Self-reported caffeine consumption miss-matched consumption measured by plasma levels of caffeine and its metabolites: results from two population-based studies

IMPORTANCE AND OBJECTIVE

Self-reported caffeine consumption has been widely used in research while it may be subject to bias. We sought to investigate the associations between self-reported caffeine consumption and plasma levels of caffeine and its two main metabolites (paraxanthine and theophylline) in the community.

METHODS

Data from two population-based studies (SKIPOGH1 and 2 (N = 1246) and CoLaus|PsyCoLaus (N = 4461)) conducted in Switzerland were used. Self-reported caffeine consumption was assessed using questionnaires. Plasma levels of caffeine and its metabolites were quantified by ultra-high performance liquid chromatography coupled to a tandem quadrupole mass spectrometer.

RESULTS

In both studies, mean log plasma levels of caffeine and its two metabolites were over 6.48 (plasma levels = 652 ng/ml) when no caffeine consumption was reported. Subsequently, nonlinear associations between log plasma levels and self-reported caffeine consumption were observed in SKIPOGH, with a change of the slope at 3-5 cups of espresso per day in SKIPOGH1 but not SKIPOGH2. In CoLaus|PsyCoLaus, increased daily consumption of caffeinated beverages was associated with increased log plasma levels with a change of the slope at 3 cups. In both studies, declared caffeine consumption higher than 3-5 cups per day was not associated with higher plasma levels of caffeine and its metabolites.

CONCLUSION

Self-reports of no or low caffeine consumption and consumption of more than 3-5 cups of coffee should be interpreted with caution, with possible under- or over-estimation. Quantifying plasma levels of caffeine and its metabolites may contribute to a better estimation of caffeine intake.

Self-reporting of psychoneurophysical (PNP) symptoms in adults with four chronic diseases: a protocol for a scoping review

BACKGROUND

Patient self-reporting of health-specific information, including symptoms, allows healthcare providers to provide more timely, personalized, and patient-centered care to meet their needs. It is critical to acknowledge that symptom reporting draws from the individual's unique sociocultural background influencing how one perceives health and illness. This scoping review will explore whether racial groups with 4 chronic diseases (cardiovascular diseases, respiratory diseases, cancers, and diabetes) differ in self-reporting of psychoneurophysical (PNP) symptoms. The PNP symptoms of interest include depressive symptoms, fatigue, anxiety, pain, cognitive impairment, sleep impairment, mood impairment, irritability, and shortness of breath.

METHODS

Four databases will be searched by a biomedical librarian: CINAHL Plus (EBSCOhost), Embase (Elsevier), PubMed (NLM), Web of Science: Core Collection (Clarivate Analytics), and limited to publications written in the English language. Two independent reviewers will screen the records' title, abstract, and then full text and extract the data from included articles using Covidence. A third reviewer will be used for resolving disagreements. Included articles must comprise adult patients with at least one of the specified chronic diseases who self-report at least one of the specified PNP symptoms. Studies that used clinician-administered questionnaires or obtained symptom responses from primary caregiver or patient designee will be excluded. Articles on patient-reported functionality or perceived quality of life will also be excluded from the review. Two reviewers will independently extract data (e.g., demographics, study design, racial group, chronic disease, measure/scale used for self-report) from each included article using Covidence and Microsoft Excel for data cleaning and analyses.

DISCUSSION

This scoping review may potentially identify the relevant and practical implications related to clinical decision-making and health outcomes for patients experiencing the psychoneurophysical symptoms included in this study. The authors will present how the results can be utilized in clinical practice, health policy, and research planning.

SYSTEMATIC REVIEW REGISTRATION

The protocol was registered on Open Science Framework (OSF) at: https://osf.io/ps7aw.

Are self-reported medical conditions and medicine use from middle-aged and older adults credible? A validation study comparing Danish SHARE-data with National Health Register data

PURPOSE

Self-reported information on medical conditions and medicine use is widely used in epidemiological research. We investigated the validity of self-reported medical conditions and medicine use from Danish participants in the Survey of Health, Ageing and Retirement in Europe.

METHODS

Self-reported health data were linked at individual level with the National Patient Registry and the Danish National Prescription Registry (n = 5572). Agreement was assessed by kappa value and presented as sensitivity, specificity, predictive values, and odds ratios.

RESULTS

The agreement of self-reported medical conditions varied by type (κ = 0.23-0.67), lowest for cholesterol-related diseases, highest for diabetes. Self-reported medicine use varied by medication type (κ = 0.33-0.90) lowest for painkillers, highest for diabetes. Women had lower odds for self-reporting medicine use correctly but higher odds for self-reported diseases. Higher age was associated with lower agreement, while higher education with higher agreement.

CONCLUSIONS

Although Danish data from the Survey of Health, Ageing and Retirement in Europe on medical conditions and medicine vary, the data are valid for epidemiological use for most medicine data, and for diseases associated with hospitalizations or influencing everyday life. Caution is warranted for self-reported data from 70+ year olds and people with lower educational level.

Importance of methodological considerations in documenting psychological trauma

The documentation of psychological trauma is obviously a challenge to clinicians while they are diving deep into remote events related to their clients or patients. The potential role of psychological trauma in the early developmental stages, and even the existence of adverse childhood experiences, is important to prove, yet it is difficult to do so. A diverse range of methods have been applied, all of which presumably benchmark a big therapeutic step; however, these enthusiastic methods frequently do not last for long. While hypnosis supporters, Freudian and Neo-Freudian disciples can be acute enough to enhance and uncover suppressed memories, modern psychiatry relies mostly on diversely structured interviews. Functional magnetic resonance and its related subtleties might help, but the questions that remain unanswered are numerous and confusing. Connecting early experiences with long-term memory while identifying psychological trauma its importance for the individual's growth trajectory; thus, it remains an intriguing issue.

