Self-reported Usage Research Articles

A latent class based imputation method under Bayesian quantile regression framework using asymmetric Laplace distribution for longitudinal medication usage data with intermittent missing values

ABSTRACTEvaluating the association between diseases and the longitudinal pattern of pharmacological therapy has become increasingly important. However, in many longitudinal studies, self-reported medication usage data collected at patients’ follow-up visits could be missing for various reasons. These pieces of missing or inaccurate/untenable information complicate determining the trajectory of medication use and its complete effects for patients. Although longitudinal models can deal with specific types of missing data, inappropriate handling of this issue can lead to a biased estimation of regression parameters especially when missing data mechanisms are complex and depend upon multiple sources of variation. We propose a latent class-based multiple imputation (MI) approach using a Bayesian quantile regression (BQR) that incorporates cluster of unobserved heterogeneity for medication usage data with intermittent missing values. Findings from our simulation study indicate that the proposed method performs better than traditional MI methods under certain scenarios of data distribution. We also demonstrate applications of the proposed method to data from the Prospective Study of Outcomes in Ankylosing Spondylitis (AS) cohort when assessing an association between longitudinal nonsteroidal anti-inflammatory drugs (NSAIDs) usage and radiographic damage in AS, while the longitudinal NSAID index data are intermittently missing.

Characteristics and Usage Patterns Among 12,151 Paid Subscribers of the Calm Meditation App: Cross-Sectional Survey.

BackgroundMeditation has become increasingly popular due to its health benefits; however, barriers to delivering meditation programs in traditional group-based formats limit the accessibility of these benefits. Smartphone-based meditation may increase the availability of these programs to larger, more diverse audiences; however, research on subscriber characteristics and usage patterns in meditation mobile apps is lacking.ObjectiveThis study aimed to describe the demographics, clinical characteristics, and usage patterns of a convenience sample of Calm subscribers and explore the relationship between self-reported app usage and changes in health, stress, and sleep.MethodsParticipants were 12,151 paying Calm subscribers (response rate=12.08%, 12,151/100,594) who completed an anonymous Web-based survey with 11 quantitative questions related to user engagement, reasons for starting Calm, and changes after using the app. Demographic characteristics, chronic health diagnoses, and sleep difficulties were also assessed. Chi-square tests were used to examine differences in app usage. Logistic regression models were used to examine demographic and health characteristics that may predict changes in health, stress, and sleep.ResultsRespondents were 18-96 years old (mean 48.57 [SD 13.79]), primarily female (79.94%, 8778/10,981), white (81.41%, 8959/11,005), and most reported a chronic health diagnosis (56.86%, 6289/11,061). Mental health diagnoses (41.13%, 4549/11,061) were more common than physical health diagnoses (32.19%, 3560/11,061). Most respondents (76.31%, 8684/11,360) reported difficulties falling or staying asleep. On average, respondents had been using Calm for 11.49 months (SD 10.49), and 60.03% (7281/12,129) used it 5 or more times per week. Meditations (used by 80.02%, 9497/11,841) and Sleep Stories (55.66%, 6591/11,841) were the most popular components. The frequency of using Calm was associated with incremental increases in the likelihood of noticing changes in mental health (χ22=136.8; P<.001), physical health (χ22=102.8; P<.001), stress (χ22=128.1; P<.001), and sleep (χ22=141.4; P<.001). Respondents who had used Calm longer were also more likely to notice changes in mental health (OR 1.06 [95% CI 1.05 to 1.06]), physical health (OR 1.01 [95% CI 1.01 to 1.02]), stress (OR 1.04 [95% CI 1.04 to 1.05]), and sleep (OR 1.004 [95% CI 1.00 to 1.01]). Subscribers with sleep difficulties used Calm more frequently (χ82=11.5; P=.003), were more likely to use Sleep Stories (χ12=1590.2; P<.001), and were more likely to notice changes in their physical health (χ12=49.2; P<.001) and sleep (χ12=2391.1; P<.001).ConclusionsResults highlight important demographic characteristics and usage patterns among a self-selected sample of Calm subscribers. Mental health concerns and sleep appear to be top reasons for downloading Calm. Sleep Stories and meditations are the most popular app components. The frequency of using Calm was associated with incremental changes in outcomes. Findings support future randomized controlled trials testing the efficacy of Calm for health, stress, and sleep. Studies should also explore strategies to attract a more diverse sample of subscribers.

