Self-reported Treatment Research Articles

Co-occurrence of chronic pain and anxiety/depression symptoms in U.S. adults: prevalence, functional impacts, and opportunities.

Co-occurrence of chronic pain and clinically significant symptoms of anxiety and/or depression is regularly noted in the literature. Yet, little is known empirically about population prevalence of co-occurring symptoms, nor whether people with co-occurring symptoms constitute a distinct subpopulation within US adults living with chronic pain or US adults living with anxiety and/or depression symptoms (A/D). To address this gap, this study analyzes data from the 2019 National Health Interview Survey, a representative annual survey of self-reported health status and treatment use in the United States (n = 31,997). Approximately 12 million US adults, or 4.9% of the adult population, have co-occurring chronic pain and A/D symptoms. Unremitted A/D symptoms co-occurred in 23.9% of US adults with chronic pain, compared with an A/D prevalence of 4.9% among those without chronic pain. Conversely, chronic pain co-occurred in the majority (55.6%) of US adults with unremitted A/D symptoms, compared with a chronic pain prevalence of 17.1% among those without A/D symptoms. The likelihood of experiencing functional limitations in daily life was highest among those experiencing co-occurring symptoms, compared with those experiencing chronic pain alone or A/D symptoms alone. Among those with co-occurring symptoms, 69.4% reported that work was limited due to a health problem, 43.7% reported difficulty doing errands alone, and 55.7% reported difficulty participating in social activities. These data point to the need for targeted investment in improving functional outcomes for the nearly 1 in 20 US adults living with co-occurring chronic pain and clinically significant A/D symptoms.

Self-Reported Pain Treatment Practices Among U.S. and Canadian Adults: Findings From a Population Survey.

Pain treatments and their efficacy have been studied extensively. Yet surprisingly little is known about the types of treatments, and combinations of treatments, that community-dwelling adults use to manage pain, as well as how treatment types are associated with individual characteristics and national-level context. To fill this gap, we evaluated self-reported pain treatment types among community-dwelling adults in the United States and Canada. We also assessed how treatment types correlate with individuals' pain levels, sociodemographic characteristics, and country of residence, and identified unique clusters of adults in terms of treatment combinations. We used the 2020 "Recovery and Resilience" United States-Canada general online survey with 2 041 U.S. and 2 072 Canadian community-dwelling adults. Respondents selected up to 10 pain treatment options including medication, physical therapy, exercise, etc., and an open-ended item was available for self-report of any additional treatments. Data were analyzed using descriptive, regression-based, and latent class analyses. Over-the-counter (OTC) medication was reported most frequently (by 55% of respondents, 95% CI 53%-56%), followed by "just living with pain" (41%, 95% CI 40%-43%) and exercise (40%, 95% CI 38%-41%). The modal response (29%) to the open-ended item was cannabis use. Pain was the most salient correlate, predicting a greater frequency of all pain treatments. Country differences were generally small; a notable exception was alcohol use, which was reported twice as often among U.S. versus Canadian adults. Individuals were grouped into 5 distinct clusters: 2 groups relied predominantly on medication (prescription or OTC), another favored exercise and other self-care approaches, one included adults "just living with" pain, and the cluster with the highest pain levels employed all modalities heavily. Our findings provide new insights into recent pain treatment strategies among North American adults and identify population subgroups with potentially unmet need for more adaptive and effective pain management.

The association of medical providers’ attitudes about naloxone and treating people with opioid use disorder and their self-reported low-barrier treatment practices

Opioid-involved overdose deaths continue to climb, in part because of suboptimal access to and retention on medications for opioid use disorder (MOUD), including buprenorphine. Low barrier buprenorphine treatment aims to reduce or eliminate the threshold for getting and staying on medication by providing immediate and long-term access to buprenorphine without strict rules or requirements. This study examines associations between medical providers’ beliefs about treating people with opioid use disorder (OUD) and naloxone access with their self-reported low-barrier buprenorphine prescribing practices. We surveyed and analyzed responses from providers (N = 86) who completed X-waiver courses in Missouri between March 2017 and September 2019, of which 55% (n = 47) both completed the full survey and endorsed prescribing buprenorphine since the training. The survey included questions about buprenorphine prescribing behaviors as well as the Naloxone-Related Risk Compensation Beliefs (NaRCC-B) scale and the Attitudes toward Patients with OUD scale. Analyses consisted of a series of linear and logistic regressions with the NaRCC-B and OUD Attitudes scales predicting various domains of low-barrier prescribing behaviors. Findings indicate medical providers’ beliefs about treating people with OUD are associated with their practice of addiction medicine, with individuals with more favorable views being more likely to endorse low-barrier buprenorphine prescribing practices including offering telemedicine and at-home inductions, prescribing higher doses of buprenorphine, treating larger caseloads, and discussing overdose risk and protective factors with their patients. Providers’ beliefs about naloxone being enabling were less related to their buprenorphine practices but strongly related to their likelihood of providing naloxone. Future research may examine which strategies effectively change prescriber attitudes and their adoption of lower-barrier prescribing practices.

