Sources Of Outcome Data Research Articles

Loneliness and depression: bidirectional mendelian randomization analyses using data from three large genome-wide association studies.

Major depression (MD) is a serious psychiatric illness afflicting nearly 5% of the world's population. A large correlational literature suggests that loneliness is a prospective risk factor for MD; correlational assocationsof this nature may be confounded for a variety of reasons. This report uses Mendelian Randomization (MR) to examine potentially causal associations between loneliness and MD. We report on analyses using summary statistics from three large genome wide association studies (GWAS). MR analyses were conducted using three independent sources of GWAS summary statistics. In the first set of analyses, we used available summary statistics from an extant GWAS of loneliness to predict MD risk. We used two sources of outcome data: the Psychiatric Genomics Consortium (PGC) meta-analysis of MD (PGC-MD; N = 142,646) and the Million Veteran Program (MVP-MD; N = 250,215). Finally, we reversed analyses using data from the MVP and PGC samples to identify risk variants for MD and used loneliness outcome data from UK Biobank. We find robust evidence for a bidirectional causal relationship between loneliness and MD, including between loneliness, depression cases status, and a continuous measure of depressive symptoms. The estimates remained significant across several sensitivity analyses, including models that account for horizontal pleiotropy. This paper provides the first genetically-informed evidence that reducing loneliness may play a causal role in decreasing risk for depressive illness, and these findings support efforts to reduce loneliness in order to prevent or ameliorate MD. Discussion focuses on the public health significance of these findings, especially in light of the SARS-CoV-2 pandemic.

Methodological Challenges in Group-based Randomised Controlled Trials for Intimate Partner Violence Perpetrators: A Meta-summary.

Evidence for treatment effects of group-based Intimate Partner Violence (IPV) perpetrators programmes remains, at best, inconclusive. In the present review, systematic/meta-analytic reviews were used to identify randomised controlled trials and a meta-summary approach was employed to identify methodological challenges in the design and conduct of these trials. Of the fifteen studies identified, seven were comparative effectiveness trials. A range of methodological challenges were also identified by the trialists; source of outcome data, treatment modality, attrition and sample characteristics were the most frequently mentioned. Although there are only a few randomised controlled trials compared to non randomised studies, the findings of both highlight the need to invest in the development of innovative and/or combined IPV treatment programmes to address co-occurring issues such as substance use and trauma. The summary of methodological challenges will provide the first step in the development of methods guidance for researchers working in this area.

Shift in representation and symbolisation of affective experience: A paradoxical outcome in therapy

Shift in representation and symbolisation of affective experience: A paradoxical outcome in therapy: Defining outcome represents a key challenge for psychotherapy theory, research and practice. The present paper uses a case study of a client with anorexia nervosa to contribute to the development of conceptual understanding of the nature of paradoxical outcome. In this case, different sources of outcome data offered different answers to the question of whether or not the therapy had been successful. Qualitative thematic analysis of therapy transcriptions was carried out, using Interpretative Phenomenological Analysis (IPA). Both the process of change that occurred in this case, and the conflicting outcome indicators, could be explained in terms of a model of affect elaboration. These findings are discussed in terms of the need for caution when interpreting results from outcome measures in psychotherapy research and practice.

PROTOCOL: Online interventions for reducing hate speech and cyberhate: A systematic review.

PROTOCOL: Online interventions for reducing hate speech and cyberhate: A systematic review.

Use of routinely collected data in a UK cohort of publicly funded randomised clinical trials

Routinely collected data about health in medical records, registriesand hospital activity statistics is now routinely collected in an electronicform.The extent to which suchsources of data are now being routinely accessed to deliver efficientclinical trials, is unclear. The aim of this study was to ascertain current practice amongst a United Kingdom (UK) cohort of recently funded and ongoing randomised controlled trials (RCTs) in relation to sources and use of routinely collected outcome data. Recently funded and ongoing RCTs were identified for inclusion by searching the National Institute for Health Research journals library. Trials that have a protocol available were assessed for inclusion and those that use or plan to use routinely collected health data for at least one outcome were included. Routinely collected data sources and outcome information were extracted. A total of 279 studies were identified with 102 eligible for data extraction. An Electronic Health Record (EHR) was the sole source of outcome data for at least one outcome in 46 trials. The most frequent sources are Hospital Episode Statistics (HES) and Office for National Statistics (ONS), with the most common outcome data to be extracted being on mortality, hospital admission, and health service resource use. Our study has found that around half of publicly funded trials in a UK cohort plan to collect outcome data from routinely collected data sources. This is much higher than the figure of 8% found in a cohort of 189 RCTs published since 2000, the majority of were carried out in North America (McCord et al., 2019).