A descriptive study of antithrombotic medication patterns in adult patients with recent venous thromboembolism.

Objectives:The objective of this study is to describe the most common self-reported antithrombotic therapy utilization patterns in a national cohort of patients with recent venous thromboembolism (VTE).Methods:Extant data from a national online survey administered to 907 patients 18 years of age or older with VTE in the last two years were analyzed. Patients’ self-reported antithrombotic usage patterns used during three phases of treatment for the most recent VTE episode were summarized using descriptive statistics.Results:The following overall antithrombotic usage patterns were identified: warfarin (38.7%), direct oral anticoagulants (DOACs) (26.1%), switching between warfarin and DOACs (13.3%), aspirin only (8.7%), switching between different DOACs (4.5%), injectable anticoagulants only (3.9%), and no treatment (4.7%). Extended antithrombotic therapy beyond 90 days was reported by 65.7% of patients. Aspirin coadministration with anticoagulant therapy occurred for 33.7%.Conclusions:In this national sample of recent VTE sufferers warfarin therapy remains the most used anticoagulant followed closely by DOAC therapy. Switching between warfarin and DOACs and between different DOACs was common which could indicate adverse events or affordability issues. Aspirin coadministration with anticoagulant therapy was present in 1 of 3 patients and is a potential medication safety intervention for anticoagulation providers.

Factors Affecting Smartphone Usage Self-Report Levels.

For the treatment of smartphone addiction, it is important to understand users' smartphone usage patterns. Most of the studies are based on self-report surveys. However, there are differences between self-reported usage and real usage. For a better understanding of usage patterns, this study identified demographic and social factors that affect smartphone usage self-report levels. Also, it was confirmed that the influencing factors differ depending on the smartphone usage content by application category.

A Social Media Study on the Effects of Psychiatric Medication Use

Understanding the effects of psychiatric medications during mental health treatment constitutes an active area of inquiry. While clinical trials help evaluate the effects of these medications, many trials suffer from a lack of generalizability to broader populations. We leverage social media data to examine psychopathological effects subject to self-reported usage of psychiatric medication. Using a list of common approved and regulated psychiatric drugs and a Twitter dataset of 300M posts from 30K individuals, we develop machine learning models to first assess effects relating to mood, cognition, depression, anxiety, psychosis, and suicidal ideation. Then, based on a stratified propensity score based causal analysis, we observe that use of specific drugs are associated with characteristic changes in an individual’s psychopathology. We situate these observations in the psychiatry literature, with a deeper analysis of pre-treatment cues that predict treatment outcomes. Our work bears potential to inspire novel clinical investigations and to build tools for digital therapeutics.

A Smartphone App to Support Carers of People Living With Cancer: A Feasibility and Usability Study.

BackgroundCarers experience unique needs while caring for someone with cancer. Interventions that address carers’ needs and well-being have been developed and tested; however, the use of smartphone apps to support adult carers looking after another adult with cancer has not been assessed.ObjectiveThe objective of this study was to test the feasibility, usability, and acceptability of a smartphone app, called the Carer Guide App, for carers of people with colorectal cancer.MethodsWe recruited carers of people with colorectal cancer from outpatient day oncology units and provided them with access to the smartphone app for 30 days. Carers had access to video instructions and email contact details for technical support. Carers received 2 email messages per week that directed them to resources available within the app. Carers completed demographic questions at baseline and questions related to feasibility and usability at 30 days post app download. We used recruitment and attrition rates to determine feasibility and relevance of content to carers’ needs as self-reported by carers. We assessed usability through the ease of navigation and design and use of technical support or instructional videos. Acceptability was measured through self-reported usage, usage statistics provided by Google Analytics, and comments for improvement.ResultsWe recruited 31% (26/85) eligible carers into the trial. Of the 26 carers, the majority were female (19, 73%), on average 57 years of age, were caring for a spouse with cancer (19, 73%), and held a university degree (19, 73%). Regarding feasibility, carers perceived the content of the Carer Guide App as relevant to the information they were seeking. Regarding usability, carers perceived the navigation and design of the app as easy to use. Of the 26 carers, 4 (15%) viewed the downloading and navigation video and 7 (27%) used the contact email address for queries and comments. Acceptability: On average, carers used the smartphone app for 22 minutes (SD 21 minutes) over the 30-day trial. Of 26 participants, 19 completed a follow-up questionnaire. Of 19 carers, 7 (37%) logged on 3 to 4 times during the 30 days and 5 (26%) logged on more than 5 times. The majority (16/19, 84%) of carers stated that they would recommend the app be available for all carers. Comments for improvement included individualized requests for specific content.ConclusionsThe Carer Guide App was feasible and usable among carers of people with colorectal cancer. Acceptability can be improved through the inclusion of a variety of information and resources. A randomized controlled trial is required to assess the impact of the Carer Guide App on carers’ health and well-being.

