Self-reported Health Outcomes Research Articles

Dietary habits and self-reported health outcomes in a cross-sectional survey of health-conscious adults eating a plant-based diet.

Given the growing popularity of plant-based diets, this study investigated the dietary habits and self-reported health outcomes of health-conscious adults consuming plant-based diets. A cross-sectional online survey (n = 315) was distributed to members of Plant-Based Health Professionals UK, a community interest company. Dietary intake was assessed through a food frequency questionnaire. Data were summarised descriptively. Dietary habits among respondents following a whole food plant-based (WFPB) and vegan diet were compared using hypothesis tests. Respondents reported following a WFPB (61%), vegan (28%) and semi plant-based (11%) diet. Median time on current dietary pattern was 5 years. Daily or more frequent consumption was reported for the following foods: fruits 77%, berries 51%, green vegetables 48%, cruciferous vegetables 45%, other vegetables 64%, beans/legumes 41%, whole grains 62%, nuts and all seeds 63%. Consumption of ultra-processed foods and plant-based meat alternatives was low. About 93% of those on a WFPB or vegan diet supplemented with vitamin B12 and 61% with vitamin D. The median body mass index was 22.4 kg/m2. Fifty per cent of participants reported weight loss after adopting a plant-based diet, with a median loss of 6.4 kg. Thirty-five per cent reported reversing or improving an underlying health condition, and 15% were able to stop or reduce prescribed medication use as a result of dietary changes. This study suggests that a well-planned plant-based diet is achievable and sustainable in a community setting and can be associated with health benefits. How to best encourage such sustainable diets among the broad population requires further research.

How group structure impacts the numbers at risk for coronary artery disease: polygenic risk scores and non-genetic risk factors in the UK Biobank cohort.

The UK Biobank is a large cohort study that recruited over 500,000 British participants aged 40-69 in 2006-2010 at 22 assessment centres from across the UK. Self-reported health outcomes and hospital admission data are two types of records that include participants' disease status. Coronary artery disease (CAD) is the most common cause of death in the UK Biobank cohort. After distinguishing between prevalence and incidence CAD events for all UK Biobank participants, we identified geographical variations in age-standardised rates of CAD between assessment centres. Significant distributional differences were found between the pooled cohort equation scores of UK Biobank participants from England and Scotland using the Mann-Whitney test. Polygenic risk scores of UK Biobank participants from England and Scotland and from different assessment centres differed significantly using permutation tests. Our aim was to discriminate between assessment centres with different disease rates by collecting data on disease-related risk factors. However, relying solely on individual-level predictions and averaging them to obtain group-level predictions proved ineffective, particularly due to the presence of correlated covariates resulting from participation bias. By using the Mundlak model, which estimates a random effects regression by including the group means of the independent variables in the model, we effectively addressed these issues. In addition, we designed a simulation experiment to demonstrate the functionality of the Mundlak model. Our findings have applications in public health funding and strategy, as our approach can be used to predict case rates in the future, as both population structure and lifestyle changes are uncertain.

Development of a nomogram for identifying periodontitis cases in Denmark.

Although self-reported health outcomes are of importance, attempts to validate a clinical applicable instrument (e.g., nomogram) combining sociodemographic and self-reported information on periodontitis have yet to be performed to identify periodontitis cases. Clinical and self-reported periodontitis, along with sociodemographic data, were collected from 197 adults. Akaike information criterion models were developed to identify periodontitis, and nomograms developed based on its regression coefficients. The discriminatory capability was evaluated by receiver-operating characteristic curves. Decision curve analysis was performed. Smoking [OR 3.69 (95%CI 1.89, 7.21)], poor/fair self-rated oral health [OR 6.62 (95%CI 3.23, 13.56)], previous periodontal treatment [OR 9.47 (95%CI 4.02, 22.25)], and tooth loss [OR 4.96 (95%CI 2.47, 9.97)], determined higher probability of having "Moderate/Severe Periodontitis". Age [OR 1.08 (95%CI 1.05, 1.12)], low educational level [OR 1.65 (95%CI 1.34, 2.23)], poor/fair self-rated oral health [OR 3.57 (95%CI 1.82, 6.99)], and previous periodontal treatment [OR 6.66 (95%CI 2.83, 15.68)] determined higher probability for "Any Periodontitis". Both nomograms showed excellent discriminatory capability (AUC of 0.83 (95%CI 0.75, 0.91) and 0.81 (95% CI 0.74, 0.88), good calibration, and slight overestimation of high risk and underestimation of low risk. Hence, our nomograms could help identify periodontitis among adults in Denmark.

