Self-reported Treatment Research Articles

Veterans self-reported reasons for non-attendance in psychotherapy for posttraumatic stress disorder.

This study explored rates of non-attendance (i.e., non-initiation, inconsistent attendance, early discontinuation) in cognitive processing therapy (CPT) and other posttraumatic stress disorder (PTSD) focused individual and group psychotherapies (i.e., interventions with at least some PTSD and/or trauma-related content) and characterized veterans' self-reported reasons for non-attendance in these treatments. Baseline and 6-month follow-up data from the Telemedicine Outreach for PTSD study, a pragmatic randomized effectiveness trial conducted in 11 Veterans Health Administration community-based outpatient clinics, was examined (N = 265 veterans). Over 90% of veterans with a scheduled psychotherapy appointment attended at least one appointment by 6-month follow-up. Self-reported treatment completion was higher for veterans attending individual CPT (25%) than for those attending PTSD-focused individual (4.4%) and group psychotherapy (15.5%). However, rates of inconsistent attendance (13.3%) and early discontinuation (18.3%) were also higher in veterans attending CPT when compared to other forms of PTSD-focused psychotherapy (inconsistent attendance-individual: 2.2%, group: 6.9%; early discontinuation-individual: 14.6%; group: 10.3%). Issues with scheduling appointments was one of the most frequently reported reasons for non-attendance across treatments (> 20%). Logistical barriers, including transportation (CPT), therapy taking too much time (PTSD-focused individual psychotherapy) and not being able to afford counseling (PTSD-focused group psychotherapy), were also commonly cited (i.e., > 15%). Those scheduled to attend CPT (26%) or PTSD-focused individual psychotherapy (11%) also cited treatment efficacy concerns as a reason for non-attendance. Findings suggest logistical barriers, particularly scheduling convenient appointments, and beliefs about treatment may be important to address when engaging veterans in psychotherapy for PTSD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The relationship between opioid agonist therapy satisfaction and fentanyl exposure in a Canadian setting

BackgroundWhile patient-reported treatment dissatisfaction is considered an important factor in determining the success of substance use disorder treatment, the levels of dissatisfaction with opioid agonist therapies (OAT) and its relationship with the risk of fentanyl exposure have not been characterized in the context of the ongoing opioid overdose crisis in the US and Canada. Our primary hypothesis was that OAT dissatisfaction was associated with an increased odds of fentanyl exposure.MethodsOur objective was to examine self-reported treatment satisfaction among OAT patients in Vancouver, Canada and the association with fentanyl exposure. Longitudinal data were derived from 804 participants on OAT enrolled in two community-recruited harmonized prospective cohort studies of people who use drugs in Vancouver between 2016 and 2018 via semi-annual interviews and urine drug screens (UDS). We employed multivariable generalized estimating equations to examine the relationship between OAT dissatisfaction and fentanyl exposure.ResultsOut of 804 participants (57.0% male), 222 (27.6%) reported being dissatisfied with OAT at baseline and 1070 out of 1930 observations (55.4%) had fentanyl exposure. The distribution of OAT reported in the sample was methadone (n = 692, 77.7%), buprenorphine-naloxone (n = 82, 9.2%), injectable OAT (i.e., diacetylmorphine or hydromorphone; (n = 65, 7.3%), slow-release oral morphine (n = 44, 4.9%) and other/study medication (n = 8, 1.0%). In the multivariable analysis, OAT dissatisfaction was positively associated with fentanyl exposure (AOR = 1.34; 95% CI: 1.08–1.66).ConclusionsA substantial proportion of OAT patients in our sample reported dissatisfaction with their OAT, and more than half were exposed to fentanyl. We also found that those who were dissatisfied with their OAT were more likely to be exposed to fentanyl. These findings demonstrate the importance of optimizing OAT satisfaction in the context of the ongoing opioid overdose crisis.