Perspectives of Nonphysician Clinical Students and Medical Lecturers on Tablet-Based Health Care Practice Support for Medical Education in Zambia, Africa: Qualitative Study.

BackgroundZambia is faced with a severe shortage of health workers and challenges in national health financing. This burdens the medical licentiate practitioner (MLP) program for training nonphysician clinical students in Zambia because of the shortage of qualified medical lecturers and learning resources at training sites. To address this shortage and strengthen the MLP program, a self-directed electronic health (eHealth) platform was introduced, comprising technology-supported learning (e-learning) for medical education and support for health care practice. MLP students were provided with tablets that were preloaded with content for offline access.ObjectiveThis study aimed to explore MLP students’ and medical lecturers’ perceptions of the self-directed eHealth platform with an offline-based tablet as a training and health care practice support tool during the first year of full implementation.MethodsWe conducted in-depth qualitative interviews with 8 MLP students and 5 lecturers and 2 focus group discussions with 16 students to gain insights on perceptions of the usefulness, ease of use, and adequacy of self-directed e-learning and health care practice support accessible through the offline-based tablet. Participants were purposively sampled. Verbatim transcripts were analyzed following hypothesis coding.ResultsThe eHealth platform (e-platform), comprising e-learning for medical education and health care practice support, was positively received by students and medical lecturers and was seen as a step toward modernizing the MLP program. Tablets enabled equal access to offline learning contents, thus bridging the gap of slow or no internet connections. The study results indicated that the e-platform appears adequate to strengthen medical education within this low-resource setting. However, student self-reported usage was low, and medical lecturer usage was even lower. One stated reason was the lack of training in tablet usage and another was the quality of the tablets. The mediocre quality and quantity of most e-learning contents were perceived as a primary concern as materials were reported to be outdated, missing multimedia features, and addressing only part of the curriculum. Medical lecturers were noted to have little commitment to updating or creating new learning materials. Suggestions for improving the e-platform were given.ConclusionsTo address identified major challenges, we plan to (1) introduce half-day training sessions at the beginning of each study year to better prepare users for tablet usage, (2) further update and expand e-learning content by fostering collaborations with MLP program stakeholders and nominating an e-platform coordinator, (3) set up an e-platform steering committee including medical lecturers, (4) incorporate e-learning and e-based health care practice support across the curriculum, as well as (5) implement processes to promote user-generated content. With these measures, we aim to sustainably strengthen the MLP program by implementing the tablet-based e-platform as a serious learning technology for medical education and health care practice support.

Using Point-of-Choice Prompts to Reduce Sedentary Behavior in Sit-Stand Workstation Users.

