BACKGROUND: "Neighborhood" and socioeconomic position (SEP) measures are inconsistently... more BACKGROUND: "Neighborhood" and socioeconomic position (SEP) measures are inconsistently defined in the literature. This research describes an innovative statistical approach to develop composite SEP indicators at two area levels in Pittsburgh, Pennsylvania. METHODS: Twelve SEP measures were derived from U.S. Census 2000. Exploratory multilevel factor analysis (MFA) was used to develop composite SEP indicators at block group (BG) and neighborhood (NB) levels. Validity was assessed by correlating SEP indicators and low birth weight (LBW) percentage; maps depicted SEP indicators and LBW percentage at BG and NB levels. RESULTS: Different SEP indicators emerged at each level. Two BG-level indicators were (i) material and economic deprivation (MEDij), representing percentage not owning a car, renting their residence, in poverty, receiving public assistance, and earning low income, and (ii) concentrated disadvantage (CDij), representing percentage of Blacks, single-headed familie...
Nursing home patients with dementia may be more likely to suffer adverse drug events from subopti... more Nursing home patients with dementia may be more likely to suffer adverse drug events from suboptimal prescribing. Previous studies have not used national samples, nor have they examined multiple types of suboptimal prescribing by dementia severity. To examine the prevalence of and factors associated with potentially suboptimal prescribing in older veteran nursing home patients with dementia. This is a retrospective descriptive study of 1303 veterans 65 years or older admitted between January 1, 2004, and June 30, 2005, with dementia for long stays (90+ days) to 133 Veterans Affairs Community Living Centers. Dementia severity was determined by the Cognitive Performance Scale and functional status dependences. Overall, 70.2% with mild-moderate dementia (n = 1076) had underuse because they did not receive an acetylcholinesterase inhibitor (AChEI), and 27.2% had evidence of inappropriate use because of a drug-disease or drug-drug-disease interaction. Of the 227 with severe dementia, 36....
Journal of the Academy of Nutrition and Dietetics, 2012
Behavioral research to improve lifestyle in broadly defined populations of patients with type 2 d... more Behavioral research to improve lifestyle in broadly defined populations of patients with type 2 diabetes is limited. We evaluated a behavioral intervention featuring technology-based self-monitoring on biophysiologic outcomes of glycemic control and markers of cardiovascular risk. In this single-site, randomized clinical trial, participants were stratified by good and poor glycemic control (glycated hemoglobin <8% or ≥8%) and absence or presence of kidney disease, (estimated glomerular filtration rate ≥60 or <60 mL/min) and randomized within strata. Measurements were obtained at 0, 3, and 6 months. Self-referred, community-dwelling adults with type 2 diabetes mellitus. The intervention group received Social Cognitive Theory-based counseling paired with technology-based self-monitoring, and results were compared with an attention control group. Glycated hemoglobin, fasting serum glucose, lipid levels, blood pressure, weight, body mass index, and waist circumference were evaluat...
Hepatocyte growth factor (HGF), c-Met, and basic fibroblast growth factor (bFGF) are molecular ma... more Hepatocyte growth factor (HGF), c-Met, and basic fibroblast growth factor (bFGF) are molecular markers that contribute to angiogenesis and proliferation in numerous cancers. We assessed the prognostic significance of these factors in tumour and stroma of endometrial cancer (EC) patients (n=211). Immunohistochemistry (IHC) was used to detect tumour and stromal protein expression of the biomarkers. Associations between expression and clinicopathological factors were assessed using Chi-square tests. Kaplan-Meier curves, log-rank tests, and Cox regression were used to summarise associations between biomarker expression and overall survival (OS) and recurrence-free survival (RFS). Tumour bFGF was significantly associated with high-grade endometrioid and clear cell histology (P<0.001), advanced stage (P=0.008), positive lymph-node involvement (P=0.002), poor OS (log-rank test, P=0.009), and poor RFS (P<0.001). In multivariable analyses, cases with HGF-positive, stromal bFGF-positive...
