Cognitive impairment indicator for the neuropsychological test batteries in the Canadian Longitudinal Study on Aging: definition and evidence for validity.

Background: Prevalence of overall cognitive impairment based on each participant's performance across a neuropsychological battery is challenging; consequently, we define and validate a dichotomous cognitive impairment/no cognitive indicator (CII) using a neuropsychological battery administered in a population-based study. This CII approximates the clinical practice of interpretation across a neuropsychological battery and can be applied to any neuropsychological dataset.

Methods: Using data from participants aged 45-85 in the Canadian Longitudinal Study on Aging receiving a telephone-administered neuropsychological battery (Tracking, N = 21,241) or a longer in-person battery (Comprehensive, N = 30,097), impairment was determined for each neuropsychological test based on comparison with normative data.

Methodological considerations when establishing reliable and valid normative data: Canadian Longitudinal Study on Aging (CLSA) neuropsychological battery.

Creation of normative data with regression corrections for demographic covariates reduces risk of small cell sizes compared with traditional normative approaches. We explored whether methods of correcting for demographic covariates (e.g.

Normative comparison standards for measures of cognition in the Canadian Longitudinal Study on Aging (CLSA): Does applying sample weights make a difference?

Large-scale studies present the opportunity to create normative comparison standards relevant to populations. Sampling weights applied to the sample data facilitate extrapolation to the population of origin, but normative scores are often developed without the use of these sampling weights because the values derived from large samples are presumed to be precise estimates of the population parameter. The present article examines whether applying sample weights in the context of deriving normative comparison standards for measures of cognition would affect the distributions of regression-based normative data when using data from a large population-based study.

The Canadian longitudinal study on aging as a platform for exploring cognition in an aging population.

We present descriptive information on the cognitive measures used in the Canadian Longitudinal Study on Aging (CLSA) Comprehensive Cohort, relate this to information on these measures in the extant literature, and identify key considerations for their use in research and clinical practice. The CLSA Comprehensive Cohort is composed of 30,097 participants aged 45-85years at baseline who provided a broad range of sociodemographic, physical, social, and psychological health information via questionnaire and took part in detailed physical and cognitive assessments. Cognitive measures included: the Rey Auditory Verbal Learning Test - immediate and 5-min delayed recall, Animal Fluency, Mental Alternation Test (MAT), Controlled Oral Word Association Test (COWAT), Stroop Test - Victoria Version, Miami Prospective Memory Test (MPMT), and a Choice Reaction Time (CRT) task.

Miami Prospective Memory Test in the Canadian Longitudinal Study on Aging.

Objective: The aim of this study was to verify the effect of age, education and sex on Miami Prospective Memory Test (MPMT) performance obtained at baseline of the Canadian Longitudinal Study on Aging (CLSA) by neurologically healthy French- and English-speaking subsamples of participants (N = 18,511).

Method: The CLSA is a nation-wide large epidemiological study with participants aged 45-85 years old at baseline. The MPMT is an event- and time-based measure of prospective memory, with scores of intention, accuracy and need for reminders, administered as part of the Comprehensive data collection.

Accuracy of Caregiver Proxy Reports of Home Care Service Use.

Although much of the research on service use by older adults with dementia relies on proxy reports by informal caregivers, little research assesses the accuracy of these reports, and that which does exist, does not focus on home care services. This brief report compares proxy reports by family caregivers to those with dementia with provincial Ministry of Health records collected for payment and monitoring. The four home care services examined include home nursing care, adult day care, home support, and respite care.

Cognitive functioning, cognitive reserve, and residential care placement in patients with Alzheimer's and related dementias.

Objective: To test the hypothesis that patients with mild to moderate dementia with higher initial cognitive reserve (higher education levels exhibit faster cognitive decline at later stages of disease progression as they approach residential care (RC) placement.

