Health Care Provider Advice Research Articles

O29 LACK OF VALIDATED BLOOD PRESSURE DEVICES FOR USE IN PREGNANCY AVAILABLE FROM AUSTRALIAN PHARMACIES

Background and objective. Self-monitoring of blood pressure (BP) at home can aid in the management of hypertension, including during pregnancy. Only 20% of home BP devices have been validated for the general population. However, specific accuracy validation in pregnant women is required for use among this population. The availability of home BP devices that have been validated for use in pregnant women is unknown, which was the aim of this study. Secondary aims were to assess device cost and claims regarding use in pregnancy. Methods. A search of pharmacies with physical and online stores in Australia that sell upper-arm cuff home BP devices was conducted. Validation status in pregnant women was determined by checking model numbers on the STRIDE-BP website. Cost of device and claims about the devices’ use in pregnancy were extracted from instruction manuals and information on the pharmacy webpage. Results. Eighteen pharmacies and 40 unique home BP devices were identified. Four (10%) devices were validated for use in pregnancy, and these were more expensive than other devices (Table). Fifteen devices listed a caution warning to seek healthcare provider advice before use if pregnant, including all four that had been validated for pregnancy. Concerningly, information about four devices stated they were recommended for pregnancy, although evidence of validation was not found on STRIDE-BP. Information about one device stated it had not been tested on pregnant women and was not suitable for use, although this information was only available in the device manual and not point-of-sale. Nineteen devices had no mention of pregnancy at all. Conclusion. Very few home BP devices available from Australian pharmacies are specifically validated for use in pregnancy, are priced higher than non-validated devices and do not effectively target their intended users. To guarantee that only validated home BP devices are used in pregnancy increased awareness is urgently needed and could be assisted by clear labelling on devices provided at the point-of-sale instore or online. Table. Home BP devices sold in 18 Australian pharmacies. BP: blood pressure. Cost displayed in Australian dollars (AUD). The percentages add to more than 100% because some devices validated in the general population were also validated for pregnancy and pre-eclampsia.

Quantifying Stated Preferences for Meningococcal Vaccines Among Adolescents/Young Adults and Parents of Adolescents in the United States: A Discrete Choice Experiment.

Invasive meningococcal disease (IMD) is a severe and life-threatening disease. In the United States (US), vaccine coverage with MenACWY and MenB meningococcal vaccines is suboptimal among adolescents/young adults aged 16-23years. A combined meningococcal vaccine (MenABCWY) could increase convenience (e.g., fewer injections) and improve coverage. The objective was to quantify preferences for hypothetical meningococcal vaccine profiles among adolescents/young adults and parents. An online discrete choice experiment was conducted among 16- to 23-year-olds, and parents of 16- to 18-year-olds. Attributes (3×4) and levels (1×2) were based on the literature and focus groups. Participants made ten pair-wise forced trade-off choices, systematically varied using a D-optimal design. Random parameter logit quantified the relative importance of vaccination attributes and estimated the trade-offs. Differences in preferences by subgroups were assessed. Totals of 300 adolescents and young adults (median age 20years) and 300 parents (median age 46years) completed the survey. Overall, 89.6% of 16- to 23-year-olds and 69.1% of parents preferred a simplified hypothetical meningococcal vaccination profile, e.g., with fewer injections (3 vs. 4) and fewer healthcare provider (HCP) visits (2-3 vs. 4). Having HCP advice and clear Centers for Disease Control and Prevention recommendations impacted vaccination choice, with both groups reporting high trust in HCP information (83.3% among 16- to 23-year-olds; 98.7% among parents). Barriers to vaccination included lack of HCP advice or awareness of meningococcal vaccines, and income level and out-of-pocket costs for parents. Adolescents/young adults and parents demonstrated a significant preference for a meningococcal vaccine that is more convenient (such as combined MenABCWY). Parents' vaccination preferences differed by income level and out-of-pocket costs, suggesting financial barriers to vaccination may exist which could result in IMD prevention inequalities. Findings from this study provide important information to support patient-facing informed policy discussions. A simplified vaccination schedule and strong recommendation could help improve vaccine uptake, schedule compliance, disease prevention, and reduce inequalities in IMD risk and prevention. A graphical abstract is available with this article.