161 Pharmacogenetics study of different psoriasis treatments

Responses to psoriasis treatment vary dramatically among patients. Pharmacogenetic studies seek to identify genetic variations that are associated with treatment response. In this study, we assessed the responses to nine treatment options (acitretin, adalimumab, coal tar, calcipotriol, dithranol, etanercept, methotrexate, photochemotherapy, and ultraviolet B radiation) among 1,692 patients that were genotyped in our recent GWAS. The number of patients administered for each treatment ranged from 127 to 1,182. Among these treatment options, the rate of self-reported treatment effectiveness had a wide range from 19.4% to 62.3%. For instance, the response rates for etanercept, adalimumab, and calcipotriol were 62.3%, 52.2%, and 19.4%, respectively. Associations between genetic markers (SNPs and INDELs) and self-reported treatment response were evaluated after adjusting for population stratification using principal components. In total, 6,502,658 common (≥ 5% minor allele frequency), well imputed (R2 ≥ 0.7), markers were included. We identified two loci achieving suggestive significance (p = 5 x 10-6) located in previously identified psoriasis-associated loci: 13q14.3 (p = 2.6 x 10-6) was associated with response to coal tar (978 patients), and 6p22.2 (p = 3.4 x 10-6) was associated with response to calcipotriol (1,182 patients). We further revealed that multiple markers in the 13q14.3 locus overlap with an active enhancer region (p = 8.6 x 10-5). This study provides support for the hypothesis that psoriasis-associated loci are also associated with treatment responses.

Children's Opioid Use at Home After Laparoscopic Appendectomy

BackgroundTo combat the opioid epidemic, prescribers need accurate information about pediatric home opioid requirements to manage acute pain after surgery. Current opioid use estimates come from retrospective surveys; this study used medication adherence technology (eCAP) to track home opioid use. PurposeTo describe children's pain treatment at home after laparoscopic appendectomy, and to compare self-reported opioid analgesic use to eCAP data and counts of returned pills. DesignProspective exploratory and descriptive study MethodsA convenience sample of 96 patients, 10-17 years of age, from a single urban nonprofit children's hospital consented to self-report pain treatment in 14-day diaries and use eCAP to monitor prescribed opioid use at home after laparoscopic appendectomy. ResultsPatients were prescribed 5-45 opioid-containing pills (mean ± standard deviation 15 ± 7.2). Of 749 opioid-containing pills prescribed to 49 patients who returned data, 689 pills were dispensed, 167.5 were used for the reason prescribed, 488 were returned to families for disposal, and 53.5 were missing. The majority of the 49 patients were opioid naïve (72%), Caucasian (64%), and male (56%), with a mean age of 14 years. Patients used 6.6 ± 6.3 opioid-containing pills by pill count and 5.6 ± 5.1 by self-report, a significant difference (p = .004). Unreported eCAP-enabled pill bottle openings typically occurred on weekends. ConclusionMedication adherence technology (eCAP) is a more rigorous method than self-report to estimate opioid needs and detect early opioid misuse. Additional rigorously designed studies of postoperative opioid use are needed to guide opioid prescribing.

The association between control level and self-reported treatment adherence across different treatment types in Japanese asthma patients.

Poor control of asthma symptoms is associated with a higher asthma disease burden, and asthma medication adherence is a known predictor for a better control status. This study sought to describe the current asthma control status, self-reported treatment adherence, and the association between them, as well as to describe how control level and better adherence impact the health outcomes of asthma patients. This study used cross-sectional data from the 2018 Japan National Health and Wellness Survey (NHWS). Asthma control status and adherence were assessed using the Asthma Control Test (ACT) and Morisky Medication Adherence Scale-8 (MMAS-8), respectively. Asthma treatment and patients' health outcomes, i.e. health-related quality of life (HRQoL) and work productivity, were self-reported. Asthma control and self-reported treatment adherence were analyzed descriptively, and the association was investigated by comparing mean ACT scores across adherence levels. Health outcomes were compared across control and adherence levels by multivariate analyses. A total of 816 patients had a physician diagnosis of asthma, with 67.0% reporting at least well controlled (ALWC). Of 505 asthma patients receiving prescription medication, half reported low adherence to medication use. Among asthma patients reporting high adherence, 35.6% were not well controlled (NWC). After adjusting for covariates, NWC asthma patients had significantly worse health outcomes than ALWC patients. One-third of asthma patients in Japan suffer from poorly controlled asthma. Results of the 2018 NHWS show that poor control status negatively affects patients' HRQoL and work productivity, suggesting an unmet need for better treatments to lessen the burden of asthma.