Method: Two provincial administrative databases were used. One contained individuals' scores of cognitive functioning (assessed at 6- to 12-month intervals using the Standardized Mini-Mental State Examination, SMMSE, 2007-2014) and education level; the second (BC Ministry of Health Home and Community Care database, 2001-2014) contained individuals' RC placement; N = 10531.

Incentive-Based Primary Care: Cost and Utilization Analysis.

Context: In its fee-for-service funding model for primary care, British Columbia, Canada, introduced incentive payments to general practitioners as pay for performance for providing enhanced, guidelines-based care to patients with chronic conditions. Evaluation of the program was conducted at the health care system level.

Objective: To examine the impact of the incentive payments on annual health care costs and hospital utilization patterns in British Columbia.

Family physicians enhance end-of-life care: evaluation of a new continuing medical education learning module in British Columbia.

Background: The Practice Support Program (PSP) is an innovative peer-to-peer continuing medical education (CME) program that offers full-service family physicians/general practitioners (GPs) in British Columbia (BC), Canada, post-graduate training on a variety of topics. We present the evaluation findings from the PSP learning module on enhancing end-of-life (EOL) care within primary care.

Methods: Pen-and-paper surveys were administered to participants three times: at the beginning of the first training session (n = 608; 69.

Financial implications of the continuity of primary care.

Background: The objective of this study was to assess the financial implications of the continuity of care, for patients with high care needs, by examining the cost of government-funded health care services in British Columbia, Canada.

Methods: Using British Columbia Ministry of Health administrative databases for fiscal year 2010-2011 and generalized linear models, we estimated cost ratios for 10 cost-related predictor variables, including patients' attachment to the practice. Patients were selected and divided into groups on the basis of their Resource Utilization Band (RUB) and placement in provincial registries for 8 chronic conditions (1,619,941 patients).

Mental health practice and attitudes of family physicians can be changed!

Objectives: An adult mental health module was developed in British Columbia to increase the use of evidence-based screening and cognitive behavioral self-management tools as well as medications that fit within busy family physician time constraints and payment systems. Aims were to enhance family physician skills, comfort, and confidence in diagnosing and treating mental health patients using the lens of depression; to improve patient experience and partnership; to increase use of action or care plans; and to increase mental health literacy and comfort of medical office assistants.

Methods: The British Columbia Practice Support Program delivered the module using the Plan-Do-Study-Act cycle for learning improvement.

Program evaluation of a child and youth mental health training program for family physicians in british columbia.

Introduction: This brief report presents findings from the program evaluation of a portion of an educational program developed to support family physicians in improving their mental health care competencies in children and youth in British Columbia.

Method: The Child and Youth Mental Health (CYMH) learning module is part of a broader initiative from the Practice Support Program (PSP) of the British Columbia Medical Association and was created specifically to assist family physicians in improving their competencies in the identification, diagnosis and delivery of best evidence-based treatments for children and youth exhibiting the most common mental disorders that can be effectively treated in most primary care practices.

Results: The initial results from the program evaluation demonstrate a substantial improvement in family physicians' knowledge of child and youth mental disorders and their self-rated clinical confidence in identifying and treating (both pharmacologically and psychotherapeutically) the most common child and youth mental disorders.

Change and predictors of change in social skills of nursing home residents with dementia.

Background: Social skills are of primary importance for those with dementia and their care providers, yet we know little about the extent to which basic social skills can be maintained over time and the predictors of change.

Methods: A total of 18 nursing homes with 149 newly admitted residents with moderate to severe dementia, 195 direct care staff, and 135 family members, in British Columbia, Canada, contributed data on change in social skills from admission to 6 months and 1 year later.

Results: Three-quarters of residents maintained or improved their basic social skills during both the time periods.

Improving primary care in British Columbia, Canada: evaluation of a peer-to-peer continuing education program for family physicians.

