Susan C. Scott

Bio: Susan C. Scott is an academic researcher from McGill University. The author has contributed to research in topics: Population & Cohort study. The author has an hindex of 24, co-authored 43 publications receiving 3228 citations. Previous affiliations of Susan C. Scott include New York University & Beth Israel Deaconess Medical Center.

Adverse Events Associated With Prescription Drug Cost-Sharing Among Poor and Elderly Persons

Abstract: ContextRising costs of medications and inequities in access have sparked calls for drug policy reform in the United States and Canada. Control of drug expenditures by prescription cost-sharing for elderly persons and poor persons is a contentious issue because little is known about the health impact in these subgroups.ObjectivesTo determine (1) the impact of introducing prescription drug cost-sharing on use of essential and less essential drugs among elderly persons and welfare recipients and (2) rates of emergency department (ED) visits and serious adverse events associated with reductions in drug use before and after policy implementation.Design and SettingInterrupted time-series analysis of data from 32 months before and 17 months after introduction of a prescription coinsurance and deductible cost-sharing policy in Quebec in 1996. Separate 10-month prepolicy control and postpolicy cohort studies were conducted to estimate the impact of the drug reform on adverse events.ParticipantsA random sample of 93 950 elderly persons and 55 333 adult welfare medication recipients.Main Outcome MeasuresMean daily number of essential and less essential drugs used per month, ED visits, and serious adverse events (hospitalization, nursing home admission, and mortality) before and after policy introduction.ResultsAfter cost-sharing was introduced, use of essential drugs decreased by 9.12% (95% confidence interval [CI], 8.7%-9.6%) in elderly persons and by 14.42% (95% CI, 13.3%-15.6%) in welfare recipients; use of less essential drugs decreased by 15.14% (95% CI, 14.4%-15.9%) and 22.39% (95% CI, 20.9%-23.9%), respectively. The rate (per 10 000 person-months) of serious adverse events associated with reductions in use of essential drugs increased from 5.8 in the prepolicy control cohort to 12.6 in the postpolicy cohort in elderly persons (a net increase of 6.8 [95% CI, 5.6-8.0]) and from 14.7 to 27.6 in welfare recipients (a net increase of 12.9 [95% CI, 10.2-15.5]). Emergency department visit rates related to reductions in the use of essential drugs also increased by 14.2 (95% CI, 8.5-19.9) per 10 000 person-months in elderly persons (prepolicy control cohort, 32.9; postpolicy cohort, 47.1) and by 54.2 (95% CI, 33.5-74.8) among welfare recipients (prepolicy control cohort, 69.6; postpolicy cohort, 123.8). These increases were primarily due to an increase in the proportion of recipients who reduced their use of essential drugs. Reductions in the use of less essential drugs were not associated with an increase in risk of adverse events or ED visits.ConclusionsIn our study, increased cost-sharing for prescription drugs in elderly persons and welfare recipients was followed by reductions in use of essential drugs and a higher rate of serious adverse events and ED visits associated with these reductions.

A review of the association between cigarette smoking and the development of nonspecific back pain and related outcomes.

Abstract: Study design A structured review of the epidemiologic literature was performed. Thirty-eight studies published in peer-reviewed journals were reviewed. The methodologic strengths and weaknesses of the studies were described and assessed qualitatively. Four studies were excluded because of difficulties in design or interpretation. Objectives To provide a systematic analysis of the literature to assess the evidence as to whether smoking is associated with the prevalence and incidence of nonspecific back pain and related outcomes. Summary of background data Evidence has been gathering regarding the association of smoking with nonspecific back pain and other back disorders, but a comprehensive summary and evaluation of the data have not been published. Results Positive associations between current smoking and nonspecific back pain were found in 18 of 26 studies in men and 18 of 20 studies in women. For sciatica and herniated discs, there were four of eight and one of five positive studies in men and women, respectively. The majority of these studies were cross-sectional (18 in men and 16 in women), with only a handful of prospective studies. Positive associations between past smoking and nonspecific back pain were reported in five of nine studies in men and five of six studies in women. In addition, increases in the prevalence and/or incidence of nonspecific back pain were found in the majority of studies in which level of consumption was analyzed and reported. An attempt was made to assess whether these results could be artifactual arising from selection bias, confounding bias, publication bias, or errors in measurement. As well, the biologic mechanisms were summarized that have been suggested by various investigators. Conclusions The available data are consistent with the notion that smoking is associated with the incidenceand prevalence of nonspecific back pain, but there are too few studies to make any conclusions for the other end points (e.g., sciatica, herniated discs). It cannot be ruled out that the association is a statistical artifact arising from either selection or confounding factors, because the evidence for nonspecific low back pain derives mostly from cross-sectional studies. In addition, it cannot be stated unequivocally that smoking preceded back pain. Long-term follow-up studies are needed to eliminate the possibility that chronic back pain preceded smoking, to better estimate dose-response correlations, and to perform biologic measurements to elucidate possible mechanisms.