Trajectories of risk and resilience: The role of empathy and perceived social support in the context of early adversity

BackgroundEvidence overwhelmingly suggests that adverse childhood experiences (ACEs) is a risk factor for poor mental health outcomes. However, the specific mechanisms via which ACEs confer an increased risk of psychopathology are less well understood. ObjectiveThe study modelled the effect of empathy and perceived social support (PSS) on mental health outcomes in a mixed clinical and non-clinical population, within the context of exposure to ACEs. Participants and settingA total of 575 participants (comprising a treatment-receiving and community-based sample), aged 18 to 65 completed self-report measures assessing early adversity, PSS, empathy, and mental health outcomes. MethodsMultiple mediation analyses were used to investigate whether empathy and PSS mediated the relationship between self-reported ACEs and mental health outcomes, and whether affective and cognitive empathy affected differentially the link between emotional neglect and psychological distress. ResultsResults revealed a statistically significant indirect effect of ACEs on adult mental health through affective empathy and PSS. Emotional neglect was the only type of adversity significantly correlated with both dimensions of empathy. The indirect effect of emotional neglect on mental health outcomes via cognitive and affective empathy was also statistically significant. ConclusionsStudy results highlight the role of affective empathy and PSS as transdiagnostic mechanisms influencing the pathway between early adversity and adult mental health, and the importance of taking these into account when designing interventions aiming to promote well-being among those who have experienced childhood adversity.

The impact of urbanization and economic development on health insurance performance: Evidence from China

Many previous studies find no significant effect of health insurance on health outcome in rural areas of China. Many researchers believe this could be because of the characteristics of health care provision in those areas. In this paper, we aim to examine if urbanization will change the situation. Our research question focuses on if urbanization will change the participation and performance of health insurance on health outcome in a positive direction. Using a longitudinal sample drawn from the China Health and Nutrition Survey (CHNS), we employed multiple estimation strategies for multiple waves to handle the potential selection bias. We find that urbanization factors such as population density, transportations and housing are associated with probability of insurance participation. That is, urbanization related factors tend to increase people’s willingness of insurance participation. We also conclude that urbanization improves the performance of insurance on self-reported health outcome. Results show that the health insurance has a significant positive impact on health production in urbanized areas. Health insurance in general increases the probability of health care utilization for all areas. However, it does not lead to a significant improvement in the health outcomes in under urbanized areas because of the health provision quality or characteristics of health insurance coverage in those areas.

0886 Impact of Multidimensional Sleep Health on Glycemic Control and Self-Reported Health Outcomes in Type 1 Diabetes

0886 Impact of Multidimensional Sleep Health on Glycemic Control and Self-Reported Health Outcomes in Type 1 Diabetes

Prevalence and Risk Factors of Depression and Posttraumatic Stress Disorder After a Mass Shooting

This cross-sectional study examines the self-reported mental health outcomes of adults 4 years after witnessing and surviving the shooting at the Route 91 Harvest Music Festival in Las Vegas, Nevada.

Association between Environmental Neighbourhood Attributes and Self-Reported Health Outcomes among Urban Residents in Eastern Europe: A Cross-Sectional Study

Environmental perception is a complex issue that has significant impacts on public health. Despite limited research on subjective perceptions of the environment in various global contexts, including Ukraine, this study aimed to identify perceived environmental factors among urban residents and to assess associations with various health indicators. This is a cross-sectional study using data from the national survey carried out in 2017 in Ukraine. Data on demographic, behavioural, socioeconomic, and lifestyle risk factors were processed. A factor analysis was used to identify three environmental factors: outdoor infrastructure, environment, and safety and roads. The associations between these factors and health indicators were assessed using complex samples logistic regression models. The study showed that perceived environmental factors were significantly associated with body mass index, physical activity, stroke, stress, and harmful habits. Outdoor infrastructure emerged as the most important factor associated with health-related outcomes. Environmental neighbourhood attributes can significantly impact an individual’s health, highlighting the need for policies and interventions that promote healthy neighbourhood environments, including improvements in outdoor infrastructure, community resources, and safety measures. Our findings suggest that urban environmental improvements should be a priority in primary disease prevention, would positively impact public health, and would be beneficial to the community.

