Recall Bias Research Articles

Exploring the Potential of Electronic Patient-Generated Health Data for Evaluating Treatment Response to Intramuscular Steroids in Rheumatoid Arthritis: Case Series.

Mobile health devices are increasingly available, presenting exciting opportunities to remotely collect high-frequency, electronic patient-generated health data (ePGHD). This novel data type may provide detailed insights into disease activity outside usual clinical settings. Assessing treatment responses, which can be hampered by the infrequency of appointments and recall bias, is a promising, novel application of ePGHD. Drugs with short treatment effects, such as intramuscular steroid injections, illustrate the challenge, as patients are unlikely to accurately recall treatment responses at follow-ups, which often occur several months later. Retrospective assessment means that responses may be over- or underestimated. High-frequency ePGHD, such as daily, app-collected, patient-reported symptoms between clinic appointments, may bridge this gap. However, the potential of ePGHD remains untapped due to the absence of established definitions for treatment response using ePGHD or established methodological approaches for analyzing this type of data. This study aims to explore the feasibility of evaluating treatment responses to intramuscular steroid therapy in a case series of patients with rheumatoid arthritis tracking daily symptoms using a smartphone app. We report a case series of patients who collected ePGHD through the REmote Monitoring Of Rheumatoid Arthritis (REMORA) smartphone app for daily remote symptom tracking. Symptoms were tracked on a 0-10 scale. We described the patients' longitudinal pain scores before and after intramuscular steroid injections. The baseline pain score was calculated as the mean pain score in the 10 days prior to the injection. This was compared to the pain scores in the days following the injection. "Response" was defined as any improvement from the baseline score on the first day following the injection. The response end time was defined as the first date when the pain score exceeded the pre-steroid baseline. We included 6 patients who, between them, received 9 steroid injections. Average pre-injection pain scores ranged from 3.3 to 9.3. Using our definitions, 7 injections demonstrated a response. Among the responders, the duration of response ranged from 1 to 54 days (median 9, IQR 7-41), average pain score improvement ranged from 0.1 to 5.3 (median 3.3, IQR 2.2-4.0), and maximum pain score improvement ranged from 0.1 to 7.0 (median 4.3, IQR 1.7 to 6.0). This case series demonstrates the feasibility of using ePGHD to evaluate treatment response and is an important exploratory step toward developing more robust methodological approaches for analysis of this novel data type. Issues highlighted by our analysis include the importance of accounting for one-off data points, varying response start times, and confounders such as other medications. Future analysis of ePGHD across a larger population is required to address issues highlighted by our analysis and to develop meaningful consensus definitions for treatment response in time-series data.

‘Freeze the measles’: how to improve backward tracing with a new digital tool

Abstract Background A measles outbreak occurred in Tuscany, between January and April 2024. There were 37 cases (Incidence: 40,5 per million) with 32 cases (24 confirmed) in the Health District of Pisa. Even if bidirectional tracing showed a better effectiveness in pandemics, there aren’t ready-to-use standardized tools for backward tracing. Methods Pisa Public Health Unit created a digital tool based on a spreadsheet and called “Freeze the measles” which records measles cases and the locations where they passed through (hotspots). These were uploaded on a cloud shared with all the tracers. Hotspots have an expiry date of 21 days. Hotspots and home address case were plotted on a digital map. In a new investigation, tracers could find out if the case visited some hotspots before getting sick and check the distance between home address and hotspots, reducing recall bias. Every case was interviewed about 21 days before rash onset (backward) and plus or minus 4 days of rash onset (forward). The tool matched data to identify contacts and exposure. Results Since the index case wasn’t found, the first 5 unrelated cases were considered index cases for this outbreak. Second and third wave involved 17 cases. The tool allows to find an epidemiological link for 16 of them, while 1 case remained unrelated. A super-spreader was identified with 12 secondary cases occurred at hospital emergency room (7), at a near home minimarket (4) and in a large furniture store (1). In second and third waves, tool was able to link 94% of cases. 2 additional cases were imported. When the last hotspot became frozen without new cases occurring, the outbreak was considered ended. The outbreak lasted 33 days. Conclusions The “Freeze the measles” tool allows to identify transmission chains through an interactive map built on cases and their mobility. Key messages • Contact tracing needs an appropriate backward investigation to be more effective. • New digital tools as ‘Freeze the measles’ could improve preparedness and management of outbreaks.