Examining the Correspondence Between Teacher- and Observer-Report Treatment Integrity Measures

Teacher-reported measures of treatment integrity (the extent to which prescribed practices are delivered as intended by teachers) have the potential to support efforts to evaluate and implement evidence-based interventions in early childhood settings. However, self-report treatment integrity measures have shown poor correspondence with observer-report treatment integrity measures, raising questions about score validity. This paper reports on the development and initial evaluation of the score reliability and validity of the Treatment Integrity Measure for Early Childhood Settings Teacher Report (TIMECS-TR), which is designed to address limitations of previous self-report treatment integrity measures that may have contributed to low correspondence with observer-rated measures. The TIMECS-TR includes 24 items designed to represent practices found in evidence-based interventions delivered in early childhood settings that target child social, emotional, and behavioral skills, rather than adherence to practices found in a specific evidence-based intervention. Fifty-four teachers (92.6% female, 7.4% male; 61.1% White) completed the TIMECS-TR weekly for a total of 618 times (M = 6.79 per child; SD = 2.16; range 2 to 11) about the practices they delivered with 91 children (45.1% female, 54.9% male; M = 4.53 years old; SD = 45.1% Black) who were at risk for emotional and behavioral disorders. Analyses indicated that the TIMECS-TR items evidenced mild to moderate test–retest score reliability over one week. However, analyses did not support the convergent score validity of the TIMECS-TR items or scale with observational ratings of the same practices. Teachers reported higher levels of practice delivery on the TIMECS-TR items relative to observer report. Overall, our findings raise concerns about the accuracy of teacher-report adherence measures. Lessons from this research can be used to identify possible reasons for the low correspondence between teacher- and observer-report treatment integrity measures so that future research can strive to dependably capture teacher delivery of the practices found in evidence-based interventions.

Self-reported infertility diagnoses and treatment history approximately 20 years after fertility treatment initiation

BackgroundInfertility history may have important implications for clinical practice and scientific discovery. Previous research on the validity of self-reported infertility measurements has been limited in scope and duration (< 5 years). In this study, we validated self-reported infertility history measures 15–23 years after fertility treatment initiation among women who utilized assisted reproductive technology (ART).MethodsWomen who received ART treatments from three Boston infertility clinics and who enrolled in a prior study (1994–2003) were re-contacted in 2018 for the AfteR Treatment Follow-up Study (ART-FS). Infertility history was collected from clinical records and two self-report questionnaires (at ART initiation and at ART-FS enrollment). Treatment history included specific details (fresh or frozen embryo transfers, number of cycles) and treatment recall prior to ART initiation. Self-reported infertility diagnoses included polycystic ovary syndrome (PCOS), endometriosis, uterine factor infertility, tubal factor infertility, diminished ovarian reserve/advanced maternal age, male factor infertility, and other/unknown. We compared self-reported measures from 2018 to self-reported and clinical data from prior study initiation, using Cohen’s kappa, sensitivity, specificity, and 95% confidence intervals.ResultsOf 2644 women we attempted to recontact, 808 completed the ART-FS, with an average follow-up of 19.6 years (standard deviation: 2.7). Recall of fertility treatment usage had moderate sensitivity (IVF = 0.85, Clomiphene/Gonadotropin = 0.81) but low specificity across different infertility treatment modalities (IVF = 0.63, Clomiphene/Gonadotropin = 0.55). Specific IVF details had low to moderate validity and reliability with clinical records. Reliability of recalled infertility diagnosis was higher when compared to self-report at ART initiation (PCOS K = 0.66, Endometriosis K = 0.76, Tubal K = 0.73) than when compared to clinical records (PCOS K = 0.31, Endometriosis K = 0.48, Tubal K = 0.62) and varied by diagnosis.ConclusionsThe ability of women to recall specific IVF treatment details was moderately accurate and recall of self-reported infertility diagnosis varied by diagnosis and measurement method.