Association of integration with oral health among Indian migrants living in the Netherlands.

Limited data exist about the relationship between acculturation and oral health. Hence, the aim of this study was to assess the association of integration with self-reported oral health, behaviours, and oral healthcare utilization among Indian migrants living in the Netherlands, a cross sectional survey study. Between February and April 2021, a random sample from Dutch municipalities was obtained for the Indian migrants living in the Netherlands (n = 147). A validated questionnaire was used to collect information on independent variables, namely socio-demographic, integration assessment tool: Immigration Policy Lab (IPL-12) and everyday discrimination scale (EDS). The outcome variables were self-reported oral health, oral health behaviours, and oral healthcare utilization. Multiple regression analysis was used to assess the associations. Higher integration among Indian migrants was associated with longer stay in the Netherlands, having a Dutch passport, intention to settle in the Netherlands, and having a permanent residence. After adjusting for covariates such as age, gender, marital status, education, income, occupation, and dental insurance, regression analysis showed that Indians with higher integration had lower odds of reporting their oral health as fair to poor [OR = 0.92(95%CI:0.0.85;0.99)] than the Indians with low integration scores. Also, Indians with higher integration had lower odds of using a manual toothbrush as compared to an electric toothbrush or use of both [OR = 0.86(95%CI:0.76;0.97)]. Highly integrated Indians had lower odds of consuming Indian sweets than lower integrated Indians (OR = 0.91; 95%CI:0.86;0.97). Indians with higher integration had 1.15 times (95% CI:1.03;1.29) higher odds of visiting a Dutch dental professional than visiting a dentist in both places (India and the Netherlands). No significant association was found between discrimination and the three outcome variables. Integration is positively association with self-reported oral health outcomes among the Indian migrants. Measure to improve integration among Indian migrants may help to promote healthy oral health behaviours and improve their oral health care utilization.

Objective and Subjective Intraindividual Variability in Sleep: Predisposing Factors and Health Consequences.

We investigated the factors that predispose or precipitate greater intraindividual variability (IIV) in sleep. We further examined the potential consequences of IIV on overall sleep quality and health outcomes, including whether these relationships were found in both self-reported and actigraphy-measured sleep IIV. In Study 1, 699 US adults completed a Sleep Intra-Individual Variability Questionnaire and self-reported psychosocial, sleep quality, and health outcomes. In Study 2, 100 university students wore actigraphy and completed psychosocial, sleep, and health surveys at multiple timepoints. In cross-sectional analyses that controlled for mean sleep duration, predisposing/precipitating factors to greater IIV were being an underrepresented racial/ethnic minority (Study 1: F = 13.95, p < .001; Study 2: F = 7.03, p = .009), having greater stress (Study 2: r values ≥ 0.32, p values ≤ .002) or trait vulnerability to stress (Study 1: r values ≥ 0.15, p values < .001), and showing poorer time management (Study 1: r values ≤ -0.12, p values ≤ .004; Study 2: r values ≤ -0.23, p values ≤ .028). In addition, both studies showed that greater sleep IIV was associated with decreased overall sleep quality, independent of mean sleep duration (Study 1: r values ≥ 0.20, p values < .001; Study 2: r values ≥ 0.33, p values ≤ .001). Concordance across subjective and objective IIV measures was modest ( r values = 0.09-0.35) and similar to concordance observed for subjective-objective mean sleep duration measures. Risk for irregular sleep patterns is increased in specific demographic groups and may be precipitated by, or contribute to, higher stress and time management inefficiencies. Irregular sleep may lead to poor sleep quality and adverse health outcomes, independent of mean sleep duration, underscoring the importance of addressing sleep consistency.