Research on Biosensor Technology in Wearable Health Monitoring Equipment

In recent years, innovative and well-researched smart devices utilizing wearable biosensor systems for health monitoring have attracted much attention from society. These health monitoring devices, equipped with various transmission modules and miniature physiological sensors, are anticipated to alleviate the escalating healthcare expenses in the post-pandemic era by offering real-time, precise physiological information and persistent health status monitoring. Additionally, such health monitoring devices can provide tailored health advice and preventive measures for healthcare providers, potentially transforming the future of healthcare. Hence, their impact spans a broad and enduring spectrum in our daily lives. This paper aims to provide a comprehensive review of current technologies used for health monitoring and current trends, developments, and research in wearable biosensor systems for health monitoring. The focus is especially on the technical design of multiparameter physiological sensing systems and the challenges they face. Also, it discusses the ethical and data protection issues associated with these wearable biosensor systems. Finally, future research directions and perspectives on wearable biosensor devices are analyzed. Moreover, this paper serves as a resource for researchers and developers in this field, providing directions for future research advancements.

Alcohol Use in Liver Transplant Recipients With Alcohol-related Liver Disease: A Comparative Assessment of Relapse Prediction Models.

The selection of liver transplant (LT) candidates with alcohol-related liver disease (ALD) is influenced by the risk of alcohol relapse (AR), yet the ability to predict AR is limited. We evaluate psychosocial factors associated with post-LT AR and compare the performance of high-risk alcoholism risk (HRAR), sustained alcohol use post-LT (SALT), and the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) scores in predicting relapse. A retrospective analysis of ALD patients undergoing LT from 2015 to 2021 at a single US transplant center was performed. Risk factors associated with post-LT AR were evaluated and test characteristics of 3 prediction models were compared. Of 219 ALD LT recipients, 23 (11%) had AR during a median study follow-up of 37.5 mo. On multivariate analysis, comorbid psychiatric illness (odds ratio 5.22) and continued alcohol use after advice from a health care provider (odds ratio 3.8) were found to be significantly associated with post-LT AR. On sensitivity analysis, SIPAT of 30 was optimal on discriminating between ALD LT recipients with and without post-LT AR. SIPAT outperformed both the HRAR and SALT scores (c-statistic 0.67 versus 0.59 and 0.62, respectively) in identifying post-LT AR. However, all scores had poor positive predictive value (<25%). AR after LT is associated with comorbid psychiatric illness and lack of heeding health care provider advice to abstain from alcohol. Although SIPAT outperformed the HRAR and SALT scores in predicting AR, all are poor predictors. The current tools to predict post-LT AR should not be used to exclude LT candidacy.

Health Care Provider Assessment, Advice, And Referral For Physical Activity: A Focus On Arthritis Management

Health Care Provider Assessment, Advice, And Referral For Physical Activity: A Focus On Arthritis Management

Contraceptive preferences and adoption following female genital fistula surgery in Uganda: a mixed-methods study

BackgroundFemale genital fistula, largely caused by prolonged obstructed labour, is treated by surgical repair. Preventing pregnancy for a minimum period post-repair is recommended to ensure adequate healing and optimize post-repair outcomes.MethodsWe examined contraceptive preferences and use among Ugandan fistula patients (n = 60) in the year following genital fistula surgery using mixed-methods. Sexual activity, contraceptive use and pregnancy status were recorded quarterly for 12 months after surgery. In-depth interviews among purposively selected participants (n = 30) explored intimate relationships, sexual experiences, reproductive intentions, and contraceptive use.ResultsMedian participant age was 28 years and almost half (48%) were married or living with partners. Counselling was provided to 97% of participants on delaying sexual intercourse, but only 59% received counselling on contraception. Sexual activity was reported by 32% after 6 months and 50% after 12 months. Eighty-three percent reported not trying for pregnancy. Among sexually active participants, contraceptive use was low at baseline (36%) but increased to 73% at 12 months. Six (10%) women became pregnant including two within 3 months post-repair. Interview participants who desired children immediately were young, had fewer children, experienced stillbirth at fistula development, and felt pressure from partners. Women adopted contraception to fully recover from fistula surgery and avoid adverse outcomes. Others simply preferred to delay childbearing. Reasons cited for not adopting contraception included misconceptions related to their fertility and to contraceptive methods and insufficient or unclear healthcare provider advice on their preferred methods.ConclusionsA high proportion of patients were not counselled by healthcare providers on contraception. Provision of comprehensive patient-centred contraceptive counselling at the time of fistula surgery and beyond is important for patients to optimize healing from fistula and minimize recurrence, as well as to meet their own reproductive preferences.