Exploring the intersection of functional recurrence, patient-reported sexual function, and treatment satisfaction after anterior buccal mucosal graft urethroplasty

PurposeTo evaluate the interplay of stricture recurrence, sexual function, and treatment satisfaction after substitution urethroplasty.MethodsObservational study of men undergoing 1-stage buccal mucosal graft urethroplasty for anterior urethral stricture between 2009 and 2016. Patients were dichotomized by self-reported treatment satisfaction. Sexual function was assessed by validated and non-validated patient-reported outcome measures. Functional recurrence was defined as symptomatic need of re-intervention. Bivariate analyses, Kaplan–Meier estimates, qualitative and quantitative analyses by uni- and multivariable regression were employed to evaluate the interplay of sexual function, functional recurrence, and treatment satisfaction.ResultsOf 534 men with bulbar (82%), penobulbar (11%), and penile strictures (7.3%), 451 (84%) were satisfied with the surgery. There were no differences in stricture location, previous treatment, graft length, or surgical technique between satisfied and unsatisfied patients (all p ≥ 0.2). Recurrence-free survival was 85% at a median follow-up of 33 mo and decreased significantly with each Likert item towards increasing dissatisfaction (p < 0.001). Dissatisfied patients more often reported postoperative loss of rigidity, tumescence, reduced ejaculatory volume, ejaculatory pain, and reduced penile length (all p ≤ 0.042). In 83 dissatisfied men, functional recurrence (28%) and oral morbidity (20%) were the main drivers of dissatisfaction in qualitative analysis. Multivariable analyses revealed functional recurrence and impaired postoperative ejaculatory function as independent predictors of treatment dissatisfaction (all p ≤ 0.029) after adjusting for confounders.ConclusionWe found an association of both functional success and sexual function with patient-reported treatment satisfaction after substitution urethroplasty. Such findings validate the clinical significance of defining the symptomatic need for re-intervention as an endpoint and underline the importance of further research evaluating sexual function before and after open urethral reconstruction.

Prevalence of insomnia disorder and sleep apnea in a sample of veterans at risk for cardiovascular disease.

The objectives of this study were to examine the proportion of study participants screening positive for insomnia disorder and/or sleep apnea in veterans engaged in routine health care and known to be at risk for cardiovascular disease and to compare these proportions with those previously documented in medical records. This was a cross-sectional analysis of baseline data from a randomized clinical intervention trial for patients at risk of cardiovascular disease and a review of study participants' medical records. Participants were veterans ≥ 40 years of age, enrolled in Veterans Affairs primary care, and diagnosed with hypertension and/or hypercholesterolemia. Self-report outcomes were the proportion of patients screening positive for an insomnia disorder and sleep apnea, self-reporting a sleep apnea diagnosis, and endorsing undertreated sleep apnea. Medical record outcomes were the proportion of patients diagnosed with insomnia and sleep apnea. Participants (n = 420) were veterans (84.8% male) with a mean age of 61.1 years. More than half of the sample (52.1%) screened positive for sleep apnea without prior self-reported diagnosis. More than one-third of the sample (39%) screened positive for an insomnia disorder. Medical records revealed considerably lower rates, with 3.8% diagnosed with insomnia, 20.5% diagnosed with sleep apnea, and about 1% diagnosed with both conditions. Undiagnosed and undertreated sleep disorders are common among veterans at risk for cardiovascular disease. Most of the sample (82%) screened positive for, or met, study criteria for sleep apnea or an insomnia disorder. Limitations include the use of self-reported sleep apnea treatment adherence, an insomnia disorder diagnosis based on questionnaire score, and a sample comprised primarily of male veterans. Routine sleep disorders screening in veterans at risk for cardiovascular disease could help to identify those at even greater risk because of the adverse effects of undiagnosed or undertreated sleep disorders. Registry; ClinicalTrials.gov; Name: Cardiovascular Intervention Improvement Telemedicine Study; URL: https://clinicaltrials.gov/ct2/show/NCT01142908; Identifier: NCT01142908.

Serious game versus standard care for rehabilitation after distal radius fractures: a protocol for a multicentre randomised controlled trial

IntroductionDistal radius fractures are among the most prevalent traumatic injuries worldwide. These injuries are associated with high healthcare-related and socioeconomic costs, mainly resulting from loss of productivity. To optimise recovery...