Demographic, socioeconomic and lifecourse risk-factors for internalized weight stigma

Abstract Background Obesity is highly stigmatized, with negative obesity-related stereotypes widespread across society. Internalized weight stigma (IWS) is linked to negative outcomes including poor mental health and disordered eating. Previous evidence examining population groups at higher risk of experiencing IWS comes from small, nonrepresentative samples. Here, we re-assess previously reported associations of IWS with social factors in a large general population birth cohort study for the first time. Methods In the Avon Longitudinal Study of Parents and Children (ALSPAC), we explored differences in IWS at age 31 years by sex, ethnicity, socioeconomic factors, and sexual orientation using multivariable regression. Using data collected over a 32-year period, we explore the impact of family, peer, and wider social influences in adolescence, and bullying from mid-childhood to adulthood, whilst minimising risk of recall bias. Results In models adjusted for potential confounders and BMI in childhood, adolescence, and adulthood (N = 4060), IWS was higher for females (0.56 S.D. higher, CI:0.50-0.61), sexual minorities (0.17 S.D. higher, CI:0.09-0.24), and less socioeconomically advantaged individuals (0.16 S.D. higher (CI:0.08-0.24) for those whose mothers had minimum or no qualifications, compared to a university degree). The social environment during adolescence and young adulthood was important: IWS was higher for people who at age 13 years felt pressure to lose weight from family (0.13 S.D., CI:0.03-0.23), and the media (S.D. 0.17, CI:0.10-0.25), or had experienced bullying (0.25 S.D., CI:0.17-0.33 for bullying at age 23 years). Conclusions Internalized weight stigma differs substantially between demographic groups, and this is not explained by differences in BMI. The family environment during adolescence, bullying, and pressure to lose weight from the media may have long-lasting impacts on adult IWS. These may be fruitful avenues for intervention to reduce IWS and its consequences. Key messages • Females, sexual minorities, and socioeconomically disadvantaged adults are at greater risk of IWS irrespective of BMI. • To reduce IWS, interventions should improve the family and social environment.

Head-to-head comparison of 68Ga-FAPI-46 PET/CT, 18F-FDG PET/CT, and contrast-enhanced CT for the detection of various tumors.

FAPI-PET/CT exhibits high tumor uptake and low background accumulation, enabling high-sensitivity tumor detection. We compared the diagnostic performance of 68Ga-FAPI-46 PET/CT plus contrast-enhanced CT (CE-CT), 18F-FDG PET/CT plus CE-CT, and standalone CE-CT in patients with various malignancies. 232 patients underwent 68Ga-FAPI-46 PET/CT,18F-FDG PET/CT, and CE-CT each within 4weeks. Detection rates were assessed by a blinded reader, with ≥ 2weeks between scans of the same patient to avoid recall bias. A sub-analysis of diagnostic performance was performed for 490 histopathologically validated lesions. Detection rates were compared using McNemar's test. Lesion-based detection rates in 68Ga-FAPI-46 PET/CT plus CE-CT, 18F-FDG PET/CT plus CE-CT, and CE-CT alone were 91.2% (1540/1688), 82.5% (1393/1688) and 60.2% (1016/1688). The detection rates were significantly higher for 68Ga-FAPI-46 PET/CT plus CE-CT than for 18F-FDG PET/CT plus CE-CT (p < 0.02 for primary lesions and p < 0.001 for total, abdominopelvic nodal, liver and other visceral lesions) and CE-CT (p < 0.0001 for total, primary, cervicothoracic nodal, abdominopelvic nodal, liver, other visceral, and bone lesions). In the sub-analysis, sensitivity, specificity, positive and negative predictive value, and accuracy were 61.3%, 96.7%, 81.4%, 91.4% and 90.0% for 68Ga-FAPI-46 PET/CT plus CE-CT, 57.0%, 95.7%, 75.7%, 90.5% and 88.4% for 18F-FDG PET/CT plus CE-CT, and 51.6%, 97.2%, 81.4%, 89.6% and 88.6% for CECT, respectively. 68Ga-FAPI-46 PET/CT plus CE-CT demonstrates a higher tumor detection rate than 18F-FDG PET/CT plus CE-CT and CE-CT in a diverse spectrum of malignancies, especially for primary, abdominopelvic nodal, liver, and other visceral lesions. Further studies on which entities draw particular benefit from 68Ga-FAPI-46 PET/CT are warranted to aid appropriate diagnostic workup. A total of N = 232 patients were analyzed. Of these, N = 50 patients were included in a prospective interventional trial (NCT05160051), and N = 175 in a prospective observational trial (NCT04571086) for correlation and clinical follow-up of PET findings; N = 7 patients were analyzed retrospectively.

The Global Burden of Absenteeism Related to COVID-19 Vaccine Side Effects Among Healthcare Workers: A Systematic Review and Meta-Analysis.

