quality, including two trajectories of marital happiness, two trajectories of marital communication, and three trajectories of marital conflict. Socioeconomic and demographic covariates are then used to illustrate how factors such as income, cohabitation, and race-ethnicity set individuals at risk of poor marital quality throughout the life course by differentiating between high and low trajectories of marital quality. Women on low marital quality trajectories are, as expected, at much greater risk of divorce. Taken together, these findings show how fundamental socioeconomic and demographic characteristics contribute to subsequent marital outcomes via their influence on trajectories of marital quality as well as providing a better picture of the complexity in contemporary patterns of marital quality.

Sequential Cohort Design Applying Propensity Score Matching to Analyze the Comparative Effectiveness of Atorvastatin and Simvastatin in Preventing Cardiovascular Events

BackgroundSequential cohort design (SCD) applying matching for propensity scores (PS) in accrual periods has been proposed to mitigate bias caused by channeling when calendar time is a proxy for strong confounders. We studied the channeling of patients according to atorvastatin and simvastatin initiation in Finland, starting from the market introduction of atorvastatin in 1998, and explored the SCD PS approach to analyzing the comparative effectiveness of atorvastatin versus simvastatin in the prevention of cardiovascular events (CVE).MethodsInitiators of atorvastatin or simvastatin use in the 45–75-year age range in 1998–2006 were characterized by their propensity of receiving atorvastatin over simvastatin, as estimated for 17 six-month periods. Atorvastatin (10 mg) and simvastatin (20 mg) initiators were matched 1∶1 on the PS, as estimated for the whole cohort and within each period. Cox regression models were fitted conventionally, and also for the PS matched cohort and the periodically PS matched cohort, to estimate the hazard ratios (HR) for CVEs.FindingsAtorvastatin (10 mg) was associated with a 11%–12% lower incidence of CVE in comparison with simvastatin (20 mg). The HR estimates were the same for a conventional Cox model (0.88, 95% confidence interval 0.85–0.91), for the analysis in which the PS was used to match across all periods and the Cox model was adjusted for strong confounders (0.89, 0.85–0.92), and for the analysis in which PS matching was applied within sequential periods (0.88, 0.84–0.92). The HR from a traditional PS matched analysis was 0.80 (0.77–0.83).ConclusionsThe SCD PS approach produced effect estimates similar to those obtained in matching for PS within the whole cohort and adjusting the outcome model for strong confounders, but at the cost of efficiency. A traditional PS matched analysis without further adjustment in the outcome model produced estimates further away from unity.