Factors that influence patient and public adverse drug reaction reporting: a systematic review using the theoretical domains framework

BACKGROUND

Only 5-10% of all adverse drug reactions (ADRs) are reported. Mechanisms to support patient and public reporting offer numerous advantages to health care systems including increasing reporting rate. Theory-informed insights into the factors implicated in patient and public underreporting are likely to offer valuable opportunity for the development of effective reporting-interventions and optimization of existing systems.

AIM

To collate, summarize and synthesize the reported behavioral determinants using the theoretical domains framework (TDF), that influence patient and public reporting of ADRs.

METHOD

Cochrane, CINAHL, Web of science, EMBASE and PubMed were systematically searched on October 25th, 2021. Studies assessing the factors influencing public or patients reporting of ADRs were included. Full-text screening, data extraction and quality appraisal were performed independently by two authors. Extracted factors were mapped to TDF.

RESULTS

26 studies were included conducted in 14 countries across five continents. Knowledge, social/professional role and identity, beliefs about consequences, and environmental context and resources, appeared to be the most significant TDF domains that influenced patient and public behaviors regarding ADR reporting.

CONCLUSION

Studies included in this review were deemed of low risk of bias and allowed for identification of key behavioural determinants, which may be mapped to evidence-based behavioral change strategies that facilitate intervention development to enhance rates of ADR reporting. Aligning strategies should focus on education, training and further involvement from regulatory bodies and government support to establish mechanisms, which facilitate feedback and follow-ups on submitted reports.

Socio-demographic correlates of diabetes self-reporting validity: a study on the adult Kurdish population

BACKGROUND

In this research, data of the DehPCS study were used to assess the validity of self-reported diabetes based on the reference criteria, including the history of taking oral anti-diabetic drugs, insulin injection, or high fasting blood sugar.

METHODS

A cross-sectional analytical study was performed on 4400 participants of the DehPCS study, aged 35-70 years. The reference criteria were oral hypoglycemic drug consumption, insulin injection, and/ or fasting blood sugar ≥126 (mg/dl). The self-reporting diabetes was investigated by well-trained interviewers before the diabetes diagnosis based on the reference criteria. The validity of self-reporting diabetes was assessed using sensitivity, specificity, as well as positive and negative predictive values. Socio-demographic correlates of self-reported agreement were examined by multinomial logistic regression.

RESULTS

Three thousand nine hundred ninety-six people participated in this study, and the participation rate was equal to 90.8%. The diabetes prevalence among the study population was 13.1% based on self-reports and 9.7% based on the reference criteria. Five hundred twenty-three participants reported diabetes, 213 (41.28%) of whom did not have it. We found a good agreement of 92.3% with an acceptable kappa value of 65.1% between self-reporting diabetes and the reference criteria. Diabetes self-reporting also guaranteed sensitivity of 78.5%, specificity of 93.9%, as well as the positive and negative predictive values of 58.7% and of 98.0%, respectively. Being female, the higher economic class, the higher body mass index (BMI), and the positive family history of diabetes increased the chance of false positive. Being male, older ages and the moderate economic class increased the chance of false positive.

CONCLUSION

Self-reporting diabetes is identified as a relatively valid tool which could fairly determine the diabetes prevalence in epidemiological studies. It should be noted that its validity is influenced by some socio-demographic characteristics.

Public acceptability of a technology-mediated stool sample collection platform to inform community-based surveillance of infectious intestinal disease: a pilot study

BACKGROUND

In the UK approximately a quarter of the population experience infectious intestinal disease (IID) each year. However, only 2% present to primary care, preventing a true determination of community burden and pathogen aetiology. The aim of this pilot study was to gauge public acceptability of a technology-mediated platform for reporting episodes of IID and for providing stool samples.

METHODS

This study employed a cross-sectional online survey design, targeting individuals 16 + years old within Liverpool City Region, UK. Information sought included demographics, comfortability of reporting illness and IID symptoms, willingness to provide stool, and favoured stool-provision method. Univariable logistic regression was used to examine associations between demographic variables and providing a stool sample. Odds ratios (OR) and associated 95% confidence intervals (CIs) were produced.

RESULTS

A total of 174 eligible participants completed the survey, with 69% female. The sample was skewed towards younger populations, with 2.9% aged 65 + years. Nearly a third (29%) had a household income of less than £30,000 per annum and 70% had attained a degree or higher. The majority identified as White British (81%) and 11% identified as ethnicities typically grouped Black, Asian and minority ethnic (BAME). Three quarters of participants were either 'Comfortable' or 'Very Comfortable' with reporting illness (75%) and with answering symptom-related questions (79%); 78% reported that they would provide a stool sample. Upon univariable analysis, increasing age - being 55 + (OR 6.28, 95% CI 1.15-117.48), and lower income (OR 2.5, 95% CI 1.02-6.60), was associated with willingness to provide a stool sample. Additionally, respondents identifying as BAME ethnicities and men may be less inclined to provide a stool sample.

CONCLUSIONS

This pilot study assessed the acceptability of technology-mediated platforms for reporting IID and provision of stool samples in the community. Respondents were biased towards younger, technologically inclined, more affluent and educated populations. Acceptability for reporting illness and providing a stool sample through technology-mediated platforms was high. While older populations were under-represented, they were more likely to agree to provide a stool sample. Qualitative research is required to better reach older and more deprived populations, and to understand potential age, gender and ethnic differences in compliance with stool sampling.

An Assessment of Perceived Stigmatization of Patients Infected with COVID-19 in the Nation's Epicenter of the Pandemic: A Cross-Sectional Study of Residents of Agege, Lagos, Nigeria

BACKGROUND

In some parts of Africa, the patients and those who survived COVID-19 are stigmatized and this has impeded the response activities put in place to control the pandemic. In spite of this, most efforts in preventing COVID-19 were geared towards the use of non-pharmacologic measures without corresponding measures to dissipate stigmatization in the community. Therefore, this study assessed the factors associated with perceived stigmatization of patients with COVID-19 among residents of Agege local government, Lagos State, Nigeria.