Trends in HIV prevalence, incidence, and progress towards the UNAIDS 95-95-95 targets in Malawi among individuals aged 15–64 years: population-based HIV impact assessments, 2015−16 and 2020−21

In 2014, UNAIDS set the goal of ending the AIDS epidemic by 2030 through the achievement of testing and treatment cascade targets. To evaluate progress achieved and highlight persisting gaps in HIV epidemic control in Malawi, we aimed to compare key indicators (prevalence, incidence, viral load suppression, and UNAIDS 95-95-95 targets) from the 2015-16 and 2020-21 Malawi Population-based HIV Impact Assessment (PHIA) survey results. The Malawi PHIAs were nationally representative, cross-sectional surveys with a two-stage cluster sampling design. The first survey was conducted between Nov 27, 2015, and Aug 26, 2016; the second survey was conducted between Jan 15, 2020, and April 26, 2021. Our analysis included survey participants aged 15-64 years. Participants were interviewed and a 14 mL blood sample was collected and tested for HIV infection using the national rapid testing algorithm. For each survey, we estimated key HIV epidemic indicators and achievement of 95-95-95 targets. The risk ratio (RR) of the indicators between surveys were computed and considered significant at a confidence level of 0·05. All results were weighted, and self-reported awareness and treatment status were adjusted to account for detection of antiretrovirals. Our analysis included 17 187 participants aged 15-64 years in 2015-16 and 21 208 in 2020-21 who participated in the surveys and blood draw. In the 2020-21 survey, 88·4% (95% CI 86·7-90·0) of people living with HIV were aware of their HIV-positive status; of those aware, 97·8% (97·1-98·5) were on antiretroviral therapy; and of those on treatment, 96·9% (95·9-97·7) were virally suppressed. Between surveys, the national HIV prevalence decreased significantly from 10·6% (10·0-11·2) to 8·9% (8·4-9·5) with RR 0·85 (95% CI 0·78-0·92; p<0·0001). The annual HIV incidence decreased from 0·37% (0·20-0·53) to 0·22% (0·11-0·34) with RR 0·61 (95% CI 0·31-1·20; p=0·15). The population viral load suppression increased from 68·3% (66·0-70·7) in 2015-16 to 87·0% (85·3-88·5) in 2020-21 (RR 1·27 [95% CI 1·22-1·32]; p<0·0001). These results suggest that Malawi had already surpassed the UNAIDS viral load suppression target for 2030 (85·7%) by 2020-21. Through strategies and evidence-informed interventions implemented in the last half decade, especially scale-up of effective HIV treatment, Malawi has made tremendous progress, including decreasing HIV prevalence and incidence and achieving both the second and third 95 targets ahead of 2030. To address the first 95, efforts in HIV diagnosis should focus on males and younger age groups. There is a continued need for effective linkage to care, retention on antiretroviral therapy, and adherence support to maintain and build on progress. US President's Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention.

Risks of returning to opioid use at treatment entry and early in opioid use disorder treatment: Role of non-opioid substances

ObjectivePatients in treatment with medications for opioid use disorder (MOUD) often report use of other substances in addition to opioids. Few studies exist that examine the relationship between use at treatment entry and early non-opioid use in opioid treatment outcome. MethodologyWe combined and harmonized three randomized, controlled MOUD clinical trials from the National Institutes of Drug Abuse (NIDA) Clinical Trials Network (CTN) (N=2197) and investigated the association of non-opioid substance use at treatment entry and during early treatment with a return to opioid use. The trials compared MOUD treatment (buprenorphine, methadone, extended-release naltrexone) in populations with opioid use disorder (OUD). Non-opioid substances were identified through harmonizing self-reported use. The primary outcomes were markers of return to opioid use by 12 weeks. ResultsWhen treatment cohorts were adjusted, no association between self-reported treatment entry use of non-opioid substances and week-12 opioid use was detected. During the first month of treatment, higher use of cocaine (OR 1.41 [1.18–1.69]) and amphetamine (OR 1.70 [1.27–2.26]) was found to be associated with higher likelihood of illicit opioid use by week 12. Exploratory analyses of potential treatment cohort-by-predictor interactions showed that those with heavier cocaine use had a lower rate of returning to opioid use in the extended-release naltrexone group than in the methadone group. ConclusionSubstance use other than opioids at treatment entry is not associated with relapse. Use of cocaine or amphetamines during the first few weeks of MOUD treatment may signal a worse outcome, suggesting a need for additional interventions.