Background: A rise in absenteeism among healthcare workers (HCWs) was recorded during the COVID-19 pandemic, mostly attributed to SARS-CoV-2 infections. However, evidence suggests that COVID-19 vaccine-related side effects may have also contributed to absenteeism during this period. This study aimed to synthesize the evidence on the prevalence of absenteeism related to COVID-19 vaccine side effects among HCWs. Methods: The inclusion criteria for this review were original quantitative studies of any design, written in English, that addressed absenteeism related to the side effects of COVID-19 vaccines among HCWs. Four databases (PubMed, Scopus, Embase, and the Web of Science) were searched for eligible articles on 7 June 2024. The risk of bias was assessed using the Newcastle-Ottawa scale. Narrative synthesis and a meta-analysis were used to synthesize the evidence. Results: Nineteen observational studies with 96,786 participants were included. The pooled prevalence of absenteeism related to COVID-19 vaccine side effects was 17% (95% CI: 13-20%), while 83% (95% CI: 80-87%) of the vaccination events did not lead in any absenteeism. Study design, sex, vaccination dose, region, and vaccine type were identified as significant sources of heterogeneity. Conclusions: A non-negligible proportion of HCWs were absent from work after reporting side effects of the COVID-19 vaccine. Various demographic factors should be considered in future vaccination schedules for HCWs to potentially decrease the burden of absenteeism related to vaccine side effects. As most studies included self-reported questionnaire data, our results may be limited due to a recall bias. Other: The protocol of the study was preregistered in the PROSPERO database (CRD42024552517).

Ostracism Experiences Are Associated With More Frequent Doctor Visits Over Time

Abstract: Background: Individuals generally see doctors to get physically well, with potential benefits but also costs. We investigate ostracism (feeling ignored and excluded) as one possible factor for frequently seeing doctors. Aims: We test three different conceptual accounts: (1) Ostracism may impact health through stress and social pain processes (i.e., sickness account). (2) Seeing doctors may satisfy psychological needs that are typically threatened by ostracism, constituting a way of coping (i.e., coping account). (3) In the reverse direction, individuals who see doctors more frequently may be ostracized out of health stigmatization (i.e., stigmatization account). Method. Ostracism experiences, number of doctor visits, and medical diagnoses were assessed in a longitudinal, nationally representative panel survey of German adults ( N = 2,001, two waves). Results: In cross-lagged panel analyses, ostracism predicts more frequent doctor visits 3 years later, even when controlling for medical diagnoses, suggesting doctor visits as a way of coping with ostracism. Number of medical diagnoses, but not doctor visits, longitudinally predict ostracism reports, potentially as an expression of health stigmatization. Limitations: The present results have been accrued in one context (Germany). We used retrospective recall of doctor visits, although we do not expect systematic recall biases based on ostracism experiences that could have altered the results. Conclusion: Ostracism leads to more frequent health care utilization. We conclude that seeing doctors more frequently may be a response to ostracism and call for efforts to develop ostracism-specific treatments and interventions.

Estimating Change in Health-Related Quality of Life before and after Stroke: Challenges and Possible Solutions.

Estimating change in health-related quality of life (HRQOL) from pre- to poststroke is challenging because HRQOL is rarely collected prior to stroke. Leveraging HRQOL data collected both before and after stroke, we sought to estimate the change in HRQOL from prestroke to early poststroke. Stroke survivors completed the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) scale at both pre- and early poststroke. Patient characteristics were compared for those who did and did not complete the PROMIS-GH. The mean change in PROMIS-GH T-score was estimated using complete case analysis, multiple imputation, and multiple imputation with delta adjustment. A total of 4,473 stroke survivors were included (mean age 63.1 ± 14.1 y, 47.5% female, 82.6% ischemic stroke). A total of 993 (22.2%) patients completed the PROMIS-GH at prestroke while 2,298 (51.4%) completed it early poststroke. Compared with those without PROMIS-GH, patients with PROMIS-GH prestroke had worse comorbidity burden. Patients who completed PROMIS-GH early poststroke had better early poststroke clinician-rated function and shorter hospital length of stay. Complete case analysis and multiple imputation revealed patients' PROMIS-GH T-scores worsened by 2 to 3 points. Multiple imputation with delta adjustment revealed patients' PROMIS-GH T-scores worsened by 4 to 10 points, depending on delta values chosen. Systematic differences in patients who completed the PROMIS-GH at both pre- and early poststroke suggest that missing PROMIS-GH scores may be missing not at random (MNAR). Multiple imputation with delta adjustment, which is better suited for MNAR data, may be a preferable method for analysis of change in HRQOL from pre- to poststroke. Given our study's large proportion of missing HRQOL data, future studies with less missing HRQOL data are necessary to verify our results. Estimating the change in health-related quality of life from pre- to poststroke is challenging because health-related quality-of-life data are rarely collected prior to stroke. Previously used methods to assess the burden of stroke on health-related quality of life suffer from recall bias and selection bias.Using health-related quality-of-life data collected both before and after stroke, we sought to estimate the change in health-related quality of life after stroke using statistical methods that account for missing data.Comparisons of patients who did and did not complete health-related quality-of-life scales at both pre- and poststroke suggested that missing data may be missing not at random.Statistical methods that account for data that are missing not at random revealed more worsening in health-related quality of life after stroke than traditional methods such as complete case analysis or multiple imputation.