METHODS

We conducted a cross-sectional survey among 333 consenting residents recruited from Agege local government area (LGA) using a multi-stage sampling technique. A semistructure, interviewer-administered questionnaire adapted from the People Living with Human Immunodefiency Virus (PLHIV) Stigma Index was used to collect data on socio-demographic characteristics, knowledge of COVID-19 and perceived stigmatization. Bivariate analysis was done using Chi-square and binary logistic regression was used to identify the determinants of perceived stigmatization at 5% level of significance.

RESULTS

The mean age of the respondents was 35.7 ± 13.6 years. Awareness about COVID-19 outbreak was 95.2%. Television (43.5%) and radio (36.9%) were the two major sources of information on COVID-19 infection and prevention. The proportions of the respondents who had poor knowledge and perceived stigmatization of COVID-19 patients were 50.0% and 47.7% respectively. A higher likelihood of perceived stigmatization was found among those aged 25 - 49 years (aOR= 3.1, 95% CI = 1.4 - 6.7), > 50 years (aOR= 2.1, 95% CI = 1.1 - 3.9) and married respondents (aOR= 1.8, 95% CI = 1.1 - 2.9).

CONCLUSION

The study highlights the poor knowledge about COVID-19 and a high level of stigmatization. Hence, targeted health educational interventions are urgently needed for the residents of Agege, most especially among married respondents as well as the adults.

An Assessment of Perceived Stigmatization of Patients Infected with COVID-19 in the Nation's Epicenter of the Pandemic: A Cross-Sectional Study of Residents of Agege, Lagos, Nigeria

BACKGROUND

In some parts of Africa, the patients and those who survived COVID-19 are stigmatized and this has impeded the response activities put in place to control the pandemic. Inspite of this, most efforts in preventing COVID-19 were geared towards the use of non-pharmacologic measures without corresponding measures to dissipate stigmatization in the community. Therefore, this study assessed the factors associated with perceived stigmatization of patients with COVID-19 among residents of Agege local government, Lagos State, Nigeria.

METHODS

We conducted a cross-sectional survey among 333 consenting residents recruited from Agege local government area (LGA) using a multi-stage sampling technique. A semistructure, interviewer-administered questionnaire adapted from the People Living with Human Immunodefiency Virus (PLHIV) Stigma Index was used to collect data on socio-demographic characteristics, knowledge of COVID-19 and perceived stigmatization. Bivariate analysis was done using Chi-square and binary logistic regression was used to identify the determinants of perceived stigmatization at 5% level of significance.

RESULTS

The mean age of the respondents was 35.7 ± 13.6 years. Awareness about COVID-19 outbreak was 95.2%. Television (43.5%) and radio (36.9%) were the two major sources of information on COVID-19 infection and prevention. The proportions of the respondents who had poor knowledge and perceived stigmatization of COVID-19 patients were 50.0% and 47.7% respectively. A higher likelihood of perceived stigmatization was found among those aged 25 - 49 years (aOR= 3.1, 95% CI = 1.4 - 6.7), > 50 years (aOR= 2.1, 95% CI = 1.1 - 3.9) and married respondents (aOR= 1.8, 95% CI = 1.1 - 2.9).

CONCLUSION

The study highlights the poor knowledge about COVID-19 and a high level of stigmatization. Hence, targeted health educational interventions are urgently needed for the residents of Agege, most especially among married respondents as well as the adults.

Patients can accurately self-report their elbow range of motion following surgery for trauma

INTRODUCTION

There is an increased demand of telemedicine in the recent century, especially with the outbreak of Covid-19. The aim of this study was to investigate patients' reliability in self-assessing own elbow range of motion following surgery for trauma.

METHODS

All patients of age ≥16 years who underwent surgery for elbow trauma at the local trauma unit between March 2015 to Aug 2018 were reviewed retrospectively. Identified cohort was invited to self-assess their elbow range of motion (ROM) using questionnaire with image instruction. They were then followed up with a clinical review for objective measurements by the lead clinician. Independent T-test was used to compare the measurements between patients and clinician. The power of the study was calculated using G∗Power software.

RESULTS

Thirty-five patients were enrolled in the study with mean age of 41 years. 11 of 35 patients had an associated elbow fracture dislocation associated. Mean patient reported total ROM was 105.7° ± 32.8°, with mean extension of 24.6° ± 18.9° to mean flexion of 130.3° ± 18.2°. Mean objective ROM measured by lead clinician was 112.6° ± 18.3°, with mean extension 22.4° ± 10.9° to mean flexion 135.0° ± 10.8°. No statistical significance was found between self-reported and clinician-based extension (p = 0.36), flexion (p = 0.076), and overall range of motion (p = 0.12).

CONCLUSION

Patients can self-assess their elbow range of motion following surgery for trauma accurately. In the midst of increasing demands for telemedicine, we suggest the application of patients' self-reporting outcome in clinical settings.

Vision redemption: Self-reporting AIEgens for combined treatment of bacterial keratitis

Bacterial keratitis (BK) is one of the most commonly leading causes of visual impairment and blindness worldwide, and suffers the risk of drug-resistant infections due to the abuse of antibiotics. Herein, we report a cationic diphenyl luminogen with aggregation-induced emission called IQ-Cm containing isoquinolinium and coumarin units for theranostic study of BK. IQ-Cm has no obvious cytotoxicity to mammalian cells below a certain concentration, and could preferentially bind to bacteria over mammalian cells. IQ-Cm can be used as a sensitive self-reporting probe to rapidly discriminate live and dead bacteria by the visual emission colors. The intrinsic dark toxicity to bacteria and generation of reactive oxygen species under light irradiation endow IQ-Cm with excellent antibacterial activity in vitro and in BK rabbit models infected with S. aureus. The present study provides a sensitive and efficient theranostic strategy for rapid discrimination of various bacterial states and the combined treatment of BK based on the intrinsic dark antibacterial activity and photodynamic therapy effect.