A Better Way to Care for Long Term Care (LTC) residents in Times of Medical Urgency: Improving Acute Care transfers for LTC Residents.

Background: Prior to the pandemic, every day approximately 28 long term care (LTC) residents were transferred to an emergency department (ED) in Alberta. This was placing increasing strain on healthcare resources and potentially negatively impacting the health and wellness of residents (e.g., exposure to iatrogenic harms). Many residents’ conditions could be managed within LTC if appropriate supports were provided. Poor communication between LTC and EDs can also lead to long ED lengths of stay, unnecessary resource utilization, sub-optimal health outcomes, and exposure to iatrogenic harms for LTC residents. Two INTERACT® tools (tools for early identification of acute medical issues) and a new care and referral pathway were implemented to help identify and address changes in health status among LTC residents sooner, improve communication between LTC and ED providers, and reduce unnecessary ED transfers. Methods: Between October 2019 and April 2022, 40 LTC homes and 4 EDs within the Calgary zone implemented the standardized LTC-to-ED care and referral pathway supported by a centralized telephone advice and transfer system for healthcare providers, community paramedics, and two INTERACT® tools (Stop and Watch for healthcare aides; Change in Condition Cards for nursing). Using a randomized stepped-wedge design, the pathway was implemented within 9 cohorts of (4-5) LTC facilities every 3 months, supported by an implementation coach. Three-hour train the trainer implementation sessions were conducted in-person or online with over 325 health practitioners in the enrolled LTC homes using strategies adapted to consider local context and barriers, as well as considering pandemic-related challenges. Evaluation Methods: Evaluation of the intervention involved both qualitative and quantitative methods. The primary study outcome is change in transfers from LTC to ED; secondary (quantitative) outcomes include hospital admissions, utilization of the centralized telephone advice and transfer system, and community paramedic visits. Analysis of these quantitative outcomes utilized negative binomial regression to estimate the incident rate with 95% confidence intervals (per 1000 residents), while adjusting for the different cohorts. The quantitative evaluation also included an economic analysis to determine potential cost savings. Interviews with healthcare providers were conducted to provide context to their experience with the intervention and ways it can be improved. These interviews will be interpreted with the involvement of members of our project resident and family advisory council. Results: Quantitative results demonstrate a reduction in the LTC-to-ED transfer rate [1.70 (95%CI 1.61-1.79) post-intervention) vs 1.91 (95%CI 1.84-2.00) pre-intervention], along with reduction in hospital admission rates [0.94 (95%CI 0.88-1.00) vs 1.08 (95%CI 1.03-1.14)]. There was an increase in utilization of the centralized telephone advice and transfer system [0.18 (95%CI 0.16-0.22) vs. 0.13 (95%CI 0.11-0.16)], but no increase in the number of community paramedic visits [2.05 (95%CI 1.94-2.16) vs 2.50 (95%CI 2.39-2.61)]. Cost and qualitative outcome data is pending. Advice and Lessons Learned: LTC staff education and use of early warning tools for identifying a change in resident health status (INTERACT® tools) and/or utilization of a centralized telephone advice and transfer system may have played a role in reducing ED transfers. We did not observe the expected relationship between community paramedic visits and reduced LTC-to-ED transfers, possibly as a result of the pandemic-related facility outbreak restrictions. Teams should tailor implementation sessions and materials to site specific needs and contexts to help address their unique barriers and facilitators. Partnerships with key stakeholders across the care continuum are essential to ensure adequate support and effective uptake and sustainability of the mutli-faceted change intervention.