High-intensity focused ultrasound (HIFU) for the treatment of female urinary incontinence: A retrospective analysis.

This study aims to demonstrate the effectiveness of high-intensity focused ultrasound, a noninvasive treatment, for managing urinary incontinence (UI) in women. This is a single-center, retrospective study involving 28 women. Patients, aged between 32 and 65, were included. Patients with insulin-dependent diabetes, neurological disease, active urinary tract infection, undiagnosed vaginal bleeding, who had incontinence surgery, and receiving estrogen therapy were excluded from the study. Incontinence severity was evaluated with the International Incontinence Consultation Questionnaire Short Form (ICIQ-SF). Patients were evaluated before treatment and 6 months after treatment using the ICIQ-SF and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Assessment short form. In the analysis of numerical variables independent or paired t test or linear mixed effects models were used. Least square means were used in post hoc comparisons. Mean age of the patients was 45.50 ± 7.59 years. There were 18 (64%) stress urinary incontinence (SUI) and 10 (36%) mixed urinary incontinence (MUI). Six months after treatment, mean ICIQ-SF and Pelvic Organ Prolapse/Urinary Incontinence Short Form Questionnaire scores showed a significant positive change. After the procedure, UI completely disappeared in 43% of the patients. The rate of severe UI decreased from 39% to 8%, and very severe UI decreased from 8% to 0%. Incontinence severity was significantly different in the MUI and SUI groups before and after the procedure. After the procedure, UI completely disappeared in 67% of the patients in the SUI group, while it remained at a mild level in 33%. The decrease in ICIQ-SF score in the SUI group was significantly higher than that in the MUI group. There were no severe adverse events, in 4 patients there was mild vaginal discharge which resolved in 1 week. This study showed that high-intensity focused ultrasound treatment, can be effective and safe even in a single session. Selection and recall biases are potential biases in retrospective studies. Lacking a control group is another limitation. Although advances in technology are very important for medical treatments, their effectiveness and safety need to be proven. Future research in this area with a larger sample size and a prospective design will offer further evidence supporting effectiveness of this treatment model.

Effect of childhood trauma on cognitive function in individuals with major depressive disorder and healthy controls

BackgroundIndividuals with major depressive disorder (MDD) exhibit cognitive impairment, while childhood trauma (CT) is associated with an elevated risk of both MDD and cognitive dysfunction. The effect of CT on cognitive function in MDD patients and healthy controls (HCs) is unclear. MethodsMDD patients and HCs were enrolled between December 2013 and December 2016. The Childhood Trauma Questionnaire (CTQ) was used to assess CT. Depressive symptoms and cognitive function were assessed at baseline and after 8-week acute-phase treatment with selective serotonin reuptake inhibitors (SSRIs) in MDD patients. ResultsA total of 909 people were included in the analysis. The interaction between MDD and CT had a main effect on Digit Symbol-Coding Test (DSCT), Stroop Color Test (SCT), and Stroop Color-Word Test (SCWT) scores. The effect of CT on cognitive function disappeared after adjusting for MDD diagnosis and years of education. Neglect could predict poor performance on SCT and SCWT in the HC group. After acute-phase treatment with SSRIs, CT did not significantly predict changes in cognitive function or depressive symptoms. LimitationsThe CTQ assessment might cause recall bias, and the cross-sectional design could not establish the causal link between CT and cognitive function. ConclusionThe effect of CT on cognitive function was modulated by MDD diagnosis and years of education. CT did not predict changes in depressive symptoms or cognitive function after acute-phase treatment with SSRIs. The direct influence of CT on cognitive function in MDD patients may be over-estimated. Trial registrationClinicalTrials.gov: NCT02023567; registration date: December 2013.

