Self-reported Use Research Articles

Patient and provider perceptions of the relationship between alcohol use and TB and readiness for treatment: a qualitative study in South Africa

BackgroundUnhealthy alcohol use is widespread in South Africa and has been linked to tuberculosis (TB) disease and poor treatment outcomes. This study used qualitative methods to explore the relationship between TB and alcohol use during TB treatment.MethodsFocus group discussions (FGDs) were conducted with 34 participants who had previous or current drug-susceptible TB and self-reported current alcohol use. Eight interviews were conducted with healthcare workers who provide TB services in Worcester, South Africa.ResultsIn this rural setting, heavy episodic drinking is normalized and perceived to be related to TB transmission and decreased adherence to TB medication. Both healthcare workers and FGD participants recommended the introduction of universal screening, brief interventions, and referral to specialized care for unhealthy alcohol use. However, participants also discussed barriers to the provision of these services, such as limited awareness of the link between alcohol and TB. Healthcare workers also specified resource constraints, while FGD participants or patients mentioned widespread stigma towards people with alcohol concerns. Both FGD participants and health providers would benefit from education on the relationship between TB and unhealthy alcohol use and had specific recommendations about interventions for alcohol use reduction. Healthcare workers also suggested that community health worker-delivered interventions could support access to and engagement in both TB and alcohol-related services.ConclusionFindings support strengthening accessible, specialized services for the identification and provision of interventions and psychosocial services for unhealthy alcohol use among those with TB.

Relating distractor suppression to problematic drinking behavior

BackgroundImpaired cognitive control has been linked to weakened self-regulatory processes underlying compulsive substance intake. Previous research has provided evidence for impaired task performance in substance-abusing groups during Stroop and Go/No-Go tasks. Mechanisms of distractor suppression in visual search might also involve overlapping regulatory components that support goal-directed behavior by resolving the attentional competition between distractors and the target of search. However, the efficiency of learning-dependent distractor suppression has not been examined in the context of drug abuse and a direct comparison between cognitive control and distractor suppression is lacking. MethodA total of 84 participants were assigned either to the heavy drinking group (ALC, n = 42) or the control group (CTL, n = 42) based on self-reported substance use. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and Barratt Impulsiveness Scale (BIS). After that, participants completed a computerized version of the Stroop task, Go/No-go task, and a visual search task measuring learning-dependent distractor suppression. ResultsThe Stroop effect and the frequency of no-go errors did not differ between groups. However, learned distractor suppression was significantly blunted in the ALC group compared to the control group. Across participants, performance on the Stroop and Go/No-go task were correlated, while the magnitude of distractor suppression was related to neither. ConclusionsOur findings support a divergence of mechanistic processes underlying cognitive control and attentional control, and demonstrate impaired learning-dependent distractor suppression in heavy drinkers relative to a control group. Impaired distractor suppression offers new insight into why drug cues can be difficult to ignore.

Do older adults drink alcohol whilst taking alcohol-interactive medication? Prevalence and ten-year mortality risk: findings from the UK Whitehall II cohort study

Background Older people commonly take prescribed medications, some of which are contra-indicated with alcohol. Few population-based studies have assessed the relationship between taking these medicines, different levels of alcohol use, and potential harm. Aims To investigate the prevalence of taking alcohol-interactive (AI) medication and alcohol consumption among older adults and to compare the ten-year mortality risk among different categories of drinkers. Methods Data were obtained from 6220 participants (mean age 70, 71% male) within the UK Whitehall II cohort study of civil servants from phase 11 (2012–2013) who were followed up for mortality over ten years. Alcohol use was based on volume of consumption in self-reported drinks per week, and hazardous pattern of consumption was assessed with the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C). AI medications were coded from self-reported medication use. Deaths were obtained from the NHS central registry (2012–2022). Results 55% of participants took AI medication and of these, 73% also consumed alcohol, and 43% drank hazardously. These participants were more likely to be male, older, and belong to lower socioeconomic groups. Among those taking AI medication, there was a significantly higher mortality hazard for ex-drinkers (HR =1.43 CI 1.14, 1.80) and nondrinkers (HR= 2.09 CI 1.33, 3.27) compared to moderate drinkers but no significant difference for higher risk/hazardous drinkers after adjusting for confounding factors. Conclusion In these older adults, there was a high prevalence of taking alcohol-interactive medication and drinking alcohol. Whilst there was no increased mortality risk other non-fatal outcomes should be considered.