Differences in health care provider advice on abstaining from tobacco use: Findings from the 2020 National Youth Tobacco Survey

BackgroundHealth care providers’ (HCP) advice on tobacco prevention and cessation is critical in addressing the tobacco use epidemic among adolescents. However, examination of whether receiving advice from HCPs differs by adolescent sociodemographic characteristics and tobacco use is limited. MethodsHCP advice to abstain from using tobacco was examined using the 2020 National Youth Tobacco Survey (N = 12,483). Sociodemographic (age, sex, sexual orientation, race/ethnicity, and region) and tobacco use (non-current, sole, dual/poly) differences by HCP advice were evaluated using adjusted logistic regression models. ResultsAmong the sample, 37.26% of adolescents received HCP advice to abstain from using tobacco products, and 31.35% received HCP advice to abstain from using e-cigarettes specifically. Adolescents who were non-Hispanic Black (vs. non-Hispanic White) were more likely not to receive HCP advice to abstain from all tobacco products (OR = 1.31, 95% CI: 1.08–1.59). Adolescents who were non-Hispanic Black (vs. non-Hispanic White) (OR = 1.41, 95% CI: 1.16–1.73) or sexual minority (vs. heterosexual) (OR = 1.16, 95% CI: 1.02–1.33) were more likely not to receive HCP advice to abstain from e-cigarettes. Adolescents who were aged 16–18 (vs. aged 9–12) (OR = 0.68, 95% CI: 0.56–0.83) or currently use dual/poly tobacco products (vs. adolescents who do not currently use tobacco) (OR = 0.56, 95% CI: 0.43–0.74) were more likely to receive HCP advice to abstain from using e-cigarettes). ConclusionsMany U.S. adolescents do not receive HCP advice to abstain from using tobacco. HCPs should increase tobacco prevention and cessation advice across adolescent groups, particularly racial/ethnic and sexual minorities. HCP training and public health policies that improve delivery of e-cigarette advice to adolescents are essential.

Barriers to childhood tuberculosis case detection and management in Cambodia: the perspectives of healthcare providers and caregivers

BackgroundDiagnosis and treatment of tuberculosis (TB) in children remain challenging, particularly in resource-limited settings. Healthcare providers and caregivers are critical in improving childhood TB screening and treatment. This study aimed to determine the barriers to childhood TB detection and management from the perspectives of healthcare providers and caregivers in Cambodia.MethodWe conducted this qualitative study between November and December 2020. Data collection included in-depth interviews with 16 healthcare providers purposively selected from four operational districts and 28 caregivers of children with TB and children in close contact with bacteriologically confirmed pulmonary TB residing in the catchment areas of the selected health centers. Data were analyzed using thematic analyses.ResultsMean ages of healthcare providers and caregivers were 40.2 years (standard deviation [SD] 11.9) and 47.9 years (SD 14.6), respectively. Male was predominant among healthcare providers (93.8%). Three-fourths of caregivers were female, and 28.6% were grandparents. Inadequate TB staff, limited knowledge on childhood TB, poor collaboration among healthcare providers in different units on TB screening and management, limited quality of TB diagnostic tools, and interruption of supplies of childhood TB medicines due to maldistribution from higher levels to health facilities were the key barriers to childhood TB case detection and management. Caregivers reported transportation costs to and from health facilities, out-of-pocket expenditure, time-consuming, and no clear explanation from healthcare providers as barriers to childhood TB care-seeking. Aging caregivers with poor physical conditions, lack of collaboration from caregivers, ignorance of healthcare provider's advice, and parent movement were also identified as barriers to childhood TB case detection and management.ConclusionsThe national TB program should further invest in staff development for TB, scale-up appropriate TB diagnostic tools and ensure its functionalities, such as rapid molecular diagnostic systems and X-ray machines, and strengthen childhood TB drug management at all levels. These may include drug forecasting, precise drug distribution and monitoring mechanism, and increasing community awareness about TB to increase community engagement.