Neuropsychiatric symptoms of patients two years after experiencing severe COVID-19: A mixed observational study

BackgroundThe impact of SARS-CoV-2 infection (COVID-19) on mental health has not been extensively studied in the medium and long term. This study assessed how clinical, biological, and social factors affect mental health in patients who recovered from severe COVID-19. The evaluation was done 90 days after hospital discharge and followed up at 12 and 24 months. MethodsA retrospective-prospective cohort mixed observational study was conducted on patients over 18 years of age who required hospitalization in Internal Medicine or ICU for severe COVID-19 pneumonia during 2020 and 2021. Demographic information, clinical variables, and data for the scales were obtained from electronic medical records and telephone interviews. For comparisons of the different variables in each clinical variable (insomnia, depression, anxiety), the Student's t-test for independent samples has been used (normal distribution); otherwise, the Mann–Whitney test will be used. All tests and intervals will be performed with a confidence level of 95. Fisher's exact or Pearson's Chi-square test has been used as appropriate for qualitative variables. Results201 patients were recruited. 37.3% presented insomnia, 22.4% anxiety, and 21.4% depressive symptoms. A direct association was established between female sex and depressive symptoms. Psychotropic history, fatigue, and C-reactive protein levels (CRP) were correlated with depression. Anosmia and ageusia, CRP, cognitive symptoms, and dyspnea predicted insomnia. Sex, orotracheal intubation (OTI), pain, fatigue, mental health history, and academic level were independent predictors of anxiety. High percentages of depressive, anxiety, and insomnia symptoms were detected in the second month after discharge and persisted at 12 and 24 months. The fatigue variable maintained a significant relationship with depressive symptoms at 2, 12 and 24 months. A possible limitation could be recall bias in retrospective data collection. ConclusionsThis is a novel study to follow up on mental health for two years in patients with severe COVID-19. Clinical, biological, and psychosocial variables could be predictors of depressive symptoms, anxiety, and insomnia. The psychiatric symptoms persisted throughout the 2-year follow-up. These findings are critical for the follow-up of these patients and open the possibility of further studies in the medium and long term.

A multicenter study to evaluate the analytical precision by pathologists using the Aperio GT 450 DX

BackgroundDigital pathology systems (DPS) are emerging as capable technologies for clinical practice. Studies have analyzed pathologists' diagnostic concordance by comparing reviews of whole slide images (WSIs) to glass slides (e.g., accuracy). This observational study evaluated the reproducibility of pathologists' diagnostic reviews using the Aperio GT 450 DX under slightly different conditions (precision). MethodDiagnostic precision was tested in three conditions: intra-system (within systems), inter-system/site (between systems/sites), and intra- and inter-pathologist (within and between pathologists). A total of five study/reading pathologists (one pathologist each for intra-system, inter-system/site, and three for intra-pathologist/inter-pathologist analyses) were assigned to the respective sub-studies.A panel of 69 glass slides with 23 unique histological features was used to evaluate the WSI system's precision. Each glass slide was scanned to generate a unique WSI. From each WSI, the field of view (FOV) was generated (at least 2 FOVs/WSI), which included the selected features (1–3 features/FOV). Each pathologist reviewed the digital slides and identified which morphological features, if any, were present in each defined FOV. To minimize recall bias, an additional 12 wild card slides from different organ types were used for which FOVs were extracted. The pathologists also read these wild card slides FOVs; however, the corresponding feature identification was not included in the final data analysis. ResultsEach measured endpoint met the pre-defined acceptance criteria of the lower bound of the 95% confidence interval (CI) overall agreement (OA) rate being ≥85% for each sub-study. The lower bound of the 95% CI for the intra-system OA rate was 95.8%; for inter-system analysis, it was 94.9%; for intra-pathologist analysis, 92.4%, whereas for inter-pathologist analyses, the lower bound of the 95% CI of the OA was 90.6%. ConclusionThe study results indicate that pathologists using the Aperio GT 450 DX WSI system can precisely identify histological features that may be required for accurately diagnosing anatomic pathology cases.

Are Danes really happier than Swedes and Australians? A comparative analysis of subjective well-being measurement issues in Denmark, Sweden, and Australia

This study examines the reliability of cross-national subjective well-being (SWB) survey data, by corroborating the persistently high SWB-rankings of Denmark through a comparison to Sweden and Australia, two countries with similar or superior social, economic, and health indicators. Our research focuses on both the affective and the cognitive component of SWB, with a special emphasis on the affective component. We investigate four potential measurement issues that could contribute to Denmark’s elevated SWB scores: linguistic inconsistencies in survey translations, variations in answering scale usage, recall bias of affect, and positivity bias in life satisfaction judgments. To address these concerns, we utilize multi-group confirmatory factor analysis, analyse emotion-focused anchoring vignettes, examine affect items across varying time frames, and contrast overall life satisfaction assessments with those of domain-specific satisfaction. Despite accounting for various potential measurement issues, our results reveal that Danes consistently report higher SWB than their Swedish and Australian counterparts, although the differences are small for several of the measures. This finding implies that the SWB survey-data is reliable in this case, and that Denmark's high SWB rankings are not attributable to measurement biases but may indeed signify genuinely high levels of SWB. This paper adds to the growing body of literature on cross-national SWB comparisons and might provide insights for researchers aiming to compare well-being across countries.