The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists, 2009
To examine racial differences in medication use by older long-stay Veterans Affairs Nursing Home ... more To examine racial differences in medication use by older long-stay Veterans Affairs Nursing Home Care Unit (NHCU) patients. Longitudinal study. 133 Veterans Affairs NHCUs. Three thousand four hundred eighty veterans 65 years of age or older admitted between January 1, 2004, and June 30, 2005, for 90 days or more. Prevalence of those taking nine or more medications (i.e., polypharmacy) and medications from specific therapeutic medication classes. Racial differences were determined using 0.05 level chi-squared tests. The sample consisted of 14.3% who were black. Blacks compared with whites (all comparisons P < 0.05 except where noted) were younger (13.6% vs. 17.4%, older than 85 years of age), had less depression (22.24 vs. 29.79%), less allergies (9.82% vs. 20.36%), and a similar rate of moderate-to severe pain (22.65% vs. 24.05; P = 0.49). The percent of polypharmacy was similar by race (blacks 74.35% vs. whites 71.18%; P = 0.62), as was the prevalence of medication class use wit...
OBJECTIVE: To compare the performances of a disease-specific severity of illness index and a prot... more OBJECTIVE: To compare the performances of a disease-specific severity of illness index and a prototypical generic severity of illness measure, MedisGroups Admission Severity Groups (ASGs), for patients with community-acquired pneumonia. DESIGN: A retrospective database study. PATIENTS: Adult patients (aged ≥ 18 years) with an ICD-9-CM principal diagnosis of pneumonia in 78 MedisGroups Comparative Database hospitals. METHODS: The pneumonia severity of
CONCLUSIONS: There was an increase in the incidence of CDAD among all antibiotic users and fluoro... more CONCLUSIONS: There was an increase in the incidence of CDAD among all antibiotic users and fluoroquinolone users, but not among users of non-fluoroquinolone antibiotics, in the period following the formulary change from levofloxacin to gatifloxacin as the preferred fluoroquinolone. However, rates of CDAD among the 3 fluoroquinolone antibiotics in the post-change period were not significantly different, and levofloxacin was the
To describe changes in rosiglitazone prescribing following the US Food and Drug Administration (F... more To describe changes in rosiglitazone prescribing following the US Food and Drug Administration (FDA) warning of potentially increased risk of myocardial infarction and removal from the Department of Veterans Affairs National Formulary (VANF), assess patient-level factors associated with rosiglitazone discontinuation, and evaluate changes in glucose control. Historical cohort. Veterans with an active outpatient prescription for rosiglitazone on April 1, 2007, were followed until June 30, 2008. Incidence rate ratios (IRRs) of rosiglitazone discontinuation were compared over time using Poisson methods. We identified patient-level factors associated with stopping rosiglitazone using multivariable Poisson regression and compared glycated hemoglobin (A1C) values across time among patients who discontinued/continued rosiglitazone using linear mixed models. Of 95,539 veterans with an active outpatient rosiglitazone prescription, 86.7% discontinued rosiglitazone. Discontinuation rates increa...
Journal for healthcare quality : official publication of the National Association for Healthcare Quality
Where minorities receive their care may contribute to disparities in care, yet, the racial concen... more Where minorities receive their care may contribute to disparities in care, yet, the racial concentration of care in the Veterans Health Administration is largely unknown. We sought to better understand which Veterans Affairs (VA) hospitals treat Black veterans and whether location of care impacted disparities. We assessed differences in mortality rates between Black and White veterans across 150 VA hospitals for any of six conditions (acute myocardial infarction, hip fracture, stroke, congestive heart failure, gastrointestinal hemorrhage, and pneumonia) between 1996 and 2002. Just 9 out of 150 VA hospitals (6% of all VA hospitals) cared for nearly 30% of Black veterans, and 42 hospitals (28% of all VA hospitals) cared for more than 75% of Black veterans. While our findings show that overall mortality rates were comparable between minority-serving and non-minority-serving hospitals for four conditions, mortality rates were higher in minority-serving hospitals for acute myocardial inf...