Sexual practices, risk perception and HIV self-testing acceptability among long-distance truck drivers in Ekiti State, Nigeria

BACKGROUND

HIV/AIDS is a global health challenge with a high burden in sub-Saharan Africa. Long-distance drivers are a high-risk group whose assessment of HIV status, awareness and willingness to undergo HIV self-testing (HIVST) could help prevent the spread of HIV infections.

OBJECTIVE

This study examined the sexual practices, risk perception and HIVST acceptability among long-distance truck drivers in Ekiti State, Nigeria.

METHODS

A cross-sectional study was conducted among long-distance truck drivers between September 2019 and December 2019. A semi-structured questionnaire was designed to investigate the perceived sexual risk factors and willingness to undergo HIVST.

RESULTS

Of the 306 drivers that participated in the study, almost half (49.8%) had their first sexual experience before they turned 18 years. About one-third (38.6%) had multiple sex partners and (34.0%) patronised commercial sex workers in the past 6 months. Consistent use of condoms was reported in a negligible percentage (3.0%), while 7.4% used intravenous drugs. Two-thirds of the respondents were interested in HIVST, while 32.2% knew their HIV status. Significant factors associated with multiple sex partners were the duration of working as a long-distance truck driver and patronage of sex workers.

CONCLUSION

A significant proportion of the long-distance drivers were engaged in unsafe sexual practices and are at risk for HIV transmission. Considering the mobile nature of the long-distance drivers, the risky practices of these workers require intense advocacy, testing and treatment to reduce HIV transmission. Scaling-up testing using HIVST has the potential to bridge the gap in the diagnosis of HIV among long-distance drivers who are willing to be tested.

Configurations of underreported cyclist-motorised vehicle and single cyclist collisions: Analysis of a self-reported survey

Lower severity cycling collisions, and single cyclist collisions (or single bicycle crashes) are significantly underreported in police statistics, introducing biases into the types of collisions that are available for analysis. Furthermore, many lower severity collisions do not appear in other collision data sources (e.g. hospital and insurance data). This in turn affects priorities for cyclist safety and puts an underemphasis on certain collision types. Due to an absence of data, little is known of the configurations of unreported collisions. In this paper, data from a recent self-reporting survey of cycling collisions in Ireland is used to provide details of cyclist collisions with motorised vehicles and single cyclist collisions, with the inclusion of unreported collision types. Pre-crash scenarios and impact configurations for cyclist collisions with bonnet-type vehicles, and collision factors and fall types for single cyclist collisions are coded. Injury patterns and police underreporting levels are compared, and representative collision scenarios are identified. This study highlights the relative importance of collisions resulting from the cyclist and vehicle travelling in the same direction, specifically, nearside-hook, vehicle lane changing, and overtaking manoeuvres are emphasised. Furthermore, cases involving the cyclist struck from the side by vehicle fronts comprise a smaller share than previous studies. Specifically, side to side impacts, impacts between the front of the cyclist/bicycle and the side of the vehicle, and impacts with open(ing) doors emerge as important impact configurations with the inclusion of self-reported cases. For single cyclist collisions, the importance of loss of traction of the tyres due to slippery road conditions and interactions with tram tracks and kerbs are emphasised. Fall types differ between single cyclist collision scenarios and are related to differences in injury severity. These findings add to existing knowledge for fatal and higher severity collisions, demonstrating that cyclist safety priorities change with inclusion of underreported, and lower severity collisions. The findings are particularly relevant to road infrastructural planners, as well as in the fields of injury biomechanics, and automated vehicle safety (ADAS). Representative scenarios for collisions with bonnet-type vehicles and single cyclist collisions have been identified, allowing for their future inclusion in development of collision and injury prevention strategies. The dataset generated in this study is available from the authors on reasonable request.

Reporting health data in waiting rooms with mobile technology: Patient expectation and confirmation

OBJECTIVES

Hospitals and medical staff use digital devices such as mobile phones and tablets to treat patients. Prior research has examined patient-reported outcomes, and the use of medical devices to do diagnosis and prognosis of patients, but not whether patients like using, and intend to use in future, mobile devices to self-report medical data. We address this research gap by developing a theoretical model based on the expectancy confirmation model (ECM) and testing it in an empirical study of patients using mobile technology to self-report data.

DESIGN

This study adopts a non-interventional cross-sectional research design. Randomly-selected patients provided data via survey and physical measurements. The target population comprises adults visiting a healthcare laboratory to get their blood drawn.

MATERIALS AND METHODS

We surveyed 190 randomly-selected patients waiting for treatment in the clinic. They were surveyed at two points in time - before and after their blood was drawn - on their demographic characteristics, research variables concerning their use of mobile devices to provide medical information, and perceived clinical data (blood pressure, height and weight). The research model was tested using structural equation modeling.

RESULTS

The study found strong support for the research model, with seven of eight hypotheses being supported. Both self-disclosure effort and feedback expectation positively affect both perceived feedback quality and confirmation. Contrary to expectations, perceived feedback quality was not found to affect confirmation. Perceived feedback quality, along with confirmation, was found to positively affect satisfaction, which was found to affect intention to disclose medical data through mobile technology.

CONCLUSIONS

The study's findings support the proposed path from feedback expectation and self-disclosure effort to confirmation to satisfaction to disclosure intention. Although perceived feedback does not affect confirmation, it affects satisfaction. Overall, we believe the results provide novel insights to both scientific research community and practitioners about using mobile technologies for self-reporting medical data.