PROTOCOL: Strategies for scaling up the implementation of interventions in social welfare: protocol for a systematic review.

PROTOCOL: Strategies for scaling up the implementation of interventions in social welfare: protocol for a systematic review.

Primary liver cancer deaths and related years of life lost attributable to hepatitis B and C viruses in India

Background and aimsMore than 25,000 people die of liver cancer annually in India. There is little information about the contribution of hepatitis B virus (HBV) and hepatitis C virus (HCV) to these deaths. We conducted a systematic review of published studies on HBV or HCV infection and liver cancer in India and estimated the population attributable fraction (PAF) of liver cancer deaths caused by these infections and the corresponding annual number of deaths and years of life lost (YLL) in the country. MethodsWe searched the PubMed and Scopus databases, as well as the reference list of relevant articles in the systematic review. For calculation of the number of liver cancer deaths attributable to HBV and HCV, we used two sources of outcome data and two relative risks for the association between HCV and liver cancer. ResultsThe PAF was 67% for HBV, 17–19% for HCV, and 71–72% for HBV and/or HCV. The annual attributable number of liver cancer deaths was approximately 17,000 for HBV; 4500 for HCV; and 18,500 for HBV and/or HCV, corresponding to approximately 297,000, 75,000, and 315,000 YLL, respectively. There was little difference in these numbers using the two sources of outcome data or the two risk estimates for HCV. ConclusionsOur findings underscore the importance of primary prevention of HBV and HCV by appropriate measures, including vaccination (HBV only), prevention of transfusion-related infections, and increased awareness of the routes of transmission and long-term health outcomes.

Abstract NS13: Road to Recovery after Stroke: Understanding Predictors of Discharge Destination, Functional Independence, and Quality of Life after Hospital Discharge

Introduction: Stroke is the leading cause of long-term disability and affects 795,000 people in the U.S. each year. This study was conducted to enhance knowledge of outcomes during recovery and the options for participating in rehabilitation and preventive care during patients’ transitions to the community. Comprehensive Stroke Certification charges hospitals with the task of expanding knowledge of functional and quality of life outcomes for all stroke patients through the continuum examining effects of stroke severity, functional impairment, and patient characteristics on discharge destinations, functional independence, and quality of life after discharge. Methods: Retrospective analysis of an acute stroke quality improvement database which includes measures collected by MedTel Outcomes LLC on all stroke patients one month after discharge. Included, is the Functional Independence Measure and standardized quality of life and participation measures. In the database are standardized measures from the medical record such stroke type, Modified Rankin score, and acute functional independence measure score for 719 patients with a 30-day follow-up phone assessment for functional and quality of life measures from January 1, 2011 to December 31, 2012. Preliminary Findings: Over 75% of patients had hemiparesis, & over 90% survived 30-days post discharge and were living in the community. At follow-up, mostwere independent in self-care, and half were independent in mobility excluding stairs. Those with right brain involvement had a complicated, slower recovery. Those with left brain involvement,had lower functional scores and a higher percentage of them were not living in the community, rather, living in institutions. Conclusions: All patients experiencing a stroke should have evidence-based information on their options & what to expect during their recovery during their transitions into the community. The data base is useful as a source of outcome data for comparative effectiveness and to build a regional collaborative outcomes database for Comparative Effectiveness Research and quality benchmarking. Findings can be used to understand the functional trajectory of recovery based on severity of stroke and other factors.

‘Where There’s Smoke …’