The relationship of childhood maltreatment, adult sexual victimization, depressed mood and symptoms of trauma with fear of childbirth

Background: Fear of childbirth (FoB) is experienced to some degree by most pregnant people and can be intense enough to merit treatment. Despite significant research on the topic of FoB, studies investigating various forms of maltreatment and mental health symptoms in relation to FoB are very limited. In particular, studies including multiple forms of maltreatment along with mental health symptoms as predictors of FoB are extremely limited. We sought to fill this gap and clarify the relative contributions of these variables to the prediction of FoB. Methods: This was a secondary analysis of data from pregnant people in Canada. Participants (N = 881) provided demographic and reproductive history information, completed self-report measures of FoB, childhood maltreatment (multiple forms), adult sexual victimization, depressed mood and symptoms of posttraumatic stress disorder (PTSD). They were also administered a diagnostic interview to assess for specific phobia, FoB. Analyses included descriptive information, Wilcoxon rank sum tests, linear and logistic regression, and path analysis. Results: Most forms of maltreatment showed some association with increased FoB. However, when assessed together, only emotional maltreatment remained a significant predictor of FoB. Both depressed mood and symptoms of PTSD contributed more to FoB than maltreatment, and mediated the relationship of emotional maltreatment with FoB. The only direct effects of childhood emotional maltreatment on FoB were for fears of medical interventions and feelings of embarrassment during labour and delivery. Limitations: Study findings fill significant gaps in our understanding of the relationship between maltreatment, mental health symptoms and FoB. However, the study sample was limited to Canadian participants, most of whom were socio-economically advantaged, cis-gender women of European descent, thus limiting the generalizability of the findings. Further, as childhood maltreatment and sexual assault experiences in adulthood were reported retrospectively, study findings are also vulnerable to recall bias. Conclusions: Findings contribute to our understanding of the relationship between childhood maltreatment, adult sexual victimization, mental health and FoB. These findings can facilitate future research and improved care via a focus on depressed mood, symptoms of PTSD, emotional maltreatment and specific fears of medical interventions and social discomfort as significant contributors to one's experience of FoB.

Quality of Life, Functional Outcomes, and Recurrence After Resection Rectopexy Versus Ventral Mesh Rectopexy for Rectal Prolapse Repair.

Resection rectopexy and ventral mesh rectopexy are widely accepted surgical options for the treatment of rectal prolapse, however reports on long-term recurrence rates and functional outcomes are lacking. We compared quality of life, long-term functional outcomes and prolapse recurrence after resection rectopexy versus ventral mesh rectopexy. We retrospectively reviewed our prospectively collected rectal prolapse surgery database. Patients who underwent resection rectopexy or ventral mesh rectopexy at our center between 2009 and 2016 were included. Two hundred twenty patients were included, of which 208 (94%) female; 85 (39%) underwent resection rectopexy, 135 (61%) ventral mesh rectopexy. Prolapse recurrence. The resection rectopexy group was younger (median 52 vs 60 years old, p = 0.02) and had more open procedures (20% vs 9%, p < 0.001). After a median follow-up of 110 (IQR 94 - 146) months for resection rectopexy and 113 (87 - 137) for ventral mesh rectopexy, recurrences occurred in 21 (26%) in the resection rectopexy and 50 (39%) in the ventral mesh rectopexy group (p = 0.041). Median time to recurrence was 44 (18 - 80) months in the resection rectopexy group and 28.5 (11 - 52.5) in the ventral mesh rectopexy group (p = 0.14). There were no differences in the recurrence rate for primary prolapses in resection rectopexy vs ventral mesh rectopexy. Recurrence rate for re-do prolapses was higher in the ventral mesh rectopexy group 63% at 10 years, versus 25% in resection rectopexy group (p = 0.006). Functional outcomes were similar between the two groups. Retrospective review, recall bias. Long-term quality of life and functional outcomes after resection rectopexy and ventral mesh rectopexy were comparable. Ventral mesh rectopexy was associated with a higher prolapse recurrence rate after recurrent rectal prolapse repair. See Video Abstract.

Combining Web Analytics and a Web-Based User Survey for LibGuides Assessment

Method name(s) Web/Data Analytics; Web Survey; Project Outcome Model Objective The aim of this method is to assess an online library guide, using both qualitativeand quantitative methods, with the specific objective of discovering who is using the guideand why, as well as understanding the impact of the guide on user learning outcomes.Approach: This method combines the use of web/data analytics (quantitative) and aweb-based survey (quantitative and qualitative) with an existing model for measuring learningoutcomes. By combining these methods, a more robust assessment of an online guide can beachieved. Data Type Used The discussed online guide assessment used data from Google Analyticsand from a web-based survey, created in Qualtrics, with learning outcome questionsdeveloped using the Project Outcome for Academic Libraries Toolkit. Strengths The combined analysis of the web analytics and survey data resulted in anexpanded assessment of the library guide and a richer picture of guide users, their behavior,and their learning outcomes. Limitations Individually, each method used in this research has limitations. Web analyticsare unable to determine users’ motivation (why) for using the guide and whether they havelearned (impact) from their behavior/interaction while using the guide. Surveys collectself-reported data and may be subject to recall bias. However, when the methods arecombined, each helps to counteract the individual limitations.