Introduction: Desk-based office workers are at occupational risk for poor health outcomes from excessive time spent sitting. Sit-stand workstations are used to mitigate sitting, but lack of workstation usage has been observed. Point-of-choice (PoC) prompts offer a complementary strategy for office workers to break up their sitting time.Study purpose: The purpose of this study was to examine the preliminary efficacy, preference, and acceptability of a theory-driven (i.e., 40 unique prompts encompassing social cognitive theory; TD-PoC) and an atheoretical basic reminder PoC prompt intervention (R-PoC) on reducing sedentary behavior in office workers with self-reported low sit-stand workstation usage (≤4 h per day).Methods: In a cross-over design, participants (N = 19, 78.9% female, 39.4 ± 10.7 years of age) completed a 5-days no-prompt control condition followed by a random and counterbalanced assignment to one of the TD-PoC and R-PoC active conditions with a 1-week washout period between. Preliminary efficacy was assessed during work hours with the activPAL micro accelerometer. Preference was assessed prior to each active condition and acceptability was assessed following each active condition via questionnaire.Results: The R-PoC prompt condition significantly decreased sitting time (b[se] = −49.0 [20.8], p = 0.03) and increased standing time (b[se] = 49.8 [19.7], p = 0.02) and displayed a significant increase in sit-stand transitions (b[se] = 2.3 [1.1], p = 0.04), relative to no-prompt control. Both the R-PoC and TD-PoC prompt conditions significantly decreased time spent in prolonged sitting bouts at b[se] = −68.1 [27.8], (p = 0.02), (b[se] = −76.7 [27.1], p = 0.008) relative to no-prompt control. Overall, the TD-PoC prompt condition displayed higher preference and acceptability ratings; however, these differences were not significant (p's > 0.05).Conclusion: While the R-PoC prompt condition was slightly more efficacious than the TD-PoC prompt condition, the TD-PoC prompt condition was rated with higher preference and acceptability scores. Large variations between participants in preference, acceptability, and intervention feedback may indicate need for tailored messaging which may facilitate sustained use in the long-term.

Evaluating Moodle use via Smart Mobile Phones. A case study in a Greek University

The use of learning management systems (LMS) has grown considerably in universities around the world. LMSs can offer a great variety of channels and workspaces to facilitate information sharing and communication among participants in a course. One of the most commonly used is Moodle, a free learning management system enabling the creation of powerful, flexible and engaging online courses and experiences. A course can consist of a number of lessons. Each lesson consists of reading materials; activities such as quizzes, tests, surveys, and projects; and social elements that encourage interaction and group work among students. This study investigated how often students used a mobile phone to access various activities on Moodle. The students’ point of view is important since they are the main users of the offered teaching technique and can cooperate in implementing and improving an e-course as a very important stakeholder in the e-learning process. A survey on self-reported usage was filled by 122 university students in a course offered by the faculty of Preschool Education at the University of Crete. Follow-up interviews were conducted to solicit students’ perceptions on mobile access to Moodle and the underlying reasons. The results show significant differences in students’ usage of various Moodle activities via mobile phones. Students’ responses also suggest that Moodle is used merely as an electronic document repository and not as an effective learning tool due to the limitations of mobile access on usability and reliability.

Contextualized bilingualism among adolescents from four different ethnic groups in Indonesia

Aims and objectives:We were interested in group differences in Indonesia in bilingualism, whether vocabulary knowledge shows a differential pattern across the languages, and whether language skill and usage differences between groups are moderated by contextual factors, such as ethnic group size.Data and analysis:We examined group differences in language usage at home and in public, self-reported proficiency, and vocabulary scores in both languages among 632 adolescents (292 males, Mage= 14.57 years) from four ethnic groups in Indonesia (214 Javanese, 115 Batak Toba, 108 Toraja, and 195 Chinese). Differential item functioning analysis was conducted to test whether adolescents had different vocabulary they only know in one language, which would indicate equality or inequality in access to knowledge in the two languages.Findings:There were large differences in language knowledge and usage. The lowest scores in ethnic language vocabulary and usage were found among the Chinese group. Across groups, scores for Bahasa Indonesia (L2) vocabulary were higher than ethnic language (L1) vocabulary. However, the ranking from easy to difficult words was similar across the languages and there were no specific sets of items that were differentially known in any language.Implication:Despite the differences in bilingualism skill and usage, all groups have similar access to different domains of the languages, and L2 (Bahasa Indonesia) seems to have become the dominant language in all groups. Our findings also imply that bilingualism comprises various domains, including language skill, self-reported proficiency, and self-reported usage, and that the associations between these components are not very strong.Originality:We investigated bilingualism among non-immigrant adolescents in an under-researched, non-WEIRD (western, educated, industrialized, rich, democratic) society. The study shows the role of language usage and skill that is different from a western context in various aspects, such as the dominance of L2 in all groups.