Associations of Perfluoroalkyl Substances with Prevalence of Metabolic Syndrome in Highly Exposed Young Adult Community Residents-A Cross-Sectional Study in Veneto Region, Italy.

Background: Studies on the association between perfluoroalkyl substances (PFAS) and metabolic syndrome (MetS) are limited, and results are inconsistent. We aimed to examine the associations between PFAS serum levels and the prevalence of MetS among highly exposed young adults (ages 20–39) residents of a large area of the Veneto Region (North-Eastern Italy) primarily stemming from PFAS water contamination before September 2013. A total of 15,876 eligible young adult residents living in the investigated municipalities were enrolled in the study from January 2017 to July 2019. Methods: MetS was defined by using a modified harmonized definition requiring the presence of 3 of the following: obesity (body mass index ≥30), elevated triglyceride (TG), reduced high-density lipoprotein cholesterol, elevated blood pressure, and hemoglobin A1c ≥ 6.1% or self-reported diabetes mellitus or drug treatment for hyperglycemia. Multivariable generalized additive models were performed to identify the associations between four serum PFAS, including perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA), and risk of MetS controlling for potential confounders. Results: A total of 1282 participants (8.1%) met the criteria of MetS with a higher prevalence among men. PFOA, PFHxS, and PFNA were not associated with the risk of MetS, whereas PFOS showed a consistent protective effect against the risk of MetS (OR 0.76, (95% CI: 0.69, 0.85) per ln-PFOS). However, we found statistically significant positive associations between PFAS serum levels and individual components of MetS, mainly elevated blood pressure and elevated TG. Conclusion: Our results did not support a consistent association between PFAS and MetS and conflicting findings were observed for individual components of MetS.

Time Trends in Comorbidity and Management of Hypertension and Self-reported Diabetes: A 15-Year Nationwide Longitudinal Study in China.

To examine time trends in comorbidity of hypertension and self-reported type 2 diabetes mellitus (T2DM) and their diagnosis, treatment, and management in China during 2000-2015 and study factors associated with these outcomes. Longitudinal data collected from the China Health and Nutrition Survey (CHNS) during 2000-2015 were analyzed. 143, 351, and 338 had both hypertension and self-reported T2DM were selected in 2000, 2011, and 2015, respectively. Average systolic blood pressure (SBP) and diastolic blood pressure (DBP) and hypertension prevalence among T2DM participants, and treatment and control of hypertension and self-reported T2DM among participants with both conditions were examined for all and by sex and weight status. Poisson regression model assessed the associations. From 2000 to 2015, among participants with self-reported T2DM, hypertension prevalence dropped from 88.4% to 83.0% and blood pressures decreased (P < 0.05). Men and overweight/obese participants had greater decreases in hypertension prevalence and DBP, while women had a larger decrease in SBP than men. Over time, among participants with both hypertension and self-reported T2DM, rates of hypertension treatment (45.3%-57.7%), hypertension control (3.0%-10.9%), and self-reported T2DM treatment (90.0%-95.6%) increased (all P < 0.001). Older, women, ever-smoking, heavier drinking, better income level, higher education level, and obesity had higher rates of prevalence, treatment, and control of hypertension, and self-reported T2DM treatment among participants with both hypertension and self-reported T2DM. Rates of hypertension treatment and control among participants with both hypertension and self-reported T2DM have improved in recent years, but were still low.

Cannabis use and co-use in tobacco smokers and non-smokers: prevalence and associations with mental health in a cross-sectional, nationally representative sample of adults in Great Britain, 2020.