Comparison of self-reports and biomedical measurements on hypertension and diabetes among older adults in China

Background

Researchers interested in the effects of health on various life outcomes often use self-reported health and disease as an indicator of true, underlying health status. However, the validity of reporting is questionable as it relies on the awareness, recall bias and social desirability. Accordingly, biomedical test is generally regarded as a more precise indication of the disease.

Methods

Using data from the third wave of China Health and Retirement Longitudinal Study (CHARLS), we selected individuals aged 40–85 years old who participated in both health interview survey and biomedical test. Sensitivity, specificity, false negative reporting and false positive reporting were used as measurements of (dis) agreement or (in) validity, and binary and multinomial logistic regression were used to estimate under-report or over-report of hypertension and diabetes.

Results

Self-reported hypertension and diabetes showed low sensitivity (73.24 and 49.21%, respectively) but high specificity (93.61 and 98.05%, respectively). False positive reporting of hypertension and diabetes were 3.97 and 1.67%, while false negative reports were extremely high at 10.14 and 7.38%. Educational attainment, hukou, age and gender affected both group-specific error and overall error with some differences in their magnitude and directions.

Conclusion

Self-reported conditions underestimate the disease burden of hypertension and diabetes in China. Adding objective measurements into social survey could improve data accuracy and allow better understanding of socioeconomic inequalities in health. Furthermore, there is an urgent need to provide basic health education and physical examination to citizens, and promote the use of healthcare to lower the incidence and unawareness of disease in China.

Can COVID-19 symptoms as reported in a large-scale online survey be used to optimise spatial predictions of COVID-19 incidence risk in Belgium?

Although COVID-19 has been spreading throughout Belgium since February, 2020, its spatial dynamics in Belgium remain poorly understood, partly due to the limited testing of suspected cases during the epidemic's early phase. We analyse data of COVID-19 symptoms, as self-reported in a weekly online survey, which is open to all Belgian citizens. We predict symptoms' incidence using binomial models for spatially discrete data, and we introduce these as a covariate in the spatial analysis of COVID-19 incidence, as reported by the Belgian government during the days following a survey round. The symptoms' incidence is moderately predictive of the variation in the relative risks based on the confirmed cases; exceedance probability maps of the symptoms' incidence and confirmed cases' relative risks overlap partly. We conclude that this framework can be used to detect COVID-19 clusters of substantial sizes, but it necessitates spatial information on finer scales to locate small clusters.

Health related quality of life in individuals at high risk for familial hypercholesterolemia undergoing genetic cascade screening in Brazil

BACKGROUND AND AIMS

Familial hypercholesterolemia (FH) is a genetic disorder associated with high risk of early major cardiovascular events (MACE) that can impact the health related quality of life (HRQoL), however, this association is unclear. This study evaluated HRQoL in index cases (IC) and first-degree relatives (FDR) of individuals at high risk of FH undergoing genetic cascade screening.

METHODS

Data collection was performed before awareness of molecular diagnosis results. Individuals were divided into four groups according to the molecular diagnosis: IC with (IC+) and without (IC-) identified mutations (n = 93 and n = 175, respectively), and affected (FDR+, n = 231) and non-affected (FDR-, n = 159) FDR of IC+. HRQoL measurements, mental (MCS) and physical component (PCS) scores were carried out with SF-12 questionnaire. Associations were tested by generalized linear models.

RESULTS

The mean age was 49 ± 15 years, 42.2% were men, MACE had occurred in 30.7%. Overall, both PCS and MCS did not differ between FH and non-FH individuals, however, IC trended to have lower PCS independent of FH presence (p=0.003). Lower PCS were associated with female sex (p=0.018), lower education (p<0.001), professional inactivity (p=0.028), previous MACE occurrence (p<0.001), hypertension (p=0.016), depression (p<0.001) and obesity (p<0.001). Lower MCS were associated with female sex (p=0.009), previous MACE occurrence (p=0.034), depression (p<0.001) and smoking (p=0.009). Neither the presence of FH causing mutations nor pharmacological lipid lowering treatment was associated with HRQoL.

CONCLUSIONS

HRQoL is not reduced in both IC and FDR FH individuals in comparison with their non-affected counterparts. Previous MACE and co-morbidities are associated with reduced HRQoL.

Bridging the gap between self-assessments and measured household food waste: A hybrid valuation approach

Great effort is invested in mapping the extent of household food waste and its main determinants. However, food waste valuation remains a challenging task. Valuation methods can be divided roughly into objective measurements that are based on physical waste surveys, and subjective self-assessments that are based on diaries or questionnaires. Self-assessment methods have been more popular than food waste measurement because they are less costly. The goal of this paper is to empirically test whether self-assessments can accurately reflect objective measurement. To answer this question, we implemented a hybrid valuation approach by integrating and comparing three methods: a self-assessment questionnaire, a physical waste survey, and a food expenditure survey. Self-assessments slightly underestimated measured food waste proportion (13.7% vs. 16.3%, respectively). The results also show a positive, yet, not very strong correlation between the measures and the self-assessments of unconsumed and partly consumed avoidable food waste in most food categories. Self-assessments of monetary losses were €42.07 per household per month on average, overestimating calculated losses of €25.74 on average. Our findings question the validity of self-assessments. The current paper demonstrates the questionable nature of the implicit assumption that self-assessment reflects the true level of food waste and suggests a rigorous method for exploring this relation.