Opioid Pain Medication Use in New Urogynecology Patients

The aim of this study was to determine the prevalence of opioid pain medication use among patients presenting for a new visit to the urogynecology clinic compared with those presenting to general gynecology. We identified all patients who presented for new patient visits to the urogynecology and gynecology clinics between January 1, 2016, and December 31, 2016. Any previous or current opioid use was extracted from the electronic medical record medication list. Statistical analysis was performed using χ and Fisher exact tests for comparisons of categorical variables. Modified Poisson regression models were used to estimate prevalence proportion ratios (PPRs). There were 1835 (955 gynecology, 880 urogynecology) patients included. Median age was 47 years (interquartile range, 29 years), and median body mass index was 28.15 kg/m (interquartile range, 9.96 kg/m). Prevalence of opioid use was lowest among women who identified as Asian or other race and highest among black and Native American women; however, when compared by ethnicity, use was lowest among Hispanic women (P = 0.01). Among new urogynecology patients, 14% had self-reported opioid pain medication usage. Opioid use was almost twice as likely in the urogynecology group (PPR, 1.86; 95% confidence interval, 1.4-2.4). When adjusted for confounders, the urogynecology group was 1.3 times as likely to report opioid use (PPR 1.29; 95% confidence interval, 1.0-1.8), with this result approaching statistical significance. Opioid use is greater in patients presenting to the urogynecology clinic compared with general gynecology. Urogynecologists need to know this information for planning and optimizing pain management in this population.

Estimation of TETRA radio use in the Airwave Health Monitoring Study of the British police forces

BackgroundThe Airwave Health Monitoring Study aims to investigate the possible long-term health effects of Terrestrial Trunked Radio (TETRA) use among the police forces in Great Britain. Here, we investigate whether objective data from the network operator could be used to correct for misreporting in self-reported data and expand the radio usage availability in our cohort. MethodsWe estimated average monthly usage of personal radio in the 12 months prior to enrolment from a missing value imputation model and evaluated its performance against objective and self-reported data. Factors associated with TETRA radio usage variables were investigated using Chi-square tests and analysis of variance. ResultsThe imputed data were better correlated with objective than self-reported usage (Spearman correlation coefficient = 0.72 vs. 0. 52 and kappa 0.56 [95% confidence interval 0.55, 0.56] vs. 0.46 [0.45, 0.47]), although the imputation model tended to under-estimate use for higher users. Participants with higher personal radio usage were more likely to be younger, men vs. women and officer vs. staff. The median average monthly usage level for the entire cohort was estimated to be 29.3 min (95% CI: [7.2, 66.6]). ConclusionThe availability of objective personal radio records for a large proportion of users allowed us to develop a robust imputation model and hence obtain personal radio usage estimates for ~50,000 participants. This substantially reduced exposure misclassification compared to using self-reported data and will allow us to carry out analyses of TETRA usage for the entire cohort in future work.

Longitudinal study of health, disease and access to care in rural Victoria: the Crossroads-II study: methods

BackgroundHigh quality, contemporary data regarding patterns of chronic disease is essential for planning by health services, policy makers and local governments, but surprisingly scarce, including in rural Australia. This dearth of data occurs despite the recognition that rural Australians live with high rates of ill health, poor health behaviours and restricted access to health services. Crossroads-II is set in the Goulburn Valley, a rural region of Victoria, Australia 100–300 km north of metropolitan Melbourne. It is primarily an irrigated agricultural area.The aim of the study is to identify changes in the prevalence of key chronic health conditions including the extent of undiagnosed and undermanaged disease, and association with access to care, over a 15 year period.Methods/designThis study is a 15 year follow up from the 2000–2003 Crossroads-I study (2376 households participated). Crossroads-II includes a similar face to face household survey of 3600 randomly selected households across four towns of sizes 6300 to 49,800 (50% sampled in the larger town with the remainder sampled equally from the three smaller towns). Self-reported health, health behaviour and health service usage information is verified and supplemented in a nested sub-study of 900 randomly selected adult participants in ‘clinics’ involving a range of additional questionnaires and biophysical measurements. The study is expected to run from October 2016 to December 2018.DiscussionBesides providing epidemiological and health service utilisation information relating to different diseases and their risk factors in towns of different sizes, the results will be used to develop a composite measure of health service access. The importance of access to health services will be investigated by assessing the correlation of this measure with rates of undiagnosed and undermanaged disease at the mesh block level. Results will be shared with partner organisations to inform service planning and interventions to improve health outcomes for local people.