In Great Britain, cannabis and tobacco are commonly used substances, both independently and together. Use of either substance is associated with mental health problems, but prevalence of co-use within these populations is unknown. We aimed to (1) estimate prevalence of cannabis use, frequency of use and routes of administration (ROA) among tobacco smokers and non-smokers and (2) investigate mental health problems among non-users, tobacco-only, cannabis-only and co-users of both substances. Cross-sectional national on-line survey (Action on Smoking and Health) fielded in February-March 2020. Great Britain. Adults in Great Britain aged ≥18years (n=12 809) MEASUREMENTS: Tobacco use status [smoker (daily or non-daily) or non-smoker (never or ex-smoker)], cannabis use frequency (never to daily), detailed ROAs of cannabis, self-reported treatment for mental health disorders (depression, anxiety and any). Statistically weighted prevalence estimates were computed to ensure representativeness. Correlates were assessed using χ2 tests and logistic regression. In Great Britain in 2020, 7.1% of the sample had used cannabis in the past year. Tobacco smokers had greater odds of using cannabis in the past year (21.9%) and using cannabis daily (8.7%) than non-smokers [past-year: 4.7%; adjusted odds ratio (aOR)=10.07, 95% confidence interval (CI)=8.4-12.0; daily: 0.7%; aOR=24.6, 95% CI=18.0-33.6)]. Co-administration with tobacco was common (46.2% of non-smokers, 80.8% of tobacco smokers). Co-users reported the highest prevalence of any treatment for mental health problems (54.2%) in comparison to cannabis-only (45.8%), tobacco-only (33.2%) and non-users (22.7%; all P≤0.05). Approximately one in 13 adults in Great Britain reports having used cannabis in the past year, approximately four times as many among cigarette smokers as non-smokers. Co-administration of cannabis and tobacco, via smoking, appears to be common, including among self-identified non-smokers. Mental health problems appear to be particularly common among dual users.

Understanding adherence to reactive treatment of asymptomatic malaria infections in The Gambia

The impact of different types of reactive case detection and/or treatment strategies for malaria elimination depends on high coverage and participants’ adherence. However, strategies to optimise adherence are limited, particularly for people with asymptomatic or no infections. As part of a cluster-randomized trial to evaluate the effect of reactive treatment in The Gambia, all residents in the compound of a diagnosed clinical malaria patient received dihydro-artemisinin–piperaquine (DP). Using a mixed method approach, we assessed which factors contribute to adherence among the contacts of malaria cases that showed no symptoms. Adherence was defined as the proportion of compound members that (1) returned all medicine bags empty and (2) self-reported (3-day) treatment completion. Among the 273 individuals from 14 compounds who received DP, 227 (83.1%) were available for and willing to participate in the survey; 85.3% (233/273) returned empty medicine bags and 91.6% (208/227) self-reported treatment completion. Although clinical malaria was not considered a major health problem, reported adherence was high. The drivers of adherence were the strong sense of responsibility towards protecting the individual, compound and the village. Adherence can be optimised through a transdisciplinary implementation research process of engaging communities to bridge the gap between research goals and social realities.

Pterygium in Rural Andean Ecuador: Epidemiology, risk factors, and barriers to care

Background: Pterygium is an ocular surface lesion that causes chronic eye irritation and eventually, vision impairment. Pathologically, prolonged ultraviolet (UV)-induced radiation damage leads to conjunctival and limbal stem cell damage. As such, rural, high-altitude equatorial communities are at particular risk due to proximity to the sun, outdoor work, and a lack of access to eye care. Methods: We conducted a cross-sectional study to determine the epidemiology of pterygium in the Chimborazo region of Ecuador. Adults presenting to Clinical FIBUSPAM's medical clinics for both ocular and nonocular reasons were examined by optometrists/ophthalmologists to identify pterygium. Affected patients completed a questionnaire about self-reported known risk factors, treatment, and barriers to care, and received UV-blocking sunglasses. Results: Of 296 patients, 165 (55%) had pterygium. The mean age was 60.2 years (range 19–88), 69% were female; 63% had unilateral pterygia, and 37% had bilateral pterygia. Symptoms occurring daily included severe photophobia (36%), foreign body sensation (28%), eye pain (24%), burning (31%), and itching (28%). In addition, 40% reported concern about eye appearance. Risk factors included spending >5 h outdoors each day working (93%), smoking (8%), and alcohol (14%). For prophylaxis, while 91% routinely wore hats outdoors, only 16% used sunglasses. For treatment, 30% used eye drops, of which two-thirds were natural remedies. About 93% wanted treatment (medications or surgical removal), 78% were concerned about access to treatment, and 43% reported cost as the major concern. Conclusions: Pterygium is highly prevalent (55%) among adults presenting for care in community health clinics in the Chimborazo Province of Ecuador. This treatable and potentially preventable cause of ocular irritation and vision loss greatly impacts the quality of life in this region. This and similar communities would benefit from improved education and outreach through care delivery models that bring affordable prevention and eye care services closer to home.