Abstract B051: A qualitative exploration of prostate cancer treatment and survivorship advice from employed prostate cancer survivors

Abstract Introduction: Prostate cancer is the most common and second most deadly non-skin cancer among American men. Prostate cancer outcomes are especially detrimental for African-American men. While prostate cancer treatment can prolong life, it can also produce debilitating results that can impact men’s ability to perform some jobs/work-related tasks, cause decisional regret, and affect their overall quality of life. Objective: To improve prostate cancer treatment decision-making and survivorship experiences of actively employed prostate cancer survivors, we asked survivors with jobs to provide advice for men facing prostate cancer treatment and their families/friends, employers/co-workers, and healthcare providers. Methods: African-American and White prostate cancer survivors were recruited primarily from support groups and two southeastern cancer centers: Inclusion criteria included having (1) had a prostatectomy or radiation therapy less than 36 months ago, (2) worked for pay within one month prior to treatment, and (3) expected at time of treatment initiation to be working 6 months later. Survivors were engaged in 60-to-90-minute in-depth interviews. Interview transcripts were analyzed using a content analysis approach to ascertain prominent themes within and between races. Results: Forty-five prostate cancer survivors (44% black and 55% white) had a mean age of 61. Over half of men from either racial group had a bachelor’s degree. Approximately 63% and 47% from both racial groups had undergone a prostatectomy or radiation therapy, respectively. Prominent themes related to advice for prostate cancer survivors included the importance of: conducting thorough research on treatment options and gaining awareness of the treatment side effects; identifying survivors or survivor support groups; and informing family, employers, and others about support needs. Advice for family and friends emphasized the significance of providing instrumental and emotional support to survivors. Employer and co-worker advice most often related to providing work-related accommodations/support (e.g., additional time or adapted work tasks) and avoiding stigmatizing treatment of the survivor. Most advice for healthcare providers focused on presenting survivors with honest, thorough, and plain-language communication about treatment options and side effects. No major differences existed in themes by race. Conclusion: Overarching needs of employed prostate cancer survivors commonly relate to the need for detailed information about their treatment process and their desire for social support from family/friends, employers/co-workers, and healthcare providers. The most vital concern for survivors is understanding how, and to what extent, side effects can affect them personally and professionally. Future research should determine what strategies might be effective for preparing these stakeholder groups to support employed prostate cancer survivors. Citation Format: Otis L. Owens, Joanne Sandberg, Andy Mayfield, Emily Dressler, Melyssa Foust. A qualitative exploration of prostate cancer treatment and survivorship advice from employed prostate cancer survivors [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B051.

Behaviors Related to Medication Safety and Use During Pregnancy.

Background: Most women take medication during pregnancy despite limited scientific evidence on safety. We investigated medication use, including changes in and reasons for changes in use during pregnancy, with attention to medication use in pregnant women with chronic conditions. Materials and Methods: We conducted an online survey of pregnant women aged ≥18 years (n = 1,226). We calculated descriptive statistics for aspects of medication use and performed multivariable logistic regression to examine associations between change in use and chronic conditions. Results: Seventy-nine percent of women took at least one medication during pregnancy. Among those, 63.2% made at least one medication change: 42.0% started, 34.9% stopped, 30.0% missed dose(s), and 18.1% lowered dose(s) from that originally prescribed or recommended. More than a third (36.5%) of women who stopped, lowered, or missed medication did so independent of health care provider advice; 54.0% cited concern about birth or developmental defects as reasons for change. Odds of medication change were higher for women with chronic conditions: digestive conditions-starting (adjusted odds ratio [AOR] = 1.8, 95% confidence interval [CI] = 1.1-2.7), stopping (AOR = 2.1, 95% CI = 1.4-3.3), and lowering (AOR = 2.4, 95% CI = 1.7-3.3) medication; mental health conditions-starting (AOR = 1.6, 95% CI = 1.2-2.2), stopping (AOR = 3.0, 95% CI = 2.3-4.0), or missing (AOR = 2.1, 95% CI = 1.6-2.8) medication; pain conditions-stopping (AOR = 2.9, 95% CI = 2.0-4.2); and respiratory conditions-starting (AOR = 2.0, 95% CI = 1.3-3.1), stopping (AOR = 1.7, 95% CI = 1.1-2.6), and missing (AOR = 2.2, 95% CI = 1.4-3.4) medication. Conclusions: Most pregnant women take medication and many, including those with chronic conditions, change their medication use during pregnancy. Medication change may occur independent of health care provider advice and due to women's safety concerns.

Gender Differences in the Attitudes and Management of People with Obesity in Saudi Arabia: Data from the ACTION-IO Study.