Resident Burnout, Wellness, Professional Development, and Engagement Before and After New Training Schedule Implementation

Burnout is a work-related syndrome of depersonalization (DP), emotional exhaustion (EE), and low personal achievement (PA) that is prevalent among internal medicine resident trainees. Prior interventions have had modest effects on resident burnout. The association of a new 4 + 4 block schedule (4 inpatient weeks plus 4 outpatient weeks) with resident burnout has not previously been evaluated. To evaluate the association of a 4 + 4 block schedule, compared with a 4 + 1 schedule, with burnout, wellness, and self-reported professional engagement and clinical preparedness among resident physicians. This nonrandomized preintervention and postintervention survey study was conducted in a single academic-based internal medicine residency program from June 2019 to June 2021. The study included residents in the categorical, hospitalist, and primary care tracks in postgraduate years 1 and 2 (PGY1 and PGY2). Data analysis was conducted from October to December 2022. In the 4 + 4 structure, resident schedules alternated between 4-week inpatient call-based rotations and 4-week ambulatory non-call-based rotations. The primary outcome was burnout, assessed using the Maslach Burnout Inventory subcategories of EE (range, 0-54), DP (range, 0-30), and PA (range, 0-48), adjusted for sex and PGY. Secondary outcomes included In-Training Examination (ITE) scores and a questionnaire on professional, educational, and health outcomes. Multivariable logistic regression was used to assess the primary outcome, 1-way analysis of variance was used to compare ITE percentiles, and a Bonferroni-adjusted Kruskal Wallis test was used for the remaining secondary outcomes. The findings were reexamined with several sensitivity analyses, and Cohen's D was used to estimate standardized mean differences (SMDs). Of the 313 eligible residents, 216 completed the surveys. A total of 107 respondents (49.5%) were women and 109 (50.5%) were men; 119 (55.1%) were PGY1 residents. The survey response rates were 78.0% (85 of 109) in the preintervention cohort and 60.6% (63 of 104) and 68.0% (68 of 100) in the 2 postintervention cohorts. The PGY1 residents had higher response rates than the PGY2 residents (119 of 152 [78.2%] vs 97 of 161 [60.2%]; P < .001). Adjusted EE scores (mean difference [MD], -6.78 [95% CI, -9.24 to -4.32]) and adjusted DP scores (MD, -3.81 [95% CI, -5.29 to -2.34]) were lower in the combined postintervention cohort. The change in PA scores was not statistically significant (MD, 1.4 [95% CI, -0.49 to 3.29]). Of the 15 items exploring professional, educational, and health outcomes, a large positive association was observed for 11 items (SMDs >1.0). No statistically significant change in ITE percentile ranks was noted. In this survey study of internal medicine resident physicians, a positive association was observed between a 4 + 4 block training schedule and internal medicine resident burnout scores and improved self-reported professional, educational, and health outcomes. These results suggest that specific 4 + 4 block combinations may better improve resident burnout than a 4 + 1 combination used previously.

Changes in self-reported health and wellbeing outcomes in 36,951 primary school children from 2014 to 2022 in Wales: an analysis using annual survey data.

This study examines the changes in childhood self-reported health and wellbeing between 2014 and 2022. An annual survey delivered by HAPPEN-Wales, in collaboration with 500 primary schools, captured self-reported data on physical health, dietary habits, mental health, and overall wellbeing for children aged 8-11 years. The findings reveal a decline in physical health between 2014 and 2022, as evidenced by reduced abilities in swimming and cycling. For example, 68% of children (95%CI: 67%-69%) reported being able to swim 25m in 2022, compared to 85% (95% CI: 83%-87%) in 2018. Additionally, unhealthy eating habits, such as decreased fruit and vegetable consumption and increased consumption of sugary snacks, have become more prevalent. Mental health issues, including emotional and behavioural difficulties, have also increased, with emotional difficulties affecting 13%-15% of children in 2017-2018 and now impacting 29% of children in 2021-2022. Moreover, indicators of wellbeing, autonomy, and competence have declined. Importantly, this trend of declining health and wellbeing predates the onset of the Covid-19 pandemic, suggesting that it is not solely attributed to the pandemic's effects. The health of primary school children has been on a declining trajectory since 2018/2019 and has continued to decline through the COVID recovery period. The study suggests that these trends are unlikely to improve without targeted intervention and policy focus.