Background: An innovative program, the Practice Support Program (PSP), for full-service family physicians and their medical office assistants in primary care practices was recently introduced in British Columbia, Canada. The PSP was jointly approved by both government and physician groups, and is a dynamic, interactive, educational and supportive program that offers peer-to-peer training to physicians and their office staff. Topic areas range from clinical tools/skills to office management relevant to General Practitioner (GP) practices and "doable in real GP time".

Does acquisition of Greeble expertise in prosopagnosia rule out a domain-general deficit?

According to the expertise account of face specialization, a deficit that affects general expertise mechanisms should similarly impair the expert individuation of both faces and other visually homogeneous object classes. To test this possibility, we attempted to train a prosopagnosic patient, LR, to become a Greeble expert using the standard Greeble expertise-training paradigm (Gauthier & Tarr, 2002). Previous research demonstrated that LR's prosopagnosia was related to an inability to simultaneously use multiple features in a speeded face recognition task (Bukach, Bub, Gauthier, & Tarr, 2006).

Improving mental healthcare by primary care physicians in British Columbia.

This article describes a new and innovative training program to assist family physicians to better care for their patients with mental health conditions. Trained family physician leaders train other family physicians. The training package includes a wide range of tools that can be used by physicians in their own offices.

Demographic corrections appear to compromise classification accuracy for severely skewed cognitive tests.

Demographic corrections for cognitive tests should improve classification accuracy by reducing age or education biases, but empirical support has been equivocal. Using a simulation procedure, we show that creating moderate or extreme skewness in cognitive tests compromises the classification accuracy of demographic corrections, findings that appear replicated within clinical data for the few neuropsychological test scores with an extreme degree of skew. For most neuropsychological tests, the dementia classification accuracy of raw and demographically corrected scores was equivalent.

Increasing value for money in the Canadian healthcare system: new findings on the contribution of primary care services.

This article presents a major new finding in regard to the value for money of primary care services. It was found that the more higher-care-needs patients were attached to a primary care practice, the lower the costs were for the overall healthcare system (for the total of medical services, hospital services and drugs). The majority of the cost reductions stemmed from decreases in the costs of hospital services.

Evaluation of healthcare services: asking the right questions to develop new policy and program-relevant knowledge for decision-making.

This article presents a framework for thinking about the key questions that need to be answered to develop new policy and program-relevant knowledge that can be used to make more informed decisions. It is a primer for administrators, policy makers and others about how to identify the knowledge they need to make decisions regarding new or existing programs. The article covers three related dimensions in evaluation: types of evaluations, key domains of inquiry and generic research questions.

Was that part of the story or did i just think so? Age and cognitive status differences in inference and story recognition.

This study expanded the inference and story recognition literature by investigating differences within the older age range, differences as a result of cognitive impairment, no dementia (CIND), and applying signal detection procedures to the analysis of accuracy data. Old-old adults and those with more severe CIND showed poorer ability to accurately recognize inferences, and less sensitivity in discriminating between statement types. Results support the proposal that participants used two different recognition strategies.

Sexual revictimization: the role of sexual self-esteem and dysfunctional sexual behaviors.

Disproportionately high rates of sexual revictimization have been noted among former victims of child sexual abuse (CSA), yet researchers have yet to determine the source of this apparent vulnerability to reexperience sexual violence. This study explores this issue by examining sexual self-esteem, sexual concerns, and sexual behaviors among 402 university women. Compared to women without a history of CSA (n = 348), women with a history of CSA (n = 54) had lower sexual self-esteem, poorer sexual adjustment, and were 2 times more likely to have experienced sexual assault since the age of 14 years.

The comparative sensitivity of ordinal multiple regression and least squares regression to departures from interval scaling.

The comparative sensitivity of ordinal multiple regression (OMR) and least squares regression (LSR) to criterion variable deviations from interval scaling was investigated by way of computer simulation. LSR on raw scores and ranks was compared to OMR on raw scores, ranks and dominances. Simulated data sets varied on predictor variable correlations, amount of prediction error, weight distinctiveness and shape of rating-scale distribution.