Assessing chronic fatigue syndrome: Self-reported physical functioning and correlations with physical testing

The pathophysiology of chronic fatigue syndrome (CFS) remains unclear; no biomarkers have thus far been identified or physical tests designed to underpin its diagnosis. Assessment mainly uses Fukuda's criteria and is based on the exclusion of symptoms related to other diseases/syndromes, subjective self-reporting, and outcomes of self-report questionnaires. In order to improve the baseline assessment and progress evaluation of individuals suspected of CFS and using an association-oriented research strategy and a cross-correlational design, this study investigates possible associations between the performance on two physical tests, i.e. 'Timed Loaded Standing' (TLS), assessing trunk-arm endurance, and the 'Stops Walking with Eyes Closed while performing a secondary Cognitive Task' (SWECCT), measuring impaired automaticity of gait, and the results of two self-report questionnaires, the Checklist Individual Strength (CIS, total score and fatigue subscale score) and the physical functioning and vitality subscales of the Short Form Health Survey (SF-36) to gauge the participants' subjective feelings of fatigue and beliefs regarding their abilities to perform daily-life activities. Comparisons of the outcomes obtained in 27 female patients with a confirmed diagnosis of CFS revealed that trunk-arm endurance as measured with the TLS correlated with the SF-36 physical functioning subscale only (raw p value: 0.004). None of the other correlations were statistically significant. It is concluded that the TLS may have potential as an objective assessment tool to support the diagnosis and monitoring of treatment effects in CFS.

Evaluating individual risk proneness with vehicle dynamics and self-report data - toward the efficient detection of At-risk drivers

Vehicle-dynamics data, now more readily available thanks to moderate-cost, embedded data logging solutions, have been used to study drivers' behavior (acceleration, braking, and yaw rate) through naturalistic driving research aimed at detecting critical safety events. In addition, self-reported measures have been developed to describe these events and to assess various individual risk factors such as sensation seeking, lack of experience, anger expression while driving, and sensitivity to distraction. In the present study, we apply both of these methods of gathering driving data in order to assess risk proneness as accurately as possible. Data were obtained from 131 drivers, who filled in an introductory questionnaire pertaining to their driving habits. Their vehicles were equipped with an external, automatic data-capture device for approximately two months. During that period, the participants reported critical safety events that occurred behind the wheel by (a) pressing a button connected to the device and (b) describing the events in logbooks. They also filled in weekly questionnaires, and at the end of the participation period, a final questionnaire with various self-reported measures pertaining to their driving activity. We processed the data by (a) performing a multiple correspondence analysis of the characteristics assessed via the automatic data capture and self-reports, and (b) categorizing the participants via hierarchical clustering of their coordinates on the dimensions obtained from the correspondence analysis. This allowed us to identify a group of drivers (n = 43) at risk, based on several self-reported measures, in particular, their recent crash involvement, and the frequency of critical acceleration/deceleration events as an objective measure. However, the at-risk drivers did not themselves report more critical safety events than the other two groups.

Examining determinants for reporting suspected adverse events following HPV vaccination in Denmark

HPV vaccination has been offered to 12-year-old girls as part of the Danish Childhood Vaccination Programme since 2009. From 2013, an increasing number of suspected severe adverse events (AE) without a documented causal link to the vaccine was observed, resulting in public concerns about vaccine safety and a decline in uptake. This study aimed at describing the group of females reporting AE and comparing them to vaccinated peers not reporting AE. A questionnaire focusing on demographics, lifestyle, and health-related issues was distributed to 251 female cases who had reported severe AE and 1,003 female controls randomly selected from the population-based Danish Vaccination Registry. All had been HPV-vaccinated. There were no significant differences on measures of self-reported psychiatric or somatic conditions before vaccination. More cases reported being physically very active prior to first HPV vaccination (OR 4.2) whereas fewer cases than controls sometimes (OR 0.31) or often/always (OR 0.36) felt sad. This is unexpected because two recent Danish registry-based case-control studies concluded that females reporting severe AE were more likely to consult a psychologist/psychiatrist and to have pre-existing psychiatric conditions before first HPV vaccination. One of these studies also showed that cases had increased health-care seeking regarding a number of somatic conditions prior to first vaccination. Our study adds value when seeking to understand the lifeworld of the affected females and their interpretations of their everyday lives pre- and post-HPV vaccination.

Socio-Economic Status and Prevalence of Self-Reported Osteoporosis in Tehran: Results from a Large Population-Based Cross-Sectional Study (Urban HEART-2)

Osteoporosis is a widespread disease among older peoples. The aim of this study is to estimate the prevalence of self-reported osteoporosis and assessing its association with socio-economic status. A population-based cross-sectional study was conducted in Tehran, Iran in 2011. Participants were 45,990 individuals aged above 20 years from 22 urban districts. Osteoporosis was measured by self-administrative questionnaire. Wealth index was constructed using principal component analysis based on household assets. Chi-square test, chi square test for trend, and crude odds ratio were used to assess associations in univariate analysis. Multiple logistic regression utilized to estimate adjusted associations between self-reported osteoporosis and socio-economic status.The overall estimated prevalence of self-reported osteoporosis was 4% (95% CI 3.88-4.13), 1.19% in men, and 6.84% in women (P < 0.001). The prevalence increased considerably as age increased (P for trend < 0.001). In multivariable analysis, education and wealth status were negative, and smoking was positively associated with the prevalence of self-reported osteoporosis. No association was found between participants' skill levels and Townsend deprivation index with the prevalence of self-reported osteoporosis.The findings of the present study have improved understanding of the association between socioeconomic status and osteoporosis in the Iranian population. It is important to consider socioeconomic status in screening and prevention programs.

The timeliness of patients reporting the side effects of chemotherapy

PURPOSE

To explore the actions cancer patients reported they would take in response to a range of common side effects of chemotherapy and whether these were considered appropriate based on current guidelines and evidence; and to explore the sociodemographic and cancer-related variables associated with patients selecting the appropriate action (immediate medical attention or reporting) for two potentially life-threatening side effects: fever, and unusual bleeding and bruising.

METHODS

Four hundred thirty-six medical oncology and haematology patients receiving chemotherapy completed two surveys to provide demographic, disease and treatment characteristics, and details on how they would respond if they experienced a range of specified side effects of chemotherapy (for example, nausea and vomiting, fatigue, and skin rash or nail changes). The proportion of patients reporting the appropriate action for each side effect was calculated. Multiple logistic regressions examined the patient demographic and cancer characteristics associated with selecting the appropriate action (seeking immediate medical attention) for two potentially life-threatening side effects of chemotherapy: high fever of 38 °C or more, and unusual bleeding or bruising.