Associations of compositional time use with self-reported health, depression, and cognitive outcomes among Chinese adolescents

Adolescents are experiencing substantial changes across many developmental dimensions. Their daily time allocation might be closely related to these changes. Using two waves of nationally representative data (Mage = 12.90, n = 8,030), this study examined the evolving time-use patterns of Chinese junior high school students (CJHSS) transitioning from grades 7 to 8 and their impacts on self-reported health, depressive symptoms, and cognitive abilities. The latent class analysis identified four stable time-use clusters among CJHSS: obedient actives (OA, highest study time), moderate actives (MoA, high study time), independent actives (IA, lowest study time and highest other time), and multifaceted actives (MuA, highest sleep time). Individual fixed-effect models revealed that transitioning to study-centered actives (OA and MoA) decreased self-reported health and increased depression, while the counterpart actives (IA and MuA) were beneficial. Specifically, study time was negatively associated with self-reported health and cognitive outcomes and positively related to depression, whereas sleep and other time led to lower depressive symptoms. Notably, the associations between time use and developmental outcomes (depression and cognition) were heterogeneous across students’ gender, family economic status, and parental education. Our findings provide novel insights regarding interventions for optimizing adolescents’ time allocation and improving their well-being under the “Double Reduction” education policy.

Abstract TP103: Association Between Neighborhood-Level Disadvantage and Patient-Reported Mental Health Outcomes in Intracerebral Hemorrhage Survivors

Introduction: The influence of social determinants of health (SDH) is well-documented across a range of medical conditions and health outcomes. Less clear is the impact of SDH on patient-reported outcomes, particularly mental health outcomes, in intracerebral hemorrhage (ICH). This study examines the association between the Area Deprivation Index (ADI), a measure of neighborhood-level disadvantage, and self-reported health outcomes in ICH survivors. Methods: This investigation is nested within the REDUCE clinical trial, an ongoing, randomized trial comparing standard-of-care to spironolactone-containing hypertension regimens in ICH survivors. Participants complete the PROMIS Global Health survey at baseline. Global Mental Health (GMH) and Global Physical Health (GPH) scores are standardized to t-scores (GMH 21.2-67.6; GPH 16.2-67.7) around a reference population mean (50 ± 10). ADI uses elements of income, education, employment, and housing quality to assign a composite score (1-100), with a higher score signifying greater disadvantage. Patients were grouped into tertiles based on ADI. GMH and GPH scores were analyzed against the reference mean via a one-sample t-test and across tertiles with a one-way ANOVA. Bivariable linear regression examined ADI as a continuous variable. Multivariable models adjusted for sex, age, race, ethnicity, ICH to baseline interval, and baseline mRS. Results: Fifty patients were included in the analysis. Those in the third, most disadvantaged, tertile had significantly lower GMH scores (39.5 ± 8.17) than the reference population (p&lt;0.001), the first tertile (54.10 ± 10.20, p&lt;0.001), and the second tertile (50.4 ± 8.90, p=0.003). In multivariable analysis, these differences remained significant (T3 vs. T1, B= -18.31, p&lt;0.001; T3 vs. T2, B= -14.67, p&lt;0.001). Further, ADI as a continuous variable was significantly associated with GMH scores in bivariable (B= -0.22, p&lt;0.001) and multivariable analysis (B= -0.23, p=0.005). No significant relationship was found between ADI and GPH. Conclusions: Higher ADI is associated with worse patient-reported mental health outcomes after ICH. Neighborhood disadvantage, and its constituting factors, should be considered in reporting post-ICH patient care and outcomes.