Self-Reported Treatment Adherence in Patients of Diabetes Mellitus Type 2: A Cross-Sectional Study in Lahore, Pakistan

Objectives: Suboptimal adherence to therapy due to neglected self-care behavior in chronic diseases is a global crisis. The aim of this research was to gauge the prevalence of adherence and to assess the effect of age, sex, education level and socioeconomic status on adherence to self-care strategies. Methods: A cross-sectional study was conducted at Diabetes Management Centre, Services Hospital Lahore. 357 patients were administered a standardized questionnaire, the Diabetes Self-Management Questionnaire. A cut off value of 7 on a 0-10 scale was labeled as good adherence. The influence of age, sex, education and income on adherence was examined by multiple logistic regression analysis.

An observational analysis of risk factors associated with symptomatic third molar teeth.

Third molar teeth (wisdom teeth) are a common cause of pain and infection in young adults. The study aimed to describe the prevalence of symptomatic third molar teeth and identify factors which predispose to third molar symptoms in a birth cohort. An observational study was undertaken nested in the Avon Longitudinal Study of Parents and Children (ALSPAC), a birth cohort based in south west England. The main outcomes were self-reported third molar pain, swelling and treatment for third molar problems, taken from questionnaires completed at age 23 years. The exposures including sex, dental history, socioeconomic status, diet, and genetic factors were obtained from earlier ALSPAC data. In total 4,222 ALSPAC participants responded to one or more questions about third molar teeth. The final sample included more female participants than male participants. The majority of participants (56.6%) reported at least one episode of pain associated with their third molars. Females had greater odds than males of reporting swelling (adjusted odds ratio (OR) 1.97; 95%confidence interval (CI) 1.56, 2.51), pain (adjusted OR=1.96; 95%CI 1.56, 2.51) and receiving both non-surgical and surgical treatment (adjusted OR=2.30; 95%CI 1.62, 3.35, adjusted OR=1.54; 95%CI 1.17, 2.06 respectively). Participants with previously filled teeth had greater odds of third molar extraction. There were no strong associations betweenindex of multiple deprivation (IMD) score or sugar intake and the third molar outcomes. There was weak evidence for a genetic contribution to third molar pain. Symptomatic third molars are common in this age group, with over half of the participants reporting pain or other symptoms. Female participants had greater odds for third molar pain, swelling and treatment.

Fixed versus individualized treatment for five common bacterial infectious syndromes: a survey of the perspectives and practices of clinicians.

Traditionally, bacterial infections have been treated with fixed-duration antibiotic courses; however, some have advocated for individualized durations. It is not known which approach currently predominates. We conducted a multinational clinical practice survey asking prescribers their approach to treating skin and soft tissue infection (SSTI), community-acquired pneumonia (CAP), pyelonephritis, cholangitis and bloodstream infection (BSI) of an unknown source. The primary outcome was self-reported treatment approach as being fully fixed duration, fixed minimum, fixed maximum, fixed minimum and maximum, or fully individualized durations. Secondary questions explored factors influencing duration of therapy. Multivariable logistic regression with generalized estimating equations was used to examine predictors of use of fully fixed durations. Among 221 respondents, 170 (76.9%) completed the full survey; infectious diseases physicians accounted for 60.6%. Use of a fully fixed duration was least common for SSTI (8.5%) and more common for CAP (28.3%), BSI (29.9%), cholangitis (35.7%) and pyelonephritis (36.3%). Fully individualized therapy, with no fixed minimum or maximum, was used by only a minority: CAP (4.9%), pyelonephritis (5.0%), cholangitis (9.9%), BSI (13.6%) and SSTI (19.5%). In multivariable analyses, a fully fixed duration approach was more common among Canadian respondents [adjusted OR (aOR) 1.76 (95% CI 1.12-2.76)] and for CAP (aOR 4.25, 95% CI 2.53-7.13), cholangitis (aOR 6.01, 95% CI 3.49-10.36), pyelonephritis (aOR 6.08, 95% CI 3.56-10.39) and BSI (aOR 4.49, 95% CI 2.50-8.09) compared with SSTI. There is extensive practice heterogeneity in fixed versus individualized treatment; clinical trials would be helpful to compare these approaches.