See related article, pages 588–593. Premature ventricular complexes (PVCs) are easily recognized abnormalities on a 12-lead electrocardiogram or rhythm strip. During medical school and residency, it was a surprise and disappointment to learn that such an obvious abnormality was dismissed as a benign rhythm disturbance and was not indicative of serious disease. In this issue of Stroke, Agarwal and colleagues1 report that PVCs seen on a single baseline 2-minute rhythm strip were associated with an increased risk of incident stroke. These findings are reported in a large cohort (>14 000) of middle-aged (45 to 64 years) American men and women followed for 15 to 17 years in the Atherosclerosis Risk in Communities (ARIC) study. In the 6.1% with PVCs, the adjusted hazard ratio for stroke was 1.4 (95% CI, 1.08 to 1.80) and the adjusted hazard ratio for a combined end point of stroke and death was 1.62 (95% CI, 1.44 to 1.83). Increased stroke risk was observed irrespective of gender and race. There was a marked increase in stroke risk in those participants with ≥4 PVCs in a 2-minute recording. PVCs are suggested to be a “culprit arrhythmia”2 in the development of cardiomyopathy and are reported to predict a heightened risk of new-onset atrial fibrillation (AF)3 and cardiovascular death.4,5 An association of PVCs with stroke risk has been reported in an earlier smaller study cited by the ARIC investigators. In the large ARIC study, PVCs were associated with new-onset AF and death. Agarwal and colleagues1 identified apparent effect modification on stroke risk between established stroke risk factors and the …

Behavioral Outcomes of Parent-Child Interaction Therapy and Triple P—Positive Parenting Program: A Review and Meta-Analysis

We conducted a review and meta-analyses of 24 studies to evaluate and compare the outcomes of two widely disseminated parenting interventions-Parent-Child Interaction Therapy and Triple P-Positive Parenting Program. Participants in all studies were caregivers and 3- to 12-year-old children. In general, our analyses revealed positive effects of both interventions, but effects varied depending on intervention length, components, and source of outcome data. Both interventions reduced parent-reported child behavior and parenting problems. The effect sizes for PCIT were large when outcomes of child and parent behaviors were assessed with parent-report, with the exclusion of Abbreviated PCIT, which had moderate effect sizes. All forms of Triple P had moderate to large effects when outcomes were parent-reported child behaviors and parenting, with the exception of Media Triple P, which had small effects. PCIT and an enhanced version of Triple P were associated with improvements in observed child behaviors. These findings provide information about the relative efficacy of two programs that have received substantial funding in the USA and Australia, and findings should assist in making decisions about allocations of funding and dissemination of these parenting interventions in the future.

NIS vs SAGES

Surgical outcomes are increasingly examined in an effort to improve quality and reduce medical error. The Nationwide Inpatient Sample (NIS) is a retrospective, claims-derived and population-based database and the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Outcomes Project is a prospective, voluntary and specialty surgeon database. We hypothesized that these two sources of outcome data would differ in regard to a single, commonly performed procedure. Both the NIS, a national sample of all nonfederal hospital discharges, and the gastroesophageal reflux disease log of the SAGES Outcomes Project were queried for all fundoplications performed between 1999 and 2001 using either ICD-9 procedure code 44.66 or CPT codes 43280 or 43324. Patients with an emergency admission, age <17 years, and/or diagnoses for either esophageal cancer or achalasia were excluded. Both demographic and outcome variables were compared by either t-test or chi-square analysis, with a p value of <0.05 as significant. Both data sets were comparable for age and gender; however, the SAGES group had a higher rate of teaching hospital affiliation (71 vs 48%, p < 0.001). SAGES fundoplications had a consistently higher rate of comorbidities, including Barrett's esophagus (2.3 vs 1.1%, p = 0.005). The NIS fundoplications had a clear trend toward more associated procedures, including cholecystectomy (7.2 vs 2%, p < 0.001). Complication rates for the NIS data set were higher, including pulmonary complications (1.7 vs 0.5%, p = 0.03). No statistically significant differences existed between the two data sets for either length of stay or mortality. The two databases indicate that fundoplication is an operation with low morbidity and mortality. The SAGES Outcomes Project demonstrated that participating surgeons had a higher affiliation with teaching hospitals, higher reporting of comorbidity, and lower associated procedures than the NIS. Despite having more comorbidity and technical difficulty, patients from the SAGES Outcomes Project had equivalent or lower complication rates.

The impact of state enterprise zones on urban manufacturing establishments

AbstractSince the early 1980s, the vast majority of states have implemented enterprise zones. This paper analyzes urban zones in six states, examining the factors that states use to choose zone locations and the subsequent effect of the zones on business activity and employment. The source of outcome data is the U.S. Bureau of Census' longitudinal research database (LRD), which tracks manufacturing establishments over time. Matched sample and geographic comparison groups are created to measure the impact of zone policy on employment, establishment, shipment, payroll, and capital spending outcomes. Consistent with previous findings, the difference‐in‐difference estimates indicate that zones have little effect, on average. However, by exploiting the establishment‐level data to examine gross as well as net changes, the analysis finds that zones have a positive effect on the outcomes of new establishments and a negative effect on the outcomes of previously existing establishments. © 2004 by the Association for Public Policy Analysis and Management.