Effectiveness of residential treatment services for veterans with substance use disorders: A propensity score matching evaluation

BackgroundPrior reviews of substance use disorder (SUD) treatment have found mixed support for residential level of care but are limited by methodology problems and the ethical concerns of randomizing patients with severe SUD to lower levels of care. MethodsThe present study is the first to use a large archival SUD residential sample with a matched comparison group and one-year follow-up period to examine the benefits of residential treatment provided to adults clinically assessed as warranting SUD residential care. We used propensity score matching in our sample (N = 6177) of veterans with a SUD who were screened and accepted for Veterans Affairs (VA) SUD residential treatment between January 1st, 2019 and June 30th, 2019. ResultsWe found evidence that VA SUD residential treatment saves veteran lives with an average 66% all-cause mortality risk reduction during the study period (b = −1.09, exp(b) = 0.34, p <0.001). Medium-to-large residential pre- to post-treatment self-reported mental health and SUD symptom improvements (|SMDrobust| = 0.54–0.93) were sustained by one-year post-screening. These residential treatment improvements were significantly larger than estimated counterfactual outcomes across self-reported SUD and stress disorder symptoms at one-year post-screening (ps <0.001). We found mixed behavioral, service utilization, and other self-reported mental health outcomes. ConclusionsWe conclude that VA SUD residential treatment is an effective level of care for veterans warranting residential care particularly for SUD symptom improvements and reductions in mortality risk.

Knowledge, practices, and self-reported health outcomes related to chemical use and safety among beauty salons and parlor workers in Polokwane, Limpopo Province

Knowledge, practices, and self-reported health outcomes related to chemical use and safety among beauty salons and parlor workers in Polokwane, Limpopo Province

HOME-BASED CARE AND PATIENT OUTCOMES: DOES THE DELIVERY TEAM MATTER?

Abstract A major challenge facing the U.S. is how to best to meet the growing demand for person-centered, high-quality long-term care in the least restrictive setting possible for community-dwelling older adults who need assistance with daily activities. This paper asks whether who is providing home care impacts patient outcomes. The relative benefits to the care recipient of informal care, formal care, or a combination of the two is largely unknown. A systematic review (Coe et al. 2021) found informal care, either solo or in concert with formal care, tends to lead to improvements in health and well-being of the care recipient compared to formal care alone. However, little of that research can show causation, and most is not based in the U.S. Recipients’ utilization of formal and informal care is affected by factors that also may affect outcomes, complicating the estimation of any causal relationship. Using the 2002-2018 Health and Retirement Study (HRS), we use family structure variables as instruments for both formal care and the combination of formal and informal care to estimate the causal impact of the home health care team on self-reported mental and physical health outcomes. Once the endogeneity of the care team is accounted for, having both formal and informal care leads to higher self-reported health and having only formal care leads to worse mental health outcomes, such as higher depression and lower positive affect, compared to informal care alone. Mobility measures seem unaffected by the type of home care provider.

MEDICARE ADVANTAGE (MA) PLAN CHARACTERISTICS ON PHYSICAL AND MENTAL HEALTH OUTCOMES OF MA BENEFICIARIES

Abstract With growing demands for better and cost-effective care delivery by Medicare Advantage (MA) plans, comparison of self-reported health outcomes is more important because those outcomes capture patients’ experiences and perspectives. The purpose of the study is to examine the characteristics of MA plans on Medicare beneficiaries’ physical and mental health status. Methods: I used the Medicare Health Outcomes (HOS) survey, a random sample of Medicare beneficiaries surveyed from each MA plan with a minimum of 500 enrollees conducted by the CMS. The current study included 3 baseline cohorts from 2015 (n=195,800), 2016 (n=178,973), and 2017 (n=172,047). I used physical component summary (PCS) and mental component summary (MCS) scores as two outcomes which include various domains of physical (exercise, pain, activity limitation) and mental health (social functioning, emotional status, depression) status. Plan characteristics include plan ownership status (for-profit (FP) vs. not-for-profit (NFP), plan types (PPO vs. HMO/cost contract), and the number of plan members. I used the linear regression method with clustering at the plan contract level due to the correlation of multiple beneficiaries within the same plan. Results: Adjusted for beneficiary level characteristics, beneficiaries in PPO plans experienced greater physical and mental health scores than HMO or cost contract plans. MA plan with less than 5k beneficiaries is associated with a lower physical health score than plans with more than 100k beneficiaries. For-profit ownership was significantly associated with lower mental health scores. Discussion: The characteristics of MA plan insurers are important factors for beneficiaries’ enrollment decisions and quality improvement efforts.

