Locus of control as a predictor of students dropping out of high school

Education is related to health. In cross-sectional data, education level has been associated with physical functioning. Also, lower levels of education have been associated with health behaviors including smoking, alcohol use, and greater body weight. In school, students may benefit from greater exposed to health-related messages, while students who have dropped out may be more susceptible to influences regarding negative health behaviors such as smoking. ^ Improved school retention might improve long-term health outcomes. However, there is limited evidence regarding modifiable factors that predict likelihood of dropping out. Two likely psychosocial measures are locus of control and parent-child academic conversations. In the current study, data from two waves of a population-based longitudinal survey, the National Education Longitudinal Survey, were utilized to evaluate whether these two psychosocial measures could predict likelihood of dropping out, for students (n = 16,749) in tenth grade at 1990, with dropout status determined at 1992, while controlling for recognized sociodemographic predictors including parental income, parental education level, race/ethnicity, and sex. Locus of control was measured with the Pearlin Mastery Scale, and parent-child academic conversations were measured by three questions concerning course selection at school, school activities and events, and things the student studied in class. ^ In a logistic regression model, with the sociodemographic control measures entered in a first step before entry of the psychosocial measures in a second step, this study determined that lower levels of locus of control were associated with greater likelihood of dropping out after two years (odds ratio (OR) = 1.11, 95% confidence interval (CI) 108 to 1.15, p < .001), and two of the three parent-child academic discussion items were associated with greater likelihood of dropping out after two years (OR = 1.69, CI 1.48-1.93, p < .001; OR = 1.22, CI 1.05-1.41, p = .01; OR = 1.01, CI .88-1.15, p = .94). ^ It is possible that interventions aimed at improving locus of control, and aimed at building parent-child academic conversations, could lower the likelihood of students dropping out, and this in turn could yield improved heath behaviors and health status in the child's future. ^

Assessing the improved discriminatory power of a new biomarker in prognostic models

Although the area under the receiver operating characteristic (AUC) is the most popular measure of the performance of prediction models, it has limitations, especially when it is used to evaluate the added discrimination of a new biomarker in the model. Pencina et al. (2008) proposed two indices, the net reclassification improvement (NRI) and integrated discrimination improvement (IDI), to supplement the improvement in the AUC (IAUC). Their NRI and IDI are based on binary outcomes in case-control settings, which do not involve time-to-event outcome. However, many disease outcomes are time-dependent and the onset time can be censored. Measuring discrimination potential of a prognostic marker without considering time to event can lead to biased estimates. In this dissertation, we have extended the NRI and IDI to survival analysis settings and derived the corresponding sample estimators and asymptotic tests. Simulation studies were conducted to compare the performance of the time-dependent NRI and IDI with Pencina’s NRI and IDI. For illustration, we have applied the proposed method to a breast cancer study.^ Key words: Prognostic model, Discrimination, Time-dependent NRI and IDI ^

Patient-centered medical home technology effects on hypertension and diabetes control

Background: Hypertension and Diabetes is a public health and economic concern in the United States. The utilization of medical home concepts increases the receipt of preventive services, however, do they also increase adherence to treatments? This study examined the effect of patient-centered medical home technologies such as the electronic health record, clinical support system, and web-based care management in improving health outcomes related to hypertension and diabetes. Methods: A systematic review of the literature used a best evidence synthesis approach to address the general question " Do patient-centered medical home technologies have an effect of diabetes and hypertension treatment?" This was followed by an evaluation of specific examples of the technologies utilized such as computer-assisted recommendations and web-based care management provided by the patient's electronic health record. Ebsco host, Ovid host, and Google Scholar were the databases used to conduct the literature search. Results: The initial search identified over 25 studies based on content and quality that implemented technology interventions to improve communication between provider and patient. After further assessing the articles for risk of bias and study design, 13 randomized controlled studies were chosen. All of the studies chosen were conducted in various primary care settings in both private practices and hospitals between the years 2000 and 2007. The sample sizes of the studies ranged from 42 to 2924 participants. The mean age for all of the studies ranged from 56 to 71 years. The percent women in the studies ranged from one to 78 percent. Over one-third of the studies did not provide the racial composition of the participants. For the seven studies that did provide information about the ethnic composition, 64% of the intervention participants were White. All of the studies utilized some type of web-based or computer-based communication to manage hypertension or diabetes care. Findings on outcomes were mixed, with nine out of 13 studies showing no significant effect on outcomes examined, and four of the studies showing significant and positive impact on health outcomes related to hypertension or diabetes Conclusion: Although the technologies improved patient and provider satisfaction, the outcomes measures such as blood pressure control and glucose control were inconclusive. Further research is needed with diverse ethnic and SES population to investigate the role of patient-centered technologies on hypertension and diabetes control. Also, further research is needed to investigate the effects of innovative medical home technologies that can be used by both patients and providers to increase quality of communication concerning adherence to treatments.^