Background: Although understanding the processes of care and medical outcomes for patients with c... more Background: Although understanding the processes of care and medical outcomes for patients with community- acquired pneumonia is instrumental to improving the quality and cost-effectiveness of care for this illness, lim- ited information is available on how physicians manage patients with this illness or on medical outcomes other than short-term mortality. Objectives: To describe the processes of care and to as-
BACKGROUND: "Neighborhood" and socioeconomic position (SEP) measures are inconsistently... more BACKGROUND: "Neighborhood" and socioeconomic position (SEP) measures are inconsistently defined in the literature. This research describes an innovative statistical approach to develop composite SEP indicators at two area levels in Pittsburgh, Pennsylvania. METHODS: Twelve SEP measures were derived from U.S. Census 2000. Exploratory multilevel factor analysis (MFA) was used to develop composite SEP indicators at block group (BG) and neighborhood (NB) levels. Validity was assessed by correlating SEP indicators and low birth weight (LBW) percentage; maps depicted SEP indicators and LBW percentage at BG and NB levels. RESULTS: Different SEP indicators emerged at each level. Two BG-level indicators were (i) material and economic deprivation (MEDij), representing percentage not owning a car, renting their residence, in poverty, receiving public assistance, and earning low income, and (ii) concentrated disadvantage (CDij), representing percentage of Blacks, single-headed familie...
Nursing home patients with dementia may be more likely to suffer adverse drug events from subopti... more Nursing home patients with dementia may be more likely to suffer adverse drug events from suboptimal prescribing. Previous studies have not used national samples, nor have they examined multiple types of suboptimal prescribing by dementia severity. To examine the prevalence of and factors associated with potentially suboptimal prescribing in older veteran nursing home patients with dementia. This is a retrospective descriptive study of 1303 veterans 65 years or older admitted between January 1, 2004, and June 30, 2005, with dementia for long stays (90+ days) to 133 Veterans Affairs Community Living Centers. Dementia severity was determined by the Cognitive Performance Scale and functional status dependences. Overall, 70.2% with mild-moderate dementia (n = 1076) had underuse because they did not receive an acetylcholinesterase inhibitor (AChEI), and 27.2% had evidence of inappropriate use because of a drug-disease or drug-drug-disease interaction. Of the 227 with severe dementia, 36....
Journal of the Academy of Nutrition and Dietetics, 2012
Behavioral research to improve lifestyle in broadly defined populations of patients with type 2 d... more Behavioral research to improve lifestyle in broadly defined populations of patients with type 2 diabetes is limited. We evaluated a behavioral intervention featuring technology-based self-monitoring on biophysiologic outcomes of glycemic control and markers of cardiovascular risk. In this single-site, randomized clinical trial, participants were stratified by good and poor glycemic control (glycated hemoglobin <8% or ≥8%) and absence or presence of kidney disease, (estimated glomerular filtration rate ≥60 or <60 mL/min) and randomized within strata. Measurements were obtained at 0, 3, and 6 months. Self-referred, community-dwelling adults with type 2 diabetes mellitus. The intervention group received Social Cognitive Theory-based counseling paired with technology-based self-monitoring, and results were compared with an attention control group. Glycated hemoglobin, fasting serum glucose, lipid levels, blood pressure, weight, body mass index, and waist circumference were evaluat...
Hepatocyte growth factor (HGF), c-Met, and basic fibroblast growth factor (bFGF) are molecular ma... more Hepatocyte growth factor (HGF), c-Met, and basic fibroblast growth factor (bFGF) are molecular markers that contribute to angiogenesis and proliferation in numerous cancers. We assessed the prognostic significance of these factors in tumour and stroma of endometrial cancer (EC) patients (n=211). Immunohistochemistry (IHC) was used to detect tumour and stromal protein expression of the biomarkers. Associations between expression and clinicopathological factors were assessed using Chi-square tests. Kaplan-Meier curves, log-rank tests, and Cox regression were used to summarise associations between biomarker expression and overall survival (OS) and recurrence-free survival (RFS). Tumour bFGF was significantly associated with high-grade endometrioid and clear cell histology (P<0.001), advanced stage (P=0.008), positive lymph-node involvement (P=0.002), poor OS (log-rank test, P=0.009), and poor RFS (P<0.001). In multivariable analyses, cases with HGF-positive, stromal bFGF-positive...