RESULTS

Two thirds of patients indicated that they would seek immediate medical attention for high fever (67%), but only 41% would seek immediate attention for bleeding or bruising. Cancer type and time since diagnosis were significantly associated with patients indicating that they would seek immediate medical attention for high fever; while time since diagnosis was the only variable significantly associated with patients reporting that they would seek immediate medical attention for unusual bleeding or bruising. For chronic side effects, like skin rash or nail changes, and tingling or numbness, which usually do not require urgent reporting, only between 12 and 16% would report them immediately. A significant proportion of patients reported that they would "do nothing" about fatigue or tiredness (24%). By comparison, less than 10% patients reported that they would do nothing for the other side effects investigated.

CONCLUSIONS

Tools need to be created so that patients better understand the side effects after being treated with chemotherapy and what action they should take.

Correction of self-reported BMI based on objective measurements: a Belgian experience

BACKGROUND

Based on successive Health Interview Surveys (HIS), it has been demonstrated that also in Belgium obesity, measured by means of a self-reported body mass index (BMI in kg/m2), is a growing public health problem that needs to be monitored as accurately as possible. Studies have shown that a self-reported BMI can be biased. Consequently, if the aim is to rely on a self-reported BMI, adjustment is recommended. Data on measured and self-reported BMI, derived from the Belgian Food Consumption Survey (FCS) 2014 offers the opportunity to do so.

METHODS

The HIS and FCS are cross-sectional surveys based on representative population samples. This study focused on adults aged 18-64 years (sample HIS = 6545 and FCS = 1213). Measured and self-reported BMI collected in FCS were used to assess possible misreporting. Using FCS data, correction factors (measured BMI/self-reported BMI) were calculated in function of a combination of background variables (region, gender, educational level and age group). Individual self-reported BMI of the HIS 2013 were then multiplied with the corresponding correction factors to produce a corrected BMI-classification.

RESULTS

When compared with the measured BMI, the self-reported BMI in the FCS was underestimated (mean 0.97 kg/m2). 28% of the obese people underestimated their BMI. After applying the correction factors, the prevalence of obesity based on HIS data significantly increased (from 13% based on the original HIS data to 17% based on the corrected HIS data) and approximated the measured one derived from the FCS data.

CONCLUSIONS

Since self-reported calculations of BMI are underestimated, it is recommended to adjust them to obtain accurate estimates which are important for decision making.

Interview-based versus self-reported anal incontinence using St Mark's incontinence score

INTRODUCTION AND HYPOTHESIS

St Mark's incontinence score (SMIS) was originally designed and validated for use in an interview setting (iSMIS), and there is conflicting evidence for the validity of the self-administered SMIS (sSMIS). Our objective was to compare self-administered and interview-based reports of anal incontinence (AI) symptoms.

METHODS

A total of 147 women reported symptoms of AI on a sSMIS before inclusion in a clinical study investigating the effect of conservative treatment for AI 1 year after delivery. After clinical investigations, an iSMIS was completed by one of two consultant surgeons blinded to the sSMIS results. The correlation and agreement among the individual items of the iSMIS and the sSMIS were assessed using Spearman's rho and weighted kappa statistics, respectively.

RESULTS

The mean iSMIS and sSMIS reported was 4.0 (SD: 3.6) and 4.3 (SD: 4.0), respectively. Spearman's rho showed a strong relationship between the two total SMIS scores (r = 0.769, n = 147, p < 0.001), and explained variance was 59% (r²=0.591). Except for the individual item about gas incontinence, women reported more frequent AI symptoms on the sSMIS than on the iSMIS. The assessment of consistency among the individual items of the iSMIS and sSMIS showed substantial agreement (κ ≥ 0.60) for all items except for fair agreement for the item about formed stool incontinence (κ = 0.22), and moderate for the item about any change in lifestyle (κ = 0.5).

CONCLUSIONS

The level of consistency between the two methods of reporting anal incontinence symptoms suggests that the St Mark's score may be used as both an interview-based and a self-administered incontinence score.

Is there a difference between hospital-verified and self-reported self-harm? Implications for repetition

OBJECTIVE

Repeated intentional self-harm (SH) is associated with economic costs and increased risk of suicide. Estimates of repetition vary according to method of data capture and are limited by short periods of follow-up observation. Some sources use hospital records and others self-reported SH (SRSH). Our aim was to examine the relationship between SRSH and hospital-verified SH (HVSH) and later repetition of SH (predictive validity). We also aimed to examine whether rates of SH repetition differ between first-time presenters and non-first-time presenters using either definition of SH.

METHOD

We conducted a large prospective study tracking SH attempts through an Accident and Emergency (A&E) department within the United Kingdom. We took a representative sample of 774 patients (30% of total who reported SH) and followed them for 5.6 years on average. The index episode of SH was recorded at the time of referral to staff in A&E. Prior episodes of SH were determined from an electronic search of A&E patient database, and in addition, recollection of prior SH as reported by the patient to their clinician at the time of index presentation was recorded.

RESULTS

Across the whole sample 32.0% of patients repeated SH within 1 year, which rose to 54.1% at completion of follow-up. Repetition rates were considerably higher in patients with a prior SH history than those presenting with a first SH episode after 1 year (47.9% vs. 19.6%) and by the end of follow-up (73.8% vs. 39.4%) (P<.001). Of 411 with self-reported first presentations, 45.2% repeated over the study period. In terms of predictive validity, 65.2% of those with previous SRSH repeated vs. 73.8% with previous HVSH (P<.001). There was low agreement between SRSH and HVSH (Kappa=0.353, 95% confidence interval 0.287-0.419, low).