Mental health service use and shortages among a cohort of women living with HIV in Canada

BackgroundThe prevalence of mental health conditions among women with HIV in Canada ranges between 29.5% and 57.4%, highlighting the need for accessible mental health care. We aimed to (1) describe the availability and use of mental health services among women with HIV and (2) identify characteristics associated with reporting that shortages of these services presented a problem in their care.MethodsBaseline data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study were analysed. Self-reported availability and use of mental health services were examined using descriptive statistics. Participants indicated whether a lack of mental health support was a problem in their care. Logistic regression models were constructed to determine associations between sociodemographic, clinical, and psychosocial characteristics and reported problematic shortages.ResultsOf 1422 women, 26.7% (n = 380) used mental health services in the last year, which most accessed through their HIV clinic. Thirty-eight percent (n = 541) reported that a shortage of mental health support was a problem in their care. Among this subset, 22.1% (n = 119) used services at their HIV clinic, 26.5% (n = 143) reported available services but did not use them, and 51.4% (n = 277) either indicated that these services were unavailable, did not know if such services were available, or were unengaged in HIV care. Factors associated with reporting problematic shortages included rural residence [adjusted odds ratio (aOR): 1.69, 95% confidence interval (CI): 1.03–2.77], higher education level (aOR: 1.43, 95% CI: 1.02–2.02), and higher HIV stigma score (aOR: 1.03, 95% CI: 1.02–1.03). Conversely, African/Caribbean/Black identity (aOR: 0.37, 95% CI: 0.26–0.54), history of recreational drug use (aOR: 0.56, 95% CI: 0.39–0.81), and Quebec residence (aOR: 0.69, 95% CI: 0.50–0.96) were associated with lower odds of reporting service shortages.ConclusionOur findings highlight the HIV clinic as the primary location of mental health service use. However, existing services may not be sufficient to reach all patients or meet specific needs. Furthermore, the low uptake among those reporting a shortage suggests a lack of connection to services or patient knowledge about their availability. Characteristics associated with reporting shortages reflect geographic and socioeconomic disparities that must be accounted for in future service design.

Is something rotten in the state of Denmark? Cross-national evidence for widespread involvement but not systematic use of questionable research practices across all fields of research.

Questionable research practices (QRP) are believed to be widespread, but empirical assessments are generally restricted to a few types of practices. Furthermore, conceptual confusion is rife with use and prevalence of QRPs often being confused as the same quantity. We present the hitherto most comprehensive study examining QRPs across scholarly fields and knowledge production modes. We survey perception, use, prevalence and predictors of QRPs among 3,402 researchers in Denmark and 1,307 in the UK, USA, Croatia and Austria. Results reveal remarkably similar response patterns among Danish and international respondents (τ = 0.85). Self-reported use indicates whether respondents have used a QRP in recent publications. 9 out of 10 respondents admitted using at least one QRP. Median use is three out of nine QRP items. Self-reported prevalence reflects the frequency of use. On average, prevalence rates were roughly three times lower compared to self-reported use. Findings indicated that the perceived social acceptability of QRPs influenced self-report patterns. Results suggest that most researchers use different types of QRPs within a restricted time period. The prevalence estimates, however, do not suggest outright systematic use of specific QRPs. Perceived pressure was the strongest systemic predictor for prevalence. Conversely, more local attention to research cultures and academic age was negatively related to prevalence. Finally, the personality traits conscientiousness and, to a lesser degree, agreeableness were also inversely associated with self-reported prevalence. Findings suggest that explanations for engagement with QRPs are not only attributable to systemic factors, as hitherto suggested, but a complicated mixture of experience, systemic and individual factors, and motivated reasoning.