Health characteristics and behaviors associated with self-reported depression among Brazilian reproductive-aged women: Data from a population-based survey (2020–2021)

This cross-sectional study aimed to evaluate the health characteristics and behaviors associated with depression in a large probabilistic sample of Brazilian reproductive-aged women. A total of 11,698 non-pregnant women aged 18–49 years old from the 26 Brazilian capitals and Federal District were interviewed by landline between 2020 and 2021. Logistic regression models were used to estimate the Odds Ratio (OR) of health characteristics and behaviors (smoking, alcohol abuse, physical activity, regular intake of fruits and vegetables, overweight, obesity and poor self-rated health) according to the presence of depression and drug treatment for depression. Medical diagnosis of depression, and other health characteristics and behaviors were self-reported. Analyses were adjusted by age, race/skin color, education, and marital status. Prevalence of self-reported depression was 13.3% and drug treatment for depression was reported by 5.3% of the total studied population. The presence of self-reported depression was associated with smoking (adjusted OR - aOR 2.15; CI95%:1.44–3.20), regular intake of fruits and vegetables (aOR 0.75; CI95%:0.59–0.95), overweight (aOR 1.38; CI95%:1.10–1.71), obesity (aOR 1.34; CI95%:1.04–1.71) and poor self-rated health (aOR 4.34; CI95%:3.04–6.21). Drug treatment for depression was associated with smoking (aOR 2.29; CI95%:1.33–3.95), overweight (aOR 1.65; CI95%:1.18–2.30) and poor self-rated health (aOR 4.20; CI95%:2.59–6.83). Self-reported depression and drug treatment for depression were associated with unfavorable health characteristics and behaviors among reproductive-aged women in Brazil.

A Non-Inferiority Evaluation of Standard and Abbreviated Developmental Trauma and Adjustment Programming for Adopted and Foster Youth in Residential Care

ABSTRACT Youth who are involved with the adoption and foster care systems report notable rates of complex trauma responses associated with their developmental experiences, which can have deleterious implications for well-being across the lifespan. We implemented a retrospective quasi-experimental non-inferiority evaluation design using a frequency matching approach to estimate the degree of differential treatment effects reported by youth who completed a Developmental Trauma and Attachment Program protocol in its standard (DTAP) or abbreviated (DTAP-A) format at a long-term residential care facility located in the Midwestern United States. Program completers were 28 youth (M age = 12.39) who predominately identified as female (n = 23, 82%) with Caucasian/White (n = 12, 43%) or Multiracial (n = 10, 35%) racial identities. Analyses of scores on the UCLA Post-traumatic Stress Disorder Reaction Index and Behavior Assessment System for Children (3rd ed.) did not identify any statistical or practical significance between DTAP and DTAP-A program completers self-reported treatment gains. However, DTAP program completers tended to report clinically significant changes in posttraumatic stress disorder and personal adjustment to greater degrees when compared to those completing the DTAP-A protocol. Implications for increasing access, resource management, and supporting a continuum of care approach are provided.

Women's experiences in injectable opioid agonist treatment programs in Vancouver, Canada.

Injectable opioid agonist treatment (iOAT) has recently been expanded in some geographical contexts in Canada as part of a response to the escalating overdose crisis. Complex gendered dynamics, including power differentials, violence, and social norms, shape the overdose crisis and drug treatment programs which can adversely impact women's experiences. This qualitative study examines how social (e.g., gender, income, housing) and structural factors (e.g., program policies) impact women's experiences of iOAT. Qualitative interviews were completed with 16 women enrolled in four iOAT programs in Vancouver, Canada. Approximately 50 hours of ethnographic observations were conducted. Interview transcripts and ethnographic fieldnotes were analyzed using a critical feminist lens by applying the concepts of embodiment, relationality, and social control to understand women's engagement and self-reported treatment outcomes. Initial iOAT engagement was a relational process, including initiating treatment with a partner and engaging with iOAT to (re)build personal relationships. Relationships with iOAT providers, including flexibility and support with medication administration, were important to women, providing an affirming embodied experience and a greater sense of agency. However, program operations (e.g., mandated daily attendance, program crowding) incompatible with women's needs (e.g., employment) could undermine these positive experiences. Women's reported outcomes highlight a tension between achieving more agency and the constraints of intensive and stigmatized treatment. This study highlights how iOAT is both a source of care and control for women from a relational and embodied perspective. Findings underscore the need for gender-attentive and flexible drug treatment services to meet the varied needs of women and the importance of providing relational care for women accessing iOAT.