CONCLUSIONS

We found relatively poor agreement between hospital-defined and self-reported SH. A total of 62.8% of those who denied SH actually had a hospital-verified previous episode. Patients with recorded prior SH and those who recall previous SH have significantly higher rates of repetition, but the two samples imprecisely overlap and predictive validity is stronger for HVSH.

Socioeconomic status and prevalence of self-reported diabetes among adults in Tehran: results from a large population-based cross-sectional study (Urban HEART-2)

INTRODUCTION

Diabetes mellitus is an important public health challenge worldwide. The prevalence of type 2 diabetes varies across countries. The aim of this study is to estimate the prevalence of type 2 diabetes and to determine related factors including socioeconomic factors in a large random sample of Tehran population in 2011.

METHODS

In this cross-sectional study, 91,814 individuals aged over 20 years were selected randomly based on a multistage, cluster sampling. All participants were interviewed by trained personnel using standard questionnaires. Prevalence and Townsend deprivation indexes were calculated. Principal component analysis (PCA) was used to construct wealth index. Logistic regression model was used in multivariate analysis.

RESULTS

The estimated prevalence of self-reported diabetes was 4.98 % overall, 4.76 %in men and 5.19 % in women (P < 0.003). In multivariate analysis, age, marital status (married and divorced/widow) and BMI were positively associated with the prevalence of self-reported diabetes. Of the socioeconomic variables, educational level and wealth status were negatively and Townsend Index was positively associated with diabetes.

CONCLUSION

Our study findings highlight low reported prevalence of diabetes among adults in Tehran. Subjects with low socioeconomic status (SES) had a higher prevalence of type 2 diabetes. Weight gain and obesity were the most important risk factors associated with type 2 diabetes. Wealth index and educational level were better socioeconomic indicators for presenting the inequality in diabetes prevalence in relation to Townsend deprivation index.

Patients' adherence and clinical effectiveness of a 14-day course of primaquine when given with a 3-day chloroquine in patients with Plasmodium vivax at the Thai-Myanmar border

Primaquine is the only antimalarial drug available for eradicating the hypnozoite stage of Plasmodium vivax to prevent the disease from recurring. However, one limitation of its clinical use is the long treatment course of 14 days, which may result in poor patients' adherence and low treatment efficacy. The aim of the current study was to assess patients' adherence and the clinical effectiveness of the unsupervised standard 14-day primaquine regimen (daily dose of 15mg base/kg body weight daily for 14 days) when given together with 3-day chloroquine (25mg base/kg body weight over 3 days). The study was conducted in 85 patients with P. vivax malaria in a malaria endemic area along the Thai-Myanmar border. Patients' adherence to primaquine therapy was assessed based on primaquine concentrations in finger-prick dried blood spot (DBS) samples alongside patients' self-reporting on drug administration and pill counting methods. Results suggest high rate of patients' adherence to this 14-day primaquine regimen (95-98% based on primaquine concentrations in DBS on days 3, 7, and 14 of treatment, and 100% based on patients' self-reporting and pill counting methods. Clinical effectiveness was 100% during the 42-day follow-up.

Prevalence and associated factors of self-reported hypertension among Tehran adults in 2011: a population-based study (Urban HEART-2)

BACKGROUND

Hypertension is an important public-health challenge worldwide. The prevalence of hypertension greatly varies across countries. The aim of this study was to estimate the prevalence of self-reported hypertension and to determine related factors in a large random sample of Tehran population in 2011.

METHODS

In this cross sectional study, 69173 individuals aged 25-64 years were selected using multistage cluster random sampling method. All participants were interviewed by trained personnel using standard questionnaires. Weighted prevalence and incidence rates were calculated and principle component analysis (PCA) was used to construct wealth index. Chi-square and odds ratio were used to assess associations in univariate analysis. Logistic Regression model was used in multivariate analysis.

RESULTS

The prevalence of self-reported hypertension was 5.27% in total, 3.83% in men and 6.64% in women (p< 0.001). The annual incidence rate of self-reported hypertension was 6.87 per 1000; 5.26 in men and 8.43 in women (p< 0.001), obviously varied across various districts. In multivariate analysis, age, sex (woman), marital status (single), obesity and smoking were positively associated with prevalence of self-reported hypertension. Education level was negatively associated to hypertension. On the other hand, wealth status was not associated to self-reported hypertension.

CONCLUSION

Our study findings highlighted low awareness rates of hypertension among Tehran adults especially in men and younger people. Hence, we recommend public health strategies to improve health education programs. Moreover, programs to develop the surveillance system and screening programs to early detection of undiagnosed cases are urgently needed particularly in high risk population subgroups.

Osteoporosis in the community: Sensitivity of self-reported estimates and medication use of those diagnosed with the condition

Objectives

To assess the sensitivity and specificity of self-reported osteoporosis compared with dual energy X-ray absorptiometry (DXA) defined osteoporosis, and to describe medication use among participants with the condition.

Methods

Data were obtained from a population-based longitudinal study and assessed for the prevalence of osteoporosis, falls, fractures and medication use. DXA scans were also undertaken.

Results

Overall 3.8% (95% confidence interval (CI) 3.2 to 4.5) of respondents and 8.8% (95% CI 7.5 to 10.3) of those aged ≥ 50 years reported that they had been diagnosed with osteoporosis by a doctor. The sensitivity (those self-reporting osteoporosis and having low bone mineral density (BMD) on DXA) was low (22.7%), although the specificity was high (94.4%). Only 16.1% of those aged ≥ 50 years and with DXA-defined osteoporosis were taking bisphosphonates.

Conclusions

The sensitivity of self-reporting to identify osteoporosis is low. Anti-osteoporotic medications are an important part of osteoporosis treatment but opportunities to use appropriate medications were missed and inappropriate medications were used.