A cross-sectional study of self-reported dietary supplement use, associated factors, and adverse events among young adults in Kuwait

BackgroundDietary supplements (DS) are commonly used to improve overall health status and correct nutritional deficiencies. However, with the global rise in DS use, there is an increased risk of misuse and/or excessive use leading to toxicity and adverse events (AE). Research on DS use and DS-related AE is limited in Kuwait. This study aimed to explore the prevalence of DS use, its associated factors, and reported AE in a population of young adults.MethodsA cross-sectional study was carried out using an online self-administered questionnaire. Non-probabilistic sampling was used via multiple social media platforms. Logistic regression analysis was performed to assess the association between sociodemographic, lifestyle characteristics and health status with DS use and AE.ResultsThe prevalence of DS use was 68.24%. DS use was found to be associated with age (odds ratio [OR] = 1.07, 95% confidence interval [CI] 1.03–1.13; p-value [p] = < 0.001) and being female (OR = 1.55, 95% CI 1.01–2.41; p = 0.047). AE related to DS use were found to be associated with having respiratory disorders (asthma) (OR = 2.09, 95% CI 1.07–4.05; p = 0.029) and digestive disorders (OR = 3.22, 95% CI 1.24–8.35; p = 0.016).ConclusionThe study findings provide valuable insights into current DS use in young adults in Kuwait, which may enable the strategic development of targeted interventions and health promotion awareness campaigns. Furthermore, they emphasize the necessity of implementing regulations and policies to effectively manage DS use and monitor AE reporting in Kuwait.

Concurrent substance use among cancer patients with and without a history of cannabis use since cancer diagnosis at an NCI-Designated Cancer Center in Florida.

Although substance use may have adverse impacts on cancer outcomes, little is known regarding patterns of concurrent substance use with cannabis among cancer patients. Our objective was to examine predictors of concurrent substance use with cannabis among cancer patients since their cancer diagnosis and explore perceptions of cannabis among these patients. Patients treated at a National Cancer Institute-designated comprehensive cancer center were invited to participate in an electronic survey regarding medical cannabis from August to November 2021. Survey data were linked to internal data resources including electronic health records and patient intake forms to obtain history of substance use (defined as within at least 3 months of cancer diagnosis) of cigarettes, injection drugs, high levels of alcohol, or clinically unsupervised prescription drugs (total n = 1094). Concurrent substance users were defined as those with any reported substance use and cannabis use at the time of cancer diagnosis. We used descriptive statistics (χ2 or exact tests) to compare groups and estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs) to identify predictors of substance use among users and nonusers of cannabis. Approximately 45% (n = 489) of the sample reported cannabis use since their cancer diagnosis. Of patients who reported using cannabis, 20% self-reported concurrent polysubstance use, while 8% of cannabis nonusers reported substance use (P < .001). Among patients who use cannabis, those who reported 2 or more self-reported treatment-related symptoms (eg, pain, fatigue) were more likely to have self-reported concurrent substance use (AOR = 3.15, 95% CI = 1.07 to 9.27) compared with those without any symptoms. Among nonusers, those with lower educational background were more likely to have a history of concurrent substance use (AOR = 3.74, 95% CI = 1.57 to 8.92). Patients who use cannabis with concurrent substance use were more likely to report improved sleep (P = .04), increased appetite (P = .03), and treatment of additional medical conditions (P = .04) as perceived benefits of cannabis use. High symptom burden may be associated with concurrent substance use with cannabis among cancer patients.

Cannabis use and patient-reported outcomes among patients at a comprehensive cancer center.

Patients with cancer report increasing rates of cannabis use, often to manage symptoms and toxicities. The efficacy and safety of cannabis, however, for some use cases remains unclear. To better understand characteristics of patients with cancer who report using cannabis, we examined data from a cannabis use survey of among patients with cancer seen at a National Cancer Institute-Designated Cancer Center. In late 2021, patients with cancer (N = 1608) treated between July 2017 and December 2019 provided cannabis use data. Additional data were obtained from medical records data and routine patient-reported outcomes collected for clinical purposes. Univariable analyses and multivariable regression analyses were conducted to identify correlates of cannabis use at different stages in the cancer care trajectory. Rates of self-reported cannabis use by patients with cancer were 59% before cancer diagnosis and 47% after diagnosis. Longitudinal rates of cannabis use were 29% for no cannabis use, 23% before diagnosis, 12% after diagnosis, and 35% for both before and after diagnosis. Demographic factors associated with cannabis use included age, sex, race, and educational achievement. Tobacco use and binge drinking were associated with higher odds of cannabis use. Cannabis use was also associated with greater self-reported interference with physical functioning due to pain and interference with social functioning due to health problems. We found high rates of cannabis use among patients with cancer, both before and after their cancer diagnosis. Future studies should further investigate psychosocial factors associated with cannabis use among patients with cancer as well as psychosocial outcomes among patients with cancer using cannabis.