Implementation, feasibility, and acceptability of 99DOTS-based supervision of treatment for drug-susceptible TB in Uganda.

99DOTS is a low-cost digital adherence technology that allows people with tuberculosis (TB) to self-report treatment adherence. There are limited data on its implementation, feasibility, and acceptability from sub-Saharan Africa. We conducted a longitudinal analysis and cross-sectional surveys nested within a stepped-wedge randomized trial at 18 health facilities in Uganda between December 2018 and January 2020. The longitudinal analysis assessed implementation of key components of a 99DOTS-based intervention, including self-reporting of TB medication adherence via toll-free phone calls, automated text message reminders and support actions by health workers monitoring adherence data. Cross-sectional surveys administered to a subset of people with TB and health workers assessed 99DOTS feasibility and acceptability. Composite scores for capability, opportunity, and motivation to use 99DOTS were estimated as mean Likert scale responses. Among 462 people with pulmonary TB enrolled on 99DOTS, median adherence was 58.4% (inter-quartile range [IQR] 38.7-75.6) as confirmed by self-reporting dosing via phone calls and 99.4% (IQR 96.4-100) when also including doses confirmed by health workers. Phone call-confirmed adherence declined over the treatment period and was lower among people with HIV (median 50.6% vs. 63.7%, p<0.001). People with TB received SMS dosing reminders on 90.5% of treatment days. Health worker support actions were documented for 261/409 (63.8%) people with TB who missed >3 consecutive doses. Surveys were completed by 83 people with TB and 22 health workers. Composite scores for capability, opportunity, and motivation were high; among people with TB, composite scores did not differ by gender or HIV status. Barriers to using 99DOTS included technical issues (phone access, charging, and network connection) and concerns regarding disclosure. 99DOTS was feasible to implement and highly acceptable to people with TB and their health workers. National TB Programs should offer 99DOTS as an option for TB treatment supervision.

Self-reported treatment effectiveness for Crohn's disease using a novel crowdsourcing web-based platform.

Internet and social media platforms have become an unprecedented source for sharing self-experience, potentially allowing the collection and integration of health data with patient experience. StuffThatWorks (STW) is an online open platform that applies machine learning and the power of crowdsourcing, where patients with chronic medical conditions can self-report and compare their individual outcomes using a structured online questionnaire. We aimed to conduct a cross-sectional, international, crowdsourcing, artificial-intelligence (AI) web-based study of patients with Crohn's disease (CD) self-reporting their outcomes. A proprietary STW Bayesian inference model was built to measure improvement in CD severity (on scale of 1-5) for each treatment and ranked treatments using effectiveness. The effectiveness of first-line biological treatments was analyzed by multiple comparisons and by calculating odds ratios and 95% confidence intervals for each treatment pair. We included 7593 self-reported CD patients for the analysis. Most of the participants were female (75.8%) and from English-speaking countries (95.7%). Overall, anti-TNF drugs were the most reported tried treatment (52.8%). Infliximab (IFX) was ranked as the most effective treatment by the STW effectiveness model followed by bowel surgery (second), adalimumab (ADA, third), ustekinumab (UST, 4rd), and vedolizumab (VDZ, fifth). In paired comparison analyses, IFX was most effective, ADA had similar effectiveness compared to UST and all three were more effective than VDZ. We present the first online crowdsourcing AI platform-based study of self-reported treatment effectiveness in CD. Net-based crowdsourcing patient-reported outcome platforms can potentially help both clinicians and patients select the best treatment for their condition.