Understanding Elementary Students’ Use of Digital Textbooks on Mobile Devices: A Structural Equation Modeling Approach

The purpose of this study is to design a structural model explaining how elementary students use digital textbooks on mobile devices. This study extends the technology acceptance model framework, with self-efficacy, learning motivation, learning strategies, and parent education level as external variables. Results show that perceived usefulness was a significant mediating factor for students’ actual usage of digital textbook on mobile devices. Self-efficacy and learning strategies influence self-reported actual usage through perceived usefulness and perceived ease of use. In addition, parent education level has a significant influence on students’ self-efficacy and especially learning motivation. These findings have broadened research on technology acceptance with emphasis on a more learning-centered framework that focuses on the learners’ characteristics and their unique contexts when using digital textbooks via mobile devices.

Jordanian twelfth-grade science teachers’ self-reported usage of science and engineering practices in the next generation science standards

ABSTRACTThis study investigated the degree that Science and Engineering Practices (SEPs) criteria from the Next Generation Science Standards (NGSS) were included in self-reported teaching practices of twelfth-grade science teachers in Jordan. This study sampled (n = 315) science teachers recruited from eight different public school directorates. The sample was surveyed using an instrument adapted from Kawasaki (2015). Results found that Jordanian science teachers incorporate (SEPs) in their classroom teaching at only a moderate level. SEPs applied most frequently included ‘using the diagram, table or graphic through instructions to clarify the subject of a new science,’ and to ‘discuss with the students how to interpret the quantitative data from the experiment or investigation’. The practice with the lowest frequency was ‘teach a lesson on interpreting statistics or quantitative data,’ which was moderately applied. No statistically significant differences at (α = 0.05) were found among these Jordanian science teachers’ self-estimations of (SEP) application into their own teaching according to the study’s demographic variables (specialisation, educational qualification, teaching experience). However, a statistically significant difference at (α = 0.05) was found among Jordanian high school science teachers’ practice means based on gender, with female teachers using SEPs at a higher rate than male teachers.

Health sciences faculty usage behaviour of electronic resources and their information literacy practices

PurposeThis paper aims to assess the usage behaviour of electronic resources (e-resources) among health sciences faculty and their level information literacy (IL) practices, and whether individual characteristics and IL skills can influence faculty member’s usage of e-resources at Muhimbili University of Health and Allied Sciences (MUHAS).Design/methodology/approachThe authors conducted questionnaire surveys using a stratified random sampling technique to 135 faculty members at MUHAS between August and October 2016. The study used regression analysis to determine factors associated with the use of e-resources among faculty members at MUHAS.FindingsIn addition to Google search engine, Wikipedia and four scholarly databases and search engines, the level of awareness of other 19 scholarly databases and search engines which are either subscribed or open access resources was less than 50 per cent. In addition to Google search engine, Wikipedia and five scholarly databases and search engines, the self-reported usage of other 18 scholarly databases and search engines was less than 50 per cent on the on “daily” and “weekly” categories. In total, 18 of the 32 IL competencies were rated below 50 per cent in the “good” grade by the faculty members. These IL competencies included information search techniques, reference management, critical appraisal and Web 2.0 technologies. The IL competencies (ß = 0.223), an experience of using e-resources (ß = 0.222) and some research disciplines [nursing (ß = 0.191) and pharmacy (ß = 0.186)] positively predicted self-reported usage of e-resources among faculty members.Originality/valueThis is a comprehensive study that assesses the use patterns of e-resources across different health sciences disciplines in a university setting, and the influence of demographic characteristics and IL skills on the usage of e-resources in Tanzania. The results of this study will be useful to academic libraries to inform and review their policies and practices in relation to the IL training programmes and information services in a university setting.