The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists, 2009
To examine racial differences in medication use by older long-stay Veterans Affairs Nursing Home ... more To examine racial differences in medication use by older long-stay Veterans Affairs Nursing Home Care Unit (NHCU) patients. Longitudinal study. 133 Veterans Affairs NHCUs. Three thousand four hundred eighty veterans 65 years of age or older admitted between January 1, 2004, and June 30, 2005, for 90 days or more. Prevalence of those taking nine or more medications (i.e., polypharmacy) and medications from specific therapeutic medication classes. Racial differences were determined using 0.05 level chi-squared tests. The sample consisted of 14.3% who were black. Blacks compared with whites (all comparisons P < 0.05 except where noted) were younger (13.6% vs. 17.4%, older than 85 years of age), had less depression (22.24 vs. 29.79%), less allergies (9.82% vs. 20.36%), and a similar rate of moderate-to severe pain (22.65% vs. 24.05; P = 0.49). The percent of polypharmacy was similar by race (blacks 74.35% vs. whites 71.18%; P = 0.62), as was the prevalence of medication class use wit...
OBJECTIVE: To compare the performances of a disease-specific severity of illness index and a prot... more OBJECTIVE: To compare the performances of a disease-specific severity of illness index and a prototypical generic severity of illness measure, MedisGroups Admission Severity Groups (ASGs), for patients with community-acquired pneumonia. DESIGN: A retrospective database study. PATIENTS: Adult patients (aged ≥ 18 years) with an ICD-9-CM principal diagnosis of pneumonia in 78 MedisGroups Comparative Database hospitals. METHODS: The pneumonia severity of
CONCLUSIONS: There was an increase in the incidence of CDAD among all antibiotic users and fluoro... more CONCLUSIONS: There was an increase in the incidence of CDAD among all antibiotic users and fluoroquinolone users, but not among users of non-fluoroquinolone antibiotics, in the period following the formulary change from levofloxacin to gatifloxacin as the preferred fluoroquinolone. However, rates of CDAD among the 3 fluoroquinolone antibiotics in the post-change period were not significantly different, and levofloxacin was the
To describe changes in rosiglitazone prescribing following the US Food and Drug Administration (F... more To describe changes in rosiglitazone prescribing following the US Food and Drug Administration (FDA) warning of potentially increased risk of myocardial infarction and removal from the Department of Veterans Affairs National Formulary (VANF), assess patient-level factors associated with rosiglitazone discontinuation, and evaluate changes in glucose control. Historical cohort. Veterans with an active outpatient prescription for rosiglitazone on April 1, 2007, were followed until June 30, 2008. Incidence rate ratios (IRRs) of rosiglitazone discontinuation were compared over time using Poisson methods. We identified patient-level factors associated with stopping rosiglitazone using multivariable Poisson regression and compared glycated hemoglobin (A1C) values across time among patients who discontinued/continued rosiglitazone using linear mixed models. Of 95,539 veterans with an active outpatient rosiglitazone prescription, 86.7% discontinued rosiglitazone. Discontinuation rates increa...
Journal for healthcare quality : official publication of the National Association for Healthcare Quality
Where minorities receive their care may contribute to disparities in care, yet, the racial concen... more Where minorities receive their care may contribute to disparities in care, yet, the racial concentration of care in the Veterans Health Administration is largely unknown. We sought to better understand which Veterans Affairs (VA) hospitals treat Black veterans and whether location of care impacted disparities. We assessed differences in mortality rates between Black and White veterans across 150 VA hospitals for any of six conditions (acute myocardial infarction, hip fracture, stroke, congestive heart failure, gastrointestinal hemorrhage, and pneumonia) between 1996 and 2002. Just 9 out of 150 VA hospitals (6% of all VA hospitals) cared for nearly 30% of Black veterans, and 42 hospitals (28% of all VA hospitals) cared for more than 75% of Black veterans. While our findings show that overall mortality rates were comparable between minority-serving and non-minority-serving hospitals for four conditions, mortality rates were higher in minority-serving hospitals for acute myocardial inf...
Background: Although understanding the processes of care and medical outcomes for patients with c... more Background: Although understanding the processes of care and medical outcomes for patients with community- acquired pneumonia is instrumental to improving the quality and cost-effectiveness of care for this illness, lim- ited information is available on how physicians manage patients with this illness or on medical outcomes other than short-term mortality. Objectives: To describe the processes of care and to as-
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Papers by Roslyn Stone