PurposeSeveral studies have investigated gender differences in various obesity-related outcomes. Females were found to have more accurate weight perception and reported more frequency of attempted weight loss. The objective of this study was to assess gender differences in the attitudes and management of people with obesity (PwO) in Saudi Arabia using data from the ACTION-IO study.Patients and MethodsA survey was conducted in Saudi Arabia in June and July 2018 on adults with obesity (based on self-reported body mass index of ≥30 kg/m2).ResultsA total of 1000 people with obesity completed the survey; 565 (56.5%) were male (mean age of 36.9 years and mean BMI of 33.5 kg/m2) and 435 (43.5%) were female (mean age of 36.3 years and mean BMI of 34.5 kg/m2). The two most reported motivations for wanting to lose weight for both groups were to improve appearance (38%) and to have more energy (35%). Females were more likely to trust their health-care provider (HCP) advice about weight management when compared to males (87% females, 82% males, p = 0.059) and were more likely to have concerns regarding long-term safety associated with prescription weight loss medications (65% female versus 59% males, p = 0.043). On the other hand, males were more likely to seek their physician to prescribe weight loss medication if they hear of a new medication (55% males versus 46% females, p = 0.014), and more to believe that there are good options available for weight loss medications (74% males versus 67% females, p = 0.040). Also, more males prefer to take weight loss medications than to have a weight loss surgery (65% males, 59% females, p = 0.054).ConclusionOverall, this study increases our understanding on the attitudes of both females and males towards the management of weight loss and opens the discussion for gender-specific weight loss interventions.

Uptake of guideline-recommended postpartum diabetes screening among diverse women with gestational diabetes: associations with patient factors in an integrated health system in USA

IntroductionClinical guidelines urge timely postpartum screening for diabetes among women with gestational diabetes mellitus (GDM), yet patient factors associated with screening uptake remain unclear. We aimed to identify patient factors...

Personal Care and Household Cleaning Product Use among Pregnant Women and New Mothers during the COVID-19 Pandemic.

This study examined product use among pregnant women and new mothers in New York City during the COVID-19 pandemic (July 2020–June 2021). Women reported use of personal care and household cleaning products within the previous month, changes in antibacterial product use, receipt of healthcare provider advice, and opinions on environmental chemicals (n = 320). On average, women used 15 personal care products and 7 household cleaning products. Non-Hispanic Black women used nearly two more personal care products; non-Hispanic Black women, those with a college degree, and essential workers used 1–3 more household cleaning products. Women who were Hispanic or reported their race and ethnicity as Other were two times more likely to use antibacterial personal care products. Non-Hispanic Black, Hispanic, and women who reported their race and ethnicity as Other were 1.5 times more likely to increase antibacterial product use during the pandemic. Nearly all women agreed that environmental chemicals pose health risks and are impossible to avoid, while less than one quarter received advice regarding product use. Product use is a modifiable source of chemical exposures. Results from this study suggest that women may have increased their product use during the pandemic. Healthcare providers may use the current focus on health hygiene to promote discussion and assessment of environmental chemical exposures with patients.

Factors that shape pregnant women\u2019s perceptions regarding the safety of cannabis use during pregnancy

BackgroundCannabis use among pregnant women has increased. We surveyed pregnant women in rural Pennsylvania to examine cannabis use and opinions regarding its safety during pregnancy. We examined associations between challenges of pregnancy (e.g., exhaustion, pain, nausea) and cannabis use.MethodsA cross-sectional survey was administered to a convenience sample of English-speaking pregnant women receiving prenatal care at Geisinger, May–June 2019. Principal component analysis (PCA) was used to construct three scores (overwhelmed/exhausted, happy/optimistic, and health worries) based on 10 questions regarding common experiences during pregnancy (e.g., nausea/vomiting, pain, exhaustion, mood). A score based on four questions regarding cannabis safety during pregnancy was also constructed.ResultsFrom a maximum of 300 surveys distributed, 284 were completed (95%). Most participants were white (87%), married (49%) or living with a partner (38%), and had private health insurance (62%). Most women indicated it was unsafe to use alcohol and tobacco products during pregnancy (> 90%), but that proportion dropped to 82% and 63% regarding recreational cannabis and medical cannabis, respectively. Only women with prior cannabis use (23% of sample) continued to do so during pregnancy: 57% of women reporting daily cannabis use prior to pregnancy continued to use cannabis during pregnancy with 33% reporting daily use. Two thirds of users during pregnancy indicated they were self-medicating for: nausea (90%), anxiety (70%), insomnia (30%), and pain management (30%). Many (56%) of the women who used cannabis during pregnancy believed it is safe. Younger women and women who were overwhelmed/exhausted or less happy/optimistic were more likely to believe cannabis use is safe. Women valued healthcare provider advice more than advice from family and friends. Study strengths include a high response rate. Weaknesses include self-report and that is was a convenience sample; however, the demographics of the sample were similar to past studies.ConclusionWomen with a history of cannabis use, especially daily use, are at risk of continuing during pregnancy and should receive counseling. Younger women and women with greater stressors during pregnancy also are at greater risk. Screening for prior use and for stressors may identify patients that would benefit from enhanced counseling.