Total recall in the SCAMP cohort: Validation of self-reported mobile phone use in the smartphone era

Mobile phone use, predominantly smartphones, is almost ubiquitous amongst both adults and children. However adults and children have different usage patterns. A major challenge with research on mobile phone use is the reliability of self-reported phone activity for accurate exposure assessment. We investigated the agreement between self-reported mobile phone use data and objective mobile operator traffic data in a subset of adolescents aged 11–12 years participating in the Study of Cognition, Adolescents and Mobile Phones (SCAMP) cohort. We examined self-reported mobile phone use, including call frequency, cumulative call time duration and text messages sent among adolescents from SCAMP and matched these data with records provided by mobile network operators (n = 350). The extent of agreement between self-reported mobile phone use and mobile operator traffic data use was evaluated using Cohen's weighted Kappa (ĸ) statistics. Sensitivity and specificity of self-reported low (< 1 call/day, ≤ 5min of call/day or ≤ 5 text messages sent/day) and high (≥ 11 calls/day, > 30min of call/day or ≥ 11 text messages sent /day) use were estimated.Agreement between self-reported mobile phone use and mobile operator traffic data was highest for the duration spent talking on mobile phones per day on weekdays (38.9%) and weekends (29.4%) compared to frequency of calls and number of text messages sent. Adolescents overestimated their mobile phone use during weekends compared to weekdays. Analysis of agreement showed little difference overall between the sexes and socio-economic groups. Weighted kappa between self-reported and mobile operator traffic data for call frequency during weekdays was κ = 0.12, 95% CI 0.06–0.18. Of the three modes of mobile phone use measured in the questionnaire, call frequency was the most sensitive for low mobile phone users on weekdays and weekends (77.1, 95% CI: 69.3—83.7 and 72.0, 95% CI: 65.0–78.4, respectively). Specificity was moderate to high for high users with the highest for call frequency during weekdays (98.4, 95% CI: 96.4–99.5).Despite differential agreement between adolescents’ self-reported mobile phone use and mobile operator traffic data, our findings demonstrate that self-reported usage adequately distinguishes between high and low use. The greater use of mobile smartphones over Wi-Fi networks by adolescents, as opposed to mobile phone networks, means operator data are not the gold standard for exposure assessment in this age group. This has important implications for epidemiologic research on the health effects of mobile phone use in adolescents.

Self-reported medication use validated through record linkage to national prescribing data

ObjectivesResearchers need to be confident about the reliability of epidemiologic studies that quantify medication use through self-report. Some evidence suggests that psychiatric medications are systemically under-reported. Modern record linkage enables validation of self-report with national prescribing data as gold standard. Here, we investigated the validity of medication self-report for multiple medication types. Study Design and SettingParticipants in the Generation Scotland population-based cohort (N = 10,244) recruited 2009–2011 self-reported regular usage of several commonly prescribed medication classes. This was matched against Scottish NHS prescriptions data using 3- and 6-month fixed time windows. Potential predictors of discordant self-report, including general intelligence and psychological distress, were studied via multivariable logistic regression. ResultsAntidepressants self-report showed very good agreement (κ = 0.85, [95% confidence interval (CI) 0.84–0.87]), comparable to antihypertensives (κ = 0.90 [CI 0.89–0.91]). Self-report of mood stabilizers showed moderate-poor agreement (κ = 0.42 [CI 0.33–0.50]). Relevant past medical history was the strongest predictor of self-report sensitivity, whereas general intelligence was not predictive. ConclusionIn this large population-based study, we found self-report validity varied among medication classes, with no simple relationship between psychiatric medication and under-reporting. History of indicated illness predicted more accurate self-report, for both psychiatric and nonpsychiatric medications. Although other patient-level factors influenced self-report for some medications, none predicted greater accuracy across all medications studied.