1235-P: High Burden of Undetected Hypertension among People with Type 2 Diabetes in India

Purpose: Despite the huge burden of diabetes and hypertension, limited information is available on the burden of undetected hypertension and associated factors among diabetics in India. Methods: We conducted a cross-sectional study and selected 12284 adults aged ≥ 30 years, using a multistage cluster random sampling technique, from rural and urban areas of North and South India. Trained interviewers administered a questionnaire to collect data on socio-demographics, lifestyle characteristics and phlebotomists collected venous blood samples. Blood pressure was measured using standard protocols. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-reported physician diagnosis or treatment and the known-diabetes was defined as self-reported physician diagnosis or treatment. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥ 90 mmHg or self-reported physician diagnosis or treatment and undetected hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥ 90 mmHg without self-reported physician diagnosis or treatment. Results: The age-adjusted prevalence of diabetes was 17.5% (16.9-18.2), known diabetes was 10.2% (9.7-10.7) and hypertension among those with diabetes was 47.3% (45.0-49.6). The age-adjusted prevalence of undetected hypertension among those with known-diabetes was 27.0% (22.0-31.9). The prevalence of undetected hypertension among known-diabetics was higher in urban area [29.4% (23.2-35.6)] than the rural area [21.5% (13.2-29.7)]. In the multinomial logistic regression, undetected hypertension among those with known-diabetes was positively associated with older age [adjusted Relative Risk Ratio (aRRR): 3.4 (1.7-6.9)], dyslipidemia [aRRR: 2.2 (1.2-4.1)] and chronic kidney disease [aRRR: 3.3 (1.2-9.2)]. Conclusions: There is a need to implement health system interventions to increase the detection of hypertension among diabetics. Disclosure S.Mohan: None. P.Jarhyan: None. D.Prabhakaran: None.

A geospatial analysis of factors influencing clinical decision-making of rural and urban dental practitioners in Tiruppur district

Objectives: The core of dental practice is clinical decision-making. Geographic information system was used in our study to evaluate the clinical decision-making of dental practitioners in urban and rural Tiruppur district, Tamil Nadu. Materials and Methods: This cross-sectional study included 50 certified dental practitioners from both urban and rural areas. The research was conducted in June 2022. The tem-item and self-administered questionnaire was designed to collect data on practitioner, patient, and provider characteristics. The questionnaire was distributed to participants through an online Google form forum, and the results, clinical decision-making, were quantified using a series of hypothetical case situations. The association between rural and urban dental practitioners was assessed using the “Chi-square test.” Results: Twenty-six (14 [56%] urban and 12 [48%] rural practitioners) chosen the most conservative treatment approach of coronoplasty for asymptomatic impacted mandibular 3rd molar. Thirty (17 [68%] urban and 13 [52%]) rural practitioners preferred the conservative treatment plan of removal of caries followed by GIC Restoration for class I dental caries in a 7-year-old child. For the case scenario relation to class I malocclusion with spacing, 16 (64%) of urban dental practitioners preferred aligner-based treatment rather than fixed orthodontic appliance. This treatment choice differs statistically between urban and rural practitioners. Conclusion: The current research revealed an association between non-clinical features and dental professionals’ self-reported treatment preferences. It provides a foundation for future research into the elements hypothesized to impact dentists’ treatment decisions.

Simultaneous Comparisons of 25 Acute Migraine Medications: A Big Data Analysis of 10 Million Patient Self-Reported Treatment Records From A Migraine Smartphone Application (S41.001)

Simultaneous Comparisons of 25 Acute Migraine Medications: A Big Data Analysis of 10 Million Patient Self-Reported Treatment Records From A Migraine Smartphone Application (S41.001)

Negative emotion differentiation and white matter microstructure

BackgroundDeficits in the differentiation of negative emotions – the ability to specifically identify one's negative emotions – are associated with poorer mental health outcomes. However, the processes that lead to individual differences in negative emotion differentiation are not well understood, hampering our understanding of why this process is related to poor mental health outcomes. Given that disruptions in some affective processes are associated with white matter microstructure, identifying the circuitry associated with different affective processes can inform our understanding of how disturbances in these networks may lead to psychopathology. Thus, examination of how white matter microstructure relates to individual differences in negative emotion differentiation (NED) may provide insights into (i) its component processes and (ii) its relationship to brain structure. MethodThe relationship between white matter microstructure and NED was examined. ResultsNED was related to white matter microstructure in right anterior thalamic radiation and inferior fronto-occipital fasciculus and left peri-genual cingulum. LimitationsAlthough participants self-reported psychiatric diagnoses and previous psychological treatment, psychopathology was not directly targeted, and thus, the extent to which microstructure related to NED could be examined in relation to maladaptive outcomes is limited. ConclusionsResults indicate that NED is related to white matter microstructure and suggest that pathways subserving processes that facilitate memory, semantics, and affective experience are important for NED. Our findings provide insights into the mechanisms by which individual differences in NED arise, suggesting intervention targets that may disrupt the relationship between poor differentiation and psychopathology.