A Systematic Review of Experimental Approaches on Public Service Motivation

Recent studies on public service motivation (PSM) have increasingly adopted experimental approaches. This article provides a systematic review of the existing experimental studies on PSM and suggests guidance for future research. We assess the existing literature based on two criteria that differentiate experimental methods from observational ones: whether PSM is measured through an experiment and whether the research design operates treatment intervention for PSM. After reviewing a sample of 26 published studies, we find that only one study met both criteria. Most studies measure PSM through a self-reported survey and lack treatment effects, making it difficult to differentiate them from observational studies. Furthermore, external validity remains a concern, as most studies use students as proxies for civil servants or focus only on Western states. We conclude that experimental studies on PSM remain at a nascent stage with much room for improvement, especially the experimental design.

The Role of Multidimensional Poverty in Antibiotic Misuse: A Study of Self-Medication and Non-Adherence in Kenya, Tanzania, and Uganda

Background: Poverty is a proposed driver of antimicrobial resistance (AMR), influencing inappropriate antibiotic (AB) use in low and middle-income countries (LMICs). However, at sub-national levels, studies investigating poverty and AB use are sparse and the results inconsistent. Methods: The Holistic Approach to Unravelling Antimicrobial Resistance (HATUA) Consortium collected data from 6,827 patients presenting with urinary tract infection (UTI) symptoms in Kenya, Uganda, and Tanzania. Using Bayesian hierarchical modelling, we investigated the association between multidimensional poverty and self-reported AB self-medication and treatment non-adherence (skipping a dose and not completing the course). We also analysed linked qualitative in-depth patient interviews (IDIs) (n = 82) and unlinked focus group discussions (FGDs) with community members (n = 44 groups). Findings: AB self-medication and non-adherence to treatment courses was significantly more common in the least deprived group compared with those in severe poverty. Adjustment for AB ‘knowledge’, attitudes and socio-demographics diminished the association with self-medication, but not non-adherence. IDIs and FGDs suggested that self-medication and non-adherence are driven by perceived inconvenience of the healthcare system, financial barriers, and ease of unregulated AB access. Interpretation: Structural barriers to optimal AB use exist at all levels of the socioeconomic hierarchy. Inefficiencies in public healthcare may be fuelling alternative antibiotic access points, for those who can afford it. In designing interventions to tackle AMR and reduce AB misuse, the behaviours and needs of wealthier population groups should not be neglected. Funding Information: UK National Institute for Health Research, Medical Research Council and the Department of Health and Social Care. Declaration of Interests: None. Ethics Approval Statement: Ethical approval for this project was obtained from the University of St Andrews, UK (No. MD14548, 10/09/19); National Institute for Medical Research, Tanzania (No. 2831, updated 26/07/19), CUHAS/BMC research ethics and review committee (No. CREC/266/2018, updated on 02/2019), Mbeya Medical Research and Ethics Committee (No. SZEC-2439/R. A/V.1/303030), Kilimanjaro Christian Medical College, Tanzania (No. 2293, updated 14/08/19). Uganda National Council for Science and Technology (number HS2406, 18/06/18); Makerere University, Uganda (number 514, 25/04/18); and Kenya Medical Research Institute (04/06/19, Scientific and Ethics Review Committee (SERU) number KEMRI/SERU/CMR/P00112/3865 V.1.2). For Uganda, administrative letters of support were obtained from the district health officers to allow the research to be conducted in the respective hospitals and health centres.