The Prognostic Consequences in the Making of the Initial Medical Diagnosis of Work-Related Back Injuries

Abstract: Study DesignA cohort of 1848 workers, representative of all sectors of industry, who were compensated for a low back injury in 1988 but not in the previous 2 years, was followed over 24 months.ObjectivesTo determine the prognostic value of the physician's initial diagnosis of back problems.Summary o

A Longitudinal View of Apathy and Its Impact After Stroke

Abstract: Background and Purpose— Stroke survivors are often described as apathetic. Because apathy may be a barrier to participation in promising therapies, more needs to be learned about apathy symptoms after stroke. The specific objective was to estimate the extent to which apathy changes with time over the first year after stroke and the impact of apathy on recovery. Methods— The Apathy Assessed cohort was formed from stroke survivors participating in a longitudinal study of health-related quality of life after stroke. A family caregiver completed an apathy questionnaire by telephone at 1, 3, 6, and 12 months after stroke (n=408). Group-based trajectory modeling and ordinal regression were used to identify distinctive groups of individuals with similar trajectories of apathy over the first year after stroke and predictors of apathy trajectory. Results— Both 3- and 5-group trajectory models fit the data. We used the 5-group model because of the potential to further explore the apathy construct. The largest group...

The Oswestry Disability Index.

Abstract: Study design The Oswestry Disability Index (ODI) has become one of the principal condition-specific outcome measures used in the management of spinal disorders. This review is based on publications using the ODI identified from the authors' personal databases, the Science Citation Index, and hand searches of Spine and current textbooks of spinal disorders. Objectives To review the versions of this instrument, document methods by which it has been validated, collate data from scores found in normal and back pain populations, provide curves for power calculations in studies using the ODI, and maintain the ODI as a gold standard outcome measure. Summary of background data It has now been 20 years since its original publication. More than 200 citations exist in the Science Citation Index. The authors have a large correspondence file relating to the ODI, that is cited in most of the large textbooks related to spinal disorders. Methods All the published versions of the questionnaire were identified. A systematic review of this literature was made. The various reports of validation were collated and related to a version. Results Four versions of the ODI are available in English and nine in other languages. Some published versions contain misprints, and many omit the scoring system. At least 114 studies contain usable data. These data provide both validation and standards for other users and indicate the power of the instrument for detecting change in sample populations. Conclusions The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure. The process of using the ODI is reviewed and should be the subject of further research. The receiver operating characteristics should be explored in a population with higher self-report disabilities. The behavior of the instrument is incompletely understood, particularly in sensitivity to real change.

Grit: Perseverance and Passion for Long-Term Goals

Abstract: The importance of intellectual talent to achievement in all professional domains is well established, but less is known about other individual differences that predict success. The authors tested the importance of 1 noncognitive trait: grit. Defined as perseverance and passion for long-term goals, grit accounted for an average of 4% of the variance in success outcomes, including educational attainment among 2 samples of adults (N=1,545 and N=690), grade point average among Ivy League undergraduates (N=138), retention in 2 classes of United States Military Academy, West Point, cadets (N=1,218 and N=1,308), and ranking in the National Spelling Bee (N=175). Grit did not relate positively to IQ but was highly correlated with Big Five Conscientiousness. Grit nonetheless demonstrated incremental predictive validity of success measures over and beyond IQ and conscientiousness. Collectively, these findings suggest that the achievement of difficult goals entails not only talent but also the sustained and focused application of talent over time.

Applied Longitudinal Data Analysis Modeling Change And Event Occurrence

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Development and Validation of the Short Grit Scale (Grit–S)

Abstract: In this article, we introduce brief self-report and informant-report versions of the Grit Scale, which measures trait-level perseverance and passion for long-term goals. The Short Grit Scale (Grit-S) retains the 2-factor structure of the original Grit Scale (Duckworth, Peterson, Matthews, & Kelly, 2007) with 4 fewer items and improved psychometric properties. We present evidence for the Grit-S's internal consistency, test-retest stability, consensual validity with informant-report versions, and predictive validity. Among adults, the Grit-S was associated with educational attainment and fewer career changes. Among adolescents, the Grit-S longitudinally predicted GPA and, inversely, hours watching television. Among cadets at the United States Military Academy, West Point, the Grit-S predicted retention. Among Scripps National Spelling Bee competitors, the Grit-S predicted final round attained, a relationship mediated by lifetime spelling practice.