A Typology of Teachers’ Self-reported Use of Student Data from Computer-Based Assessment Programmes in Secondary Education

Teachers in secondary education have to deal with a growing diversity in student population, which asks for differentiation of their teaching. Computer-based assessments (CBA’s) are educational software tools that, for a particular school subject, allow students to practice their knowledge or skills, leading to results about students’ performance or ability level at that point in time. Information derived from CBA’s (known as learning analytics) has the potential to support teachers to differentiate by informing them of each student’s current level. In this study, our aim was to provide a typology of how and why teachers in secondary education use analytics, with the subsequent aim of providing recommendations for teacher professional development. Four profiles were found: high users, selective users, early stage users, and non-users. We provide recommendations for each of these profiles.

Interviewing and interrogation practices and beliefs, 20 years later: A national self-report survey of American police.

This survey examined current law enforcement beliefs and practices about interviewing and interrogation to gauge whether they have evolved given the research and training developed over the past 20 years. We hypothesized that police beliefs and practices would have evolved along with research findings over the past 20 years. We surveyed 526 law enforcement officers about the practices and beliefs regarding interviewing and interrogation. We asked questions about officers' beliefs about rates of true and false confessions, time spent in the interrogation room, beliefs about their ability to detect deception, training experience, practices of recording interrogations, and their self-reported use of interrogation techniques. Overall, when we compared our survey with Kassin et al.'s (2007) seminal survey, we found both similar results and evolving positive trends. The average interview was reportedly 1.6 hr, virtually no different from that in Kassin and colleagues' study. In addition, our sample reported that 26.2% of innocent suspects at least partially falsely confessed. Further, whereas Kassin and colleagues found that fewer than one in 10 interrogations were video recorded, we found that now more than half of interrogations are recorded in this way. In a geographically diverse sample of U.S. law enforcement officers, we found significant positive trends toward knowledge and practices informed by research generated over the past decades on interviewing and interrogation. Although causality could not be determined, these findings indicate an evolution of the U.S. law enforcement mindset in a more science-based direction. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Passively sensing smartphone use in teens with rates of use by sex and across operating systems

Youth screen media activity is a growing concern, though few studies include objective usage data. Through the longitudinal, U.S.-based Adolescent Brain Cognitive Development (ABCD) Study, youth (mage = 14; n = 1415) self-reported their typical smartphone use and passively recorded three weeks of smartphone use via the ABCD-specific Effortless Assessment Research System (EARS) application. Here we describe and validate passively-sensed smartphone keyboard and app use measures, provide code to harmonize measures across operating systems, and describe trends in adolescent smartphone use. Keyboard and app-use measures were reliable and positively correlated with one another (r = 0.33) and with self-reported use (rs = 0.21–0.35). Participants recorded a mean of 5 h of daily smartphone use, which is two more hours than they self-reported. Further, females logged more smartphone use than males. Smartphone use was recorded at all hours, peaking on average from 8 to 10 PM and lowest from 3 to 5 AM. Social media and texting apps comprised nearly half of all use. Data are openly available to approved investigators (https://nda.nih.gov/abcd/). Information herein can inform use of the ABCD dataset to longitudinally study health and neurodevelopmental correlates of adolescent smartphone use.

Tinnitus and cardiovascular disease: the population-based Tromsø Study (2015–2016)

IntroductionPeople with tinnitus are likely to have other co-occurring disorders that should be considered when diagnosing and understanding tinnitus as a health problem. The association between tinnitus and cardiovascular health...

Beyond tobacco: genomic disparities in lung cancer between smokers and never-smokers