Factors associated with quit attempt and successful quitting among adults who smoke tobacco in Ethiopia: Global Adult Tobacco Survey (GATS) 2016

INTRODUCTIONTobacco is the leading cause of preventable death in the world. Identification of factors associated with quit attempts and successful quitting can help strengthen tobacco cessation programs. In Ethiopia, no prior study of such factors exists. Our aim was to identify factors associated with quit attempts and successful quitting among adults who smoke tobacco in Ethiopia.METHODSWe used the Ethiopian 2016 Global Adult Tobacco Survey (GATS) data (n=10150). GATS is a nationally representative household survey that collects data on sociodemographic and tobacco-related characteristics. We calculated prevalence of reported past 12 months quit attempts and successful quitting and performed logistic regression to obtain prevalence ratios with 95% confidence intervals. A p<0.05 was considered statistically significant.RESULTSOverall 42.0% of people who smoked tobacco made a quit attempt. Men were more likely (APR=3.9; 95% CI: 1.4–10.7) to make a quit attempt compared to women but were less likely to successfully quit (APR=0.6; 95% CI: 0.3–0.9). Those aware of the health harms of tobacco were 2.5 (95% CI: 1.1–5.5) and 3.9 (95% CI: 1.8–8.5) times as likely to make a quit attempt and successfully quit, respectively, than those unaware. Receiving healthcare provider advice to quit was not associated with quit attempts.CONCLUSIONSMore than 4 in 10 people smoking tobacco in Ethiopia are making attempts to quit. Receipt of healthcare provider advice to quit is not yet associated with quit attempts in Ethiopia; however, awareness of the health harms of tobacco is a powerful predictor of quit attempt and success in quitting. Improved access to cessation support and expanded awareness of the health harms of tobacco are urgently needed to enhance both quit attempts and success across Ethiopia.

Provider–Patient Interactions as Predictors of Lifestyle Behaviors Related to the Prevention and Management of Diabetes

Growing evidence suggests that healthcare provider advice may reduce alcohol use, increase physical activity, and improve the adoption of other desirable lifestyle behaviors among patients. However, how brief interventions and other provider–patient interactions can shape the cumulative adoption of multiple modifiable behaviors is less well studied for diabetes prevention and control. Using weighted Internet panel survey data from a large socio-demographically diverse urban population in the United States (n = 1003), the present study describes differences in group characteristics among those who ‘had been ever diagnosed’ with prediabetes/diabetes versus those who had not. It also examines the associations between the cumulative adoption of lifestyle behaviors and each of the following: (a) lifetime prediabetes/diabetes diagnosis; (b) brief lifestyle intervention exposure (i.e., ever received provider encouragement to modify lifestyle behaviors); and (c) recent provider–patient communication about diabetes. There were several group differences among those who ‘had been ever diagnosed’ with prediabetes/diabetes versus those who had not, by age, employment status, health status, nutrition knowledge, blood pressure/hypertension diagnosis, and diabetes-related health behaviors (p &lt; 0.05). Each of the three provider–patient interactions of interest were positively associated with a higher cumulative sum of adopted modifiable lifestyle behaviors for diabetes prevention and management. The results suggest that provider advice/provider–patient interactions of any type can have a salutary impact on whether individuals with prediabetes or type 2 diabetes will engage in recommended lifestyle behavior modifications.