Associations between treatment burden, self-reported treatment qualities, antiretroviral therapy obtainment, and health-related quality of life among Ugandan PLWH

BackgroundUnderstanding related risk factors of health-related quality of life (HRQoL) could avoid treatment failure and provide an insight of personalized treatment approach among people living with HIV/AIDS (PLWH). The objective of this study was to identify factors associated with self-reported treatment qualities and domains of health-related quality of life (HRQoL) among PLWH in Uganda.MethodData were from “Life on antiretroviral therapy: People’s adaptive coping and adjustment to living with HIV as a chronic condition in Wakiso District, Uganda” in English. The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire was used to assess the HRQoL of 263 PLWH in the sample. Considering variance inflation factors, multiple regression analyses were performed to assess the associations between demographic factors, ART obtainment, treatment burden, and self-reported treatment qualities, associations between demographic factors, self-reported treatment qualities, and HRQoL, and association between ART obtainment and HRQoL. Controlling for the confounding effects, several regression anatomies were employed to explore the associations between self-reported treatment qualities and six domains of HRQoL.ResultsIn the sample, the geographical distribution were urban (5.70%), semi-urban (37.26%), and rural (57.03%). 67.30% of the participants were females. The mean age of the sample was 39.82 years (standard deviation = 9.76) ranging from 22 to 81 years. Multiple logistic regressions reported statistically significant associations of distance to ART facility with self-reported quality of services, advice, manners, and counseling, statistically significant association between self-reported manners quality and four domains of HRQoL, and statistically significant association between TASO membership and domains of HRQoL. Plots from regression anatomies reported that self-reported treatment qualities had statistically significant associations with six domains of HRQoL.ConclusionsTreatment burden, self-reported treatment qualities, ART obtainment, and TASO were possible determinants of individual domains of HRQoL among PLWH in Uganda. PLWH’s HRQoL might be improved by promoting medical quality and optimizing ART obtainment in the healthcare providers’ practice. Findings in this study had important implications for the redesign of clinical guidelines, healthcare delivery, and health care co-ordination among PLWH globally.

Estimating the Prevalence of over- and Under-Reporting in HIV Testing, Status and Treatment in Rural Northeast South Africa: A Comparison of a Survey and Clinic Records.

We assess the accuracy of self-reported testing, HIV status, and treatment responses compared to clinical records in Ehlanzeni District, South Africa. We linked a 2018 population-based survey of adults 18-49 years old with clinical data at local primary healthcare facilities from 2014 to 2018. We calculated self-reported testing, HIV status, and treatment, and triangulated findings with clinic record data. We adjusted testing estimates for known gaps in HIV test documentation. Of 2089 survey participants, 1657 used a study facility and were eligible for analysis. Half of men and 84% of women reported an HIV test in the past year. One third of reported tests could be confirmed in clinic data within 1 year and an additional 13% within 2 years; these fractions increased to 57% and 22% respectively limiting to participants with a verified clinic file. After accounting for gaps in clinic documentation, we found that prevalence of recent HIV testing was closer to 15% among men and 51% in women. Estimated prevalence of known HIV was 16.2% based on self-report vs. 27.6% with clinic documentation. Relative to clinical records among confirmed clinic users, self report of HIV testing and of current treatment were highly sensitive but non-specific (sensitivity 95.5% and 98.8%, specificity 24.2% and 16.1% respectively), while self report of HIV status was highly specific but not sensitive (sensitivity 53.0%, specificity 99.3%). While clinical records are imperfect, survey-based measures should be interpreted with caution in this rural South African setting.

ENGAGING PATIENTS IN INFLAMMATORY BOWEL DISEASE CARE — WHAT DETERMINES ACTIVE PARTICIPATION?

Patient-provider co-production of care is integral to managing inflammatory bowel diseases (IBD), chronic and incurable conditions that affect patients’ quality of life. Patients in the IBD Qorus Learning Health System self-report symptoms and treatment goals prior to clinic visits via electronic surveys, which helps their providers develop patient-centered treatment plans. This study examines factors that predict patients’ active participation in the program to inform future strategies to promote programmatic engagement and continuity of care.