Musculoskeletal Injury in Australian Infantry Personnel: A Cross-sectional Study to Understand Prevention Priorities.

Musculoskeletal injury patterns are under-investigated in the Royal Australian Infantry Corps. Subsequently, more evidence is needed to support injury prevention processes in this population. One difficulty in collecting injury information to monitor injury patterns within combat populations accurately is known injury concealment behaviors in such populations. This study aims to examine musculoskeletal injury epidemiology within Australian infantry battalions using a tailored approach to mitigate reporting avoidance. A cross-sectional study using an anonymous online survey captured musculoskeletal injury information directly from personnel serving within 2 Australian infantry battalions. The survey requested information on participants' injury frequency in the previous 12 months and the context of participants' most severe injury. Injury context was restricted to the most severe during the period to limit recall bias. The applied injury case definition encompassed all injuries that affected an individual's ability to perform in their role. A descriptive analysis of all data recorded across the 2 battalions was conducted. Subgroup statistical difference was assessed by examining the 95% CI overlap between groups. The Department of Defence and Veterans' Affairs Human Research Ethics Committee granted ethical approval for this study. Overall, 166 individuals self-reported at least 1 injury in the past 12 months, representing a period prevalence of 55.5% (95% CI, 49.8-61.0%). No statistically significant prevalence differences existed between employment type, age, or sex. Approximately a quarter of injured participants were medically reclassified because of their injury, impacting their deployment fitness (n = 40, 24.4%). The following results relate to the most severe injury personnel experienced. Most injuries were service-related (n = 152, 91.6%). Field activities (n = 64, 39.3%) and physical training (n = 59, 36.2%) were the most common injury-related activities. Running was the most reported injury mechanism (n = 35, 21.7%), followed by pack marching (n = 29, 18.9%) and fall, slip, or trip (n = 18, 11.2%). Musculoskeletal injuries are common in the Australian infantry and significantly burden the workforce. Physical training and field exercises are most associated with injury and represent opportunities for injury risk-mitigation strategies to support the overall deployability of personnel and the combat effectiveness of their battalions. Future research should more formally explore the injury risk factors related to these activities using more robust study designs to collect injury and exposure information more accurately and reliably. One study strength includes using military-specific international injury surveillance guidelines to inform the survey design, to collect the recommended injury information for effective surveillance, and to enable future research comparison. A second study strength was tailoring the survey to promote participatory engagement, providing a high completion rate. A challenge in conducting this research was coordinating participant recruitment and data collection during domestic operations. Such challenges reflect the reality of conducting research in the military.

Analyzing the reporting error of public transport trips in the Danish national travel survey using smart card data

AbstractHousehold travel surveys have been used for decades to collect individuals and households’ travel behavior. However, self-reported surveys are subject to recall bias, as respondents might struggle to recall and report their activities accurately. This study examines the time reporting error of public transit users in a nationwide household travel survey by matching, at the individual level, five consecutive years of data from two sources, namely the Danish national travel survey (TU) and the Danish smart card system (Rejsekort). Survey respondents are matched with travel cards from the Rejsekort data solely based on the respondents’ declared spatiotemporal travel behavior. Approximately, 70% of the respondents were successfully matched with Rejsekort travel cards. The findings reveal a median time reporting error of 11.34 min, with an Interquartile Range of 28.14 min. Furthermore, a statistical analysis was performed to explore the relationships between the survey respondents’ reporting error and their socio-economic and demographic characteristics. The results indicate that females and respondents with a fixed schedule are in general more accurate than males and respondents with a flexible schedule in reporting their times of travel. Moreover, trips reported during weekdays or via the internet displayed higher accuracies compared to trips reported during weekends and holidays or via telephone interviews. This disaggregated analysis provides valuable insights that could help in improving the design and analysis of travel surveys, as well accounting for reporting errors/biases in travel survey-based applications. Furthermore, it offers valuable insights underlying the psychology of travel recall by survey respondents.