Impact of blinded retrospective continuous glucose monitoring on clinical decision making and glycemic control in persons with type 2 diabetes on insulin therapy

Background and aimsBlinded retrospective continuous glucose monitoring (rCGM) provides detailed information about real-life glycaemic profile. In persons with type 2 diabetes without adequate glycaemic control, the structured introduction of rCGM may be beneficial to sustain improvements in diabetes management. Methods and results102 individuals with insulin-treated type 2 diabetes, age less than 66 years old and HbA1c >7.5%, were recruited. Participants performed a 7-day blinded rCGM (iPro2) every four months for one year. Biochemical, anthropometric, and rCGM data was collected. Participants' and healthcare professionals’ perceptions were assessed.90 participants completed the protocol. HbA1c was 9.1 ± 0.1% one year prior to enrolment and 9.4 ± 0.1% at enrolment (p < 0.01). With the rCGM-based intervention, a decrease in HbA1c was achieved at 4 months (8.4 ± 0.1%, p < 0.0001), and 12 months (8.1 ± 0.1%, p < 0.0001). A significant increase in time-in-range was observed (50.8 ± 2.4 at baseline vs 61.5 ± 2.2% at 12 months, for 70–180 mg/dL, p < 0.001), with no difference in exposure time to hypoglycaemia. After 12 months, there was an increase in self-reported diabetes treatment satisfaction (p < 0.05). ConclusionIn persons with type 2 diabetes and poor metabolic control, specific data from blinded rCGM informed therapeutic changes and referral to targeted education consultations on nutrition and insulin administration technique. Therapeutic changes were made more frequently and targeted to changes in medication dose, timing, and/or type, as well as to lifestyle. Together, these brought significant improvements in clinical outcomes, effective shared decision-making, and satisfaction with treatment. Registration numberNCT04141111.

Self-reports of treatment for secondary health conditions: results from a longitudinal community survey in spinal cord injury.

Longitudinal community survey. To describe the treatment for secondary health conditions as reported by individuals living with spinal cord injury (SCI) and to identify potential predictors of treatment. Community (people with SCI living in Switzerland). Data on the frequency, severity, and treatment of 14 common health conditions (HCs) in the past three months were collected in two surveys by the Swiss Spinal Cord Injury (SwiSCI) cohort study, in 2012 and 2017. Variation in treatment was analyzed using descriptive statistics, by survey period and severity of HC. Conditional multilevel random-effects logistic regression was used to describe differences in self-reported treatment with respect to sociodemographic and socioeconomic factors in addition to SCI characteristics and severity and number of HCs. Severe or chronic autonomic dysreflexia and sleep problems showed in the self-report as the HCs with the lowest occurrence/frequency of treatment. Across all HCs, higher age, shorter time since injury, the total number of HCs, and level of severity were associated with a higher propensity for reporting treatment. Individuals with severe financial difficulties additionally had 1.40 greater odds of receiving treatment (95% CI 1.09-1.80). This study identified systematic differences in the report of HCs and their treatment within the Swiss SCI community. This study thus provides a basis to guide future research on identifying targets of intervention for long-term clinical management of SCI.

Comparing Accelerometer and Self-Reported Treatment Effects in a Technology-Supported Physical Activity Intervention.

To estimate and compare the change in moderate-to-vigorous physical activity (MVPA) between an accelerometer and technology-supported physical activity (PA) log across a 3-week PA intervention. Participants (N = 204, 77% female, age = 33 ± 11 years, body mass index = 28.2 ± 7.1 kg/m2) were randomized to one of two activity-related intervention arms: (1) increase MVPA intervention or (2) decrease sedentary behavior active control. Participants wore an accelerometer while simultaneously completing a technology-based PA log every day for 5 weeks: a 2-week baseline assessment phase and a 3-week intervention phase. Bivariate linear mixed-effects models and correlations were used to characterize the relationship of MVPA between measurement methods throughout the intervention. Effect sizes were calculated to determine the intervention effect by measurement method. At baseline, PA log MVPA was 28 minutes greater than accelerometer-based minutes of MVPA in the active control group. This difference was 35 minutes (95% CI [23.7, 46.1]) greater at follow-up than at baseline measurement in the MVPA intervention group. In the active control group, there was a significant 16-minute (95% CI [6.0, 26.5]) increase between the two measures from baseline to follow-up. The intervention effect size based on the PA log was 0.27 (95% CI [0.14, 0.39]) and 0.42 (95% CI [0.28, 0.56]) when using the accelerometer. Our results indicate that PA log MVPA and accelerometer MVPA estimate significantly different minutes per day of MVPA. It is important researchers use caution when comparing MVPA intervention outcomes from different measurement methods.