A Randomized Controlled Trial of Continuous Subpleural Bupivacaine After Thoracoscopic Surgery

We sought to evaluate the merit of routine placement of a subpleural tunneled pain catheter delivering local anesthetic as measured by narcotic medication usage and subjective pain score analysis. Eighty-six patients were randomized into the subpleural catheter or intraoperative incision site injection groups in a 1:1 fashion, and underwent thoracoscopic surgery using 2 incisions. All patients had standardized anesthetic delivery and postoperative pain control. Patients' use of pain medication and pain scores was tracked for 7 days postoperatively. There was no significant difference in the 2 groups' usage of narcotics (P = 0.23), acetaminophen (P = 0.23), or nonsteroidal antiinflammatory drugs (P = 0.57) over time from linear mixed model analysis. The subpleural catheter group had significantly higher nonsteroidal antiinflammatory drug self-reported usage on postoperative day 4 (P = 0.04), postoperative day 5 (P = 0.05), postoperative day 6 (P = 0.01), and postoperative day 7 (P <0.01). There were no significant differences in average daily pain scores (all P ≥ 0.06). Length of hospital stay and results from 30-day postoperative surveys were not significantly different between the subpleural catheter and the intraoperative incision site injection groups. Our results did not show any objective differences between the subpleural catheter and the intraoperative incision site injection groups to justify routine use of tunneled subpleural catheters. The main limitation of this study is missing self-reported data. The differences noted in daily nonsteroidal antiinflammatory drug use in the pain catheter arm may actually suggest slightly worse pain control in those patients, although the clinical significance seems to be minimal.

PSYCHOLOGICAL FACTORS ASSOCIATED WITH SELF-REPORTED SYMPTOM BURDEN, QUALITY OF LIFE AND HEALTH CARE USAGE AMONG PAROXYSMAL ATRIAL FIBRILLATION PATIENTS

Atrial fibrillation (AF) is associated with distressing symptoms, impaired quality of life (QoL) and hospital readmissions. Anxiety sensitivity (AnxS), a cognitive trait, predisposes individuals to interpret autonomic changes as harmful. AnxS measured with the Anxiety Sensitivity Index (AnxSI), has been associated with AF symptoms independently of objective disease variables. The more recently developed AnxSI-R provides dimensional scores including fear of cardiovascular/somatic reactions. We report from an ongoing study, to: 1) describe clinician- and self-reported AF symptom burden, self-reported health care usage, QoL, anxiety and depression among AF patients at differing care stages; 2) determine whether AnxSI-R scores were associated with AF symptom burden, health-care usage and QoL, independently of age, sex and left atrial diameter from echocardiogram (echo-LAD). To date, 59 eligible consenting subjects (24 females; mean age=57.6 years) with paroxysmal AF, LVEF>55%, no documented stroke/TIA, recruited from an outpatient arrhythmia clinic between Sept/13-April/17, have been categorized as: 1) non-candidates for catheter ablation, n=20; 2) ablation candidates, n=19, mean anticipated time to ablation= 5.6 weeks; 3) ablation, n=20, mean post-ablation interval =20.1 weeks. Measurement included: Canadian Cardiovascular Society Severity of Atrial Fibrillation Scale (SAF; 0-5 mild-severe; clinician-completed); Atrial Fibrillation Severity Scale (AFSS: burden 0-5 low-high; health-care usage 0-6 low-high; well-being/QoL 1-10 low-high), Hospital Anxiety and Depression Scale (HADS; anxiety, depression each 0-21 mild-severe), and AnxSI-R (0-168 mild-severe), patient-completed. Echo-LAD was available for 23 subjects. Parametric and non-parametric statistics were used to analyze continuous and categorical variables, respectively. Stepwise multiple regression with covariates age, sex echo-LAD and the AnxSI-R cardiovascular/somatic score was used to predict subjective (AFSS) symptom burden, well-being and health-care usage. The ablation group had significantly lower CCS-SAF arrhythmia symptom ratings (table) compared to each of the other groups (p < .001). Mean subjective symptom burden (figure) was higher in the ablation candidates vs. each of the other groups (p < .001). Health-care usage was significantly lower among non-candidates compared to ablation (p < .049). None of mean well-being/QoL, anxiety or depression varied significantly between groups. From regression (n=23): AnxS cardiovascular/somatic score (R=.55, p=.006) predicted symptom burden; sex (R=.45, p=.031) predicted well-being; AnxS cardiovascular/somatic score (R=.44, p=.038) predicted health-care usage. AF symptom burden, highest in ablation candidates, may be affected by AnxS independently of objective disease severity. As symptom burden influences treatment decisions, psychological factors may warrant consideration. The AnxSI-R has potential for identifying high-AnxS patients.View Large Image Figure ViewerDownload Hi-res image Download (PPT)