Characterization of e-cigarette users according to device type, use behaviors, and self-reported health outcomes: Findings from the EMIT study.

Electronic cigarettes (e-cigarettes) rapidly evolved from large modifiable (MOD) devices, to small and affordable 'POD' devices. Detailed information on user demographics and preferences according to device type, which can inform potential chemical exposure and policy recommendations, is currently limited. The goal of this study is to describe user demographics, use behaviors and preferences, as well as self-reported health outcomes according to the e-cigarette device type used. From April 2019 to March 2020, 91 participants from Maryland (18 MOD users, 26 POD users, 16 dual users (use of both combustible and e-cigarettes), and 31 non-users (never e-cigarette users and never smokers or >6 months former use) were recruited. A comprehensive questionnaire collected sociodemographic characteristics, e-cigarette/tobacco use behaviors, self-reported health outcomes, device characteristics and preferences. Chi-squared tests for categorical variables, ANOVA for continuous variables, qualitative thematic analysis, linear and logistic regressions were used to assess relationships between variables and groups. POD users were younger (average 22.5 years) than MOD users (30.8 years) or dual users (34.3 years) (p<0.001). MOD users reported more puffs per day (mean ± SD: 373 ± 125 puffs) compared to POD users (123.0 ± 172.5). E-cigarette users who were former smokers used 1.16 mg/mL lower nicotine concentrations compared to lifetime exclusive e-cigarette users (p=0.03) in linear models. Exclusive POD users self-reported more coughing than exclusive MOD or dual users (p=0.02). E-cigarette users reported more shortness of breath, headaches, and fatigue from their e-cigarette use compared to non-users. We found significant differences between user demographics, e-cigarette preferences, device characteristics, and use behaviors by user group. This information can help explain exposure to chemicals from e-cigarettes, including compounds with known toxic effects (e.g. metals, formaldehyde), and help inform the design of prevention and intervention strategies and policy decisions.

Evaluation of a 12-week app-guided exercise intervention in patients with knee osteoarthritis (re.flex): a study protocol for a randomized controlled trial

BackgroundCurrent health care demonstrates an insufficient provision and utilization of physical exercises despite their recommendation as a first-line treatment in clinical guidelines for patients with knee osteoarthritis (OA). Mobile health (m-health) technologies offer new opportunities to guide and monitor home-based exercise programs by using mobile devices and inertial sensors in combination with a digital application (app). This study will evaluate patient benefits resulting from the use of the specific digital health application re.flex for patients with knee OA.MethodsThis monocentric, two-arm, randomized controlled parallel-group trial will evaluate the effectiveness of the app- and sensor-guided exercise program re.flex for patients with moderate-to-severe knee OA. We aim to recruit 200 participants via newspapers, newsletters and information events. Participants will be randomly allocated to the intervention group and the control group in a 1:1 ratio. Participants in the control group will not receive any study intervention or instruction for any change to their previous health care utilization. Despite this, they are allowed to make use of usual care provided by their treating physician. The intervention group comprises a 12-week home training program with three sessions per week in addition to usual care. Exercises will be guided and monitored by use of the training app (re.flex) and two accelerometers that are attached proximally and distally to the affected knee joint. Pre- and postmeasurements will take place at baseline (t0) and after 12 weeks (t1). Primary outcomes will be osteoarthritis-specific pain and physical function measured with the Knee Osteoarthritis Outcome Score (KOOS) subscales Pain and Function in daily living (ADL). Second, further self-reported health outcomes, a performance measurement, app logfiles and safety will be assessed. Intervention effects will be calculated by baseline-adjusted analysis of covariance (ANCOVA) using an intention-to-treat approach. Multiple imputation will be applied.DiscussionRe.flex can bridge part of the gap between recommendations for strengthening exercises in patients with knee OA and the insufficient actual care situation. This randomized controlled trial is designed to provide conclusions on the effectiveness of the health application re.flex for the population under study and will provide further insight into adherence rates and the safety of its use.Trial registrationThe trial was registered on 20/01/2023 at www.drks.de (ID: DRKS00030932).