BackgroundTobacco use is one of the main risk factors for Lung Cancer (LC) development. However, about 10–20% of those diagnosed with the disease are never-smokers. For Non-Small Cell Lung Cancer (NSCLC) there are clear differences in both the clinical presentation and the tumor genomic profiles between smokers and never-smokers. For example, the Lung Adenocarcinoma (LUAD) histological subtype in never-smokers is predominately found in young women of European, North American, and Asian descent. While the clinical presentation and tumor genomic profiles of smokers have been widely examined, never-smokers are usually underrepresented, especially those of a Latin American (LA) background. In this work, we characterize, for the first time, the difference in the genomic profiles between smokers and never-smokers LC patients from Chile.MethodsWe conduct a comparison by smoking status in the frequencies of genomic alterations (GAs) including somatic mutations and structural variants (fusions) in a total of 10 clinically relevant genes, including the eight most common actionable genes for LC (EGFR, KRAS, ALK, MET, BRAF, RET, ERBB2, and ROS1) and two established driver genes for malignancies other than LC (PIK3CA and MAP2K1). Study participants were grouped as either smokers (current and former, n = 473) or never-smokers (n = 200) according to self-report tobacco use at enrollment.ResultsOur findings indicate a higher overall GA frequency for never-smokers compared to smokers (58 vs. 45.7, p-value < 0.01) with the genes EGFR, KRAS, and PIK3CA displaying the highest prevalence while ERBB2, RET, and ROS1 the lowest. Never-smokers present higher frequencies in seven out of the 10 genes; however, smokers harbor a more complex genomic profile. The clearest differences between groups are seen for EGFR (15.6 vs. 21.5, p-value: < 0.01), PIK3CA (6.8 vs 9.5) and ALK (3.2 vs 7.5) in favor of never-smokers, and KRAS (16.3 vs. 11.5) and MAP2K1 (6.6 vs. 3.5) in favor of smokers. Alterations in these genes are comprised almost exclusively by somatic mutations in EGFR and mainly by fusions in ALK, and only by mutations in PIK3CA, KRAS and MAP2K1.ConclusionsWe found clear differences in the genomic landscape by smoking status in LUAD patients from Chile, with potential implications for clinical management in these limited-resource settings.

Eye tracking insights into physician behaviour with safe and unsafe explainable AI recommendations

We studied clinical AI-supported decision-making as an example of a high-stakes setting in which explainable AI (XAI) has been proposed as useful (by theoretically providing physicians with context for the AI suggestion and thereby helping them to reject unsafe AI recommendations). Here, we used objective neurobehavioural measures (eye-tracking) to see how physicians respond to XAI with N = 19 ICU physicians in a hospital’s clinical simulation suite. Prescription decisions were made both pre- and post-reveal of either a safe or unsafe AI recommendation and four different types of simultaneously presented XAI. We used overt visual attention as a marker for where physician mental attention was directed during the simulations. Unsafe AI recommendations attracted significantly greater attention than safe AI recommendations. However, there was no appreciably higher level of attention placed onto any of the four types of explanation during unsafe AI scenarios (i.e. XAI did not appear to ‘rescue’ decision-makers). Furthermore, self-reported usefulness of explanations by physicians did not correlate with the level of attention they devoted to the explanations reinforcing the notion that using self-reports alone to evaluate XAI tools misses key aspects of the interaction behaviour between human and machine.

Alcohol and drug use in adults younger than 60 years with hip fracture – A comparison of validated instruments and the clinical eye: A prospective multicenter cohort study of 218 patients

BackgroundIt is a common preconception that young individuals sustaining hip fractures have alcohol and/or drug use disorder. It is important to evaluate the actual use to avoid complications and plan the rehabilitation. AimThe primary objective was to assess alcohol and drug consumption in hip fracture patients <60 years using the validated Alcohol Use Disorders Identification Test (AUDIT) and Drug Use Disorders Identification Test (DUDIT) scores. We secondarily investigated the agreement between the instruments and the physicians’ clinical evaluation of usage. Material and methodsThis is a sub-study of 91 women and 127 men from a multicenter cohort study of patients with an acute hip fracture treated at four hospitals in Denmark and Sweden. AUDIT and DUDIT forms were completed by the patients. In addition, the researchers made an evaluation of the patients’ alcohol/drug use based on direct patient contact and information on previous alcohol/drug use from medical charts. AUDIT ranges 0–40 with 6 (women) and 8 (men) as the cut-off for hazardous use. DUDIT ranges 0–44 with cut-offs of 2 and 6 indicating drug-related problems. ResultsAccording to the AUDIT, 29 % of the patients had a hazardous alcohol use (25 % women, 31 % men), whilst the clinical evaluation identified 26 % (24 % women, 28 % men). However, there was a low agreement between “the clinical eye” and AUDIT, as the clinical evaluation only correctly identified 35 of 56 individuals with AUDIT-scores indicating hazardous alcohol use. DUDIT equaled drug related problems in 8 % (5 % women, 10 % men), the clinical evaluation depicted 8 % with drug related problems (4 % women, 10 % men). The agreement was low between “the clinical eye” and DUDIT; only 7 of 15 with DUDIT-scores indicating drug related problems were correctly