How Do Health Schemas Inform Healthy Behaviours During Pregnancy? Qualitative Findings from the Be Healthy in Pregnancy (BHIP) Study.

Excess gestational weight gain (GWG) is associated with adverse long and short-term outcomes for both woman and child, yet evidence demonstrates pregnant women are frequently not engaging in healthy behaviours linked to appropriate weight gain. The purpose of the current study was to explore women's values and beliefs related to weight, nutrition and physical activity during pregnancy and to describe how these beliefs influence their behaviours. As part of a larger randomized controlled trial, we conducted 20 focus groups with 66 pregnant women between 16 and 24-weeks gestation using a semi-structured interview guide. Focus groups were recorded and transcribed verbatim and analyzed using a grounded theory approach. Three personal health schemas emerged from the findings which illustrated women's diverging beliefs about their health behaviours in pregnancy. 'Interconnected health' described beliefs regarding the impact their health had on that of their growing baby and awareness of risks associated with inappropriate weight gain. 'Gestational weight gain as an indicator of health' illustrated perceptions regarding how GWG impacted health and the utility of guidelines. Finally, 'Control in pregnancy' described the sense of agency over one's body and health. Our results showed that health-related behaviours in pregnancy are driven by personal health schemas which are often discordant with clinical evidence. Interventions and health care provider advice aimed at behaviour modification would benefit from first understanding and addressing these schemas. Tackling the conflict between beliefs and behaviour may improve health outcomes associated with appropriate weight gain in pregnancy.

Family Members Involvement in Patient Care: Are They Invited?

Introduction: Health care providers are expected to gain vital information regarding the patient, illness, and relationships from family members and the social network through therapeutic conversation, particularly when a patient is in a position where he/she cannot provide reliable or complete information. This review aimed to provide simple advice and tips for healthcare providers regarding the engagement of family members in developing an optimal nursing and medical healthcare plans for their relative patients during hospitalization and after being discharged Conclusions: The involvement of family members within a patient’s social network is essential for the development of an appropriate medical and nursing care plan. There is a pressing need to effectively use information obtained from family therapy interviews. Keeping an open communication channel with close family members during patient hospitalization is beneficial to the patient, family members and to healthcare providers. This will also offer a mutual understanding and a better adherence to the agreed healthcare plan. Furthermore, many aspects of medicine, including primary healthcare can be improved by family therapy. Key Words: Family-Oriented Patient Care, Healthcare Providers, Communication Skills, Family Therapy

Compliance to antihypertensive therapy and associated factors among adults’ hypertensive patients attending medical clinics in Kilifi County Kenya

Background: Hypertension is both public health and medical problem worldwide. Compliance to antihypertensive therapy is key in avoiding hypertension complications. The purpose of this study was to establish compliance to antihypertensive therapy and associated factors among adults’ hypertensive patients in Kilifi county Kenya.Methods: A facility-based cross-sectional was undertaken in four public health facilities in Kilifi County Kenya. Two hundred and thirteen hypertensive patients were recruited in the study. Data was collected using a pretested questionnaire and analyzed using Statistical package for social sciences (SPSS) version 23 software. Chi-square test was utilized in establishing the relations, while logistic regression was adopted to determine independent risk factors for compliance.Results: Compliance to antihypertensive therapy was recorded in 31 (14.6%) of the patients. A statistically significant association was established between compliance to antihypertensive therapy and patients knowledge (p&lt;0.001); age (p=0.024); education (p=0.04); income (p=0.013); duration on treatment (p=0.005); cost (p=0.029); health care provider advice (p=0.009); consistency of therapy (p=0.002); medicines availability (p=0.021); and health facility distance (p=0.013). Independent risk factors for compliance to antihypertensive therapy were the duration on treatment of (OR=0.383; 95%CI 0.151-0.972); Knowledge on hypertension (OR=2.715; 95%CI 1.598-4.615); Health care worker follow-ups (OR=0.452; 95%CI 0.282-0.726); and cost of medication (OR=2.682; 95%CI 1.134-6.345).Conclusions: Anti-hypertensive therapy compliance among patients was low. This could be attributed to factors that are socio-demographic, patient, and health service-related in nature. Prompt public health interventions that are patient-community centred are necessary to improve compliance to antihypertensive therapy.