Post-traumatic growth promotes resilience development: A Longitudinal Mediation Model

BackgroundThe frequent occurrence of global disasters poses unprecedented challenges to nursing practice. The frontline nurses in disaster relief are exposed to these events and bear significant levels of stress and psychological distress. Resilience and posttraumatic growth (PTG) are essential protective factors that contribute to sustaining their mental health. The purpose of this study was to determine the directional relationship between resilience and PTG using a cross-lagged design. Furthermore, employing longitudinal mediation to test whether the T1 resilience of frontline nurses would promote the development of T3 resilience through the mediating role of T2 PTG. MethodsA total of 258 frontline nurses were selected as subjects. They completed self-reported measurements in three periods. The present study was conducted using a cross-lagged panel model and a longitudinal mediation model. ResultsThe results of cross-lagged path analysis from T2 to T3 showed that PTG could positively predict the development of resilience (β = 0.235, p < 0.001). Resilience did not positively predict the development of PTG (p > 0.05). The analysis of mediating effect results showed that the development of PTG at T2 mediated the relationship between resilience from T1 to T3. LimitationsFindings may be limited by self-report, recall bias of resilience before the epidemic and short tracking frequency. ConclusionsThese results can identify individuals with an increased risk of low resilience under disaster and the mediating role of posttraumatic growth in promoting the development of nurses' resilience, which provides a theoretical basis for psychological crisis intervention and the resilience promotion plan for posttraumatic growth under disaster events.

The impact of adverse childhood experiences on cognitive function among middle-aged and older Chinese adults: Multiple mediators of cognitive reserve and depressive symptoms

BackgroundAdverse childhood experiences (ACEs) are associated with later cognitive decline. However, the mechanisms underlying the effects of different types of ACEs are unclear. This study examined how ACEs impact cognitive function, specifically deprivation-related ACEs (DrACEs) and threat-related ACEs (TrACEs). Additionally, we explored the potential role of cognitive reserve (CR) and depression in these relationships. MethodsData were taken from the China Health and Retirement Longitudinal Study (CHARLS) of 2014 and 2020. CR, depressive symptoms and cognitive function measures were collected from 2020. ACEs were assessed at the 2014 Life Course Survey. The main analyses included 7113 participants aged 45 years or older. To explore potential associations, linear regression and SPSS Macro PROCESS were employed. ResultsAmong middle-aged and older adults, only exposure to DrACEs was associated with cognitive function ((β = −0.101 [95%CI: −0.150, −0.052]) for DrACEs = 1; (β = −0.250 [95%CI: −0.333, −0.167]) for DrACEs ≥ 2). The indirect effects mediated by CR and depressive symptoms were statistically significant. LimitationsThe use of retrospective self-reported data for ACEs may introduce recall bias. ConclusionsChinese middle-aged and older adults who have experienced DrACEs exhibit poorer cognitive function, while the association between TrACEs and cognitive function was not significant. And the impact of DrACEs on cognitive function was mediated by CR and depressive symptoms. Further research is necessary to validate our findings, establish causal links, and uncover the underlying mechanisms involved.

Canadian beach cohort study: protocol of a prospective study to assess the burden of recreational water illness

BackgroundRecreational water activities at beaches are popular among Canadians. However, these activities can increase the risk of recreational water illnesses (RWI) among beachgoers. Few studies have been conducted in Canada to determine the risk of these illnesses. This protocol describes the methodology for a study to determine the risk and burden of RWI due to exposure to fecal pollution at beaches in Canada.MethodsThis study will use a mixed-methods approach, consisting of a prospective cohort study of beachgoers with embedded qualitative research. The cohort study involves recruiting and enrolling participants at public beaches across Canada, ascertaining their water and sand contact exposure status, then following-up after seven days to determine the incidence of acute RWI outcomes. We will test beach water samples each recruitment day for culture-based E. coli, enterococci using rapid molecular methods, and microbial source tracking biomarkers. The study started in 2023 and will continue to 2025 at beaches in British Columbia, Manitoba, Ontario, and Nova Scotia. The target enrollment is 5000 beachgoers. Multilevel logistic regression models will be fitted to examine the relationships between water and sand contact and RWI among beachgoers. We will also examine differences in risks by beachgoer age, gender, and beach location and the influence of fecal indicator bacteria and other water quality parameters on these relationships. Sensitivity analyses will be conducted to examine the impact of various alternative exposure and outcome definitions on these associations. The qualitative research phase will include focus groups with beachgoers and key informant interviews to provide additional contextual insights into the study findings. The study will use an integrated knowledge translation approach.DiscussionInitial implementation of the study at two Toronto, Ontario, beaches in 2023 confirmed that recruitment is feasible and that a high completion rate (80%) can be achieved for the follow-up survey. While recall bias could be a concern for the self-reported RWI outcomes, we will examine the impact of this bias in a negative control analysis. Study findings will inform future recreational water quality guidelines, policies, and risk communication strategies in Canada.