Outcome variables and their assessment in alcohol treatment studies: 1968-1998.

This article provides a historical overview of the assessment of outcome variables in alcohol treatment studies that were first published between 1968 and 1998. The review focuses on changes over time in (1) the number of outcome variables and the number of different types of outcome variables assessed, (2) the likelihood of assessing specific types of outcome variables, (3) the methods used to assess outcome variables, and (4) the status of outcome assessment in more recent studies first published between 1990 and 1998. Reports of 357 alcohol treatment trials with two or more treatment/control groups were coded with respect to the number and types of outcome variables assessed, sources of outcome data, and methodological aspects of outcome assessment. Although the number of outcome variables assessed in studies, on average, did not increase significantly over time, the number of different types of outcome variables did increase. An expected decrease in the assessment of categorical abstinence was not found, but another categorical variable, global ratings of drinking improvement, did decrease over time. More recent studies were more likely to assess such continuous variables as time abstinent, alcohol consumption, time drinking, dependence symptoms, and drinking-related problems. Physiological markers of drinking/alcohol misuse also were assessed more frequently in later years. Some aspects of outcome assessment methods exhibited improvement over time; validity data were more likely to be provided or cited, and self-reports of drinking behaviors were more likely to be corroborated in studies first published in more recent years. However, the percentages of studies that provided/cited reliability data for outcome measures, indicated that follow-up data collectors were not affiliated with treatment and were unaware of respondents' treatment conditions, and reported that respondents were alcohol-free at follow-up did not rise significantly over time. Although the methods of outcome assessment improved between 1968 and 1998, much room for improvement remains.

Outcomes research in surgical oncology.

There have been significant developments and advances in the area of outcomes research in the past 25 years. Unfortunately, many surgical oncologists may not have a clear concept of outcomes research and the methodology involved. A literature-based review article was done that included an overview of outcomes research, and study design and types, outcome measures, outcome instruments, and sources of outcome data were examined. In addition, we reviewed small area variation/volume outcome analysis as well as quality-of-life studies and their applications in surgical oncology clinical investigation. Specific examples from surgical oncology were identified. As the costs of health care have increased, so has the emphasis on measuring outcomes of medical and surgical care to determine the quality and appropriateness of care. Marked variations in a variety of outcomes after oncological procedures have been attributed to individual surgeon and institution characteristics. Because much of the clinical surgical oncology literature deals only with the traditional mortality and morbidity outcomes, a more comprehensive examination of patient outcomes is required to fully evaluate the impact of patient management decisions. Health-related quality of life can be measured and analyzed in several ways and decisions regarding the use of such methodology are dependent on multiple factors. Surgical oncologists should recognize that the true value of their interventions requires systematic and comprehensive examination of patient outcomes.

The Impact of Encounter Groups on Participants: Some Preliminary Findings

Eighteen encounter groups were studied, representing lo approaches to personal change: T Groups, Rogerian, personal growth, sensory awareness, Gestalt, transactional analysis, psychodrama, Synanon, marathons, psychoanalytic, and Berzon's PEER Tapes. The study aims were (a) to assess the impact of such experiences for participants and (b) to isolate the group conditions associated with change. College undergraduates who expressed interest in having an encounter group experience were randomly assigned to the groups. A control group of 69 persons supplied data for contrast with those collected from the 209 experimental participants. Outcome assessment procedures were developed to assess (i) peak experiences, (2) self-esteem and self-ideal discrepancies, (3) values, (4) life decision making, (5) interpersonal orientation, (6) interpersonal constructs, (7) coping styles, and (8) interpersonal ftyles. Individuals were tested prior to group assignment, at the end of the three-month experience (30 hours of group), and again six/eight months later. Other sources of outcome data included (a) leader ratings, (b) peer group ratings of in-group behavior, and (c) external 'social network" judgments of change. All group sessions were attended by systematically rotated observers, who made codings of Content, working pattern, emotional climate, themes, normative behavior, rewarding and sanctioning behavior, and leader behavior and style. Other measures of group conditions were derived from participants, including questionnaircs on norms, cohesion, member roles, and Ss' phenomenal view of critical group events and major learning experiences. Preliminary findings are reviewed, including evidence on both positive and negative outcomes, and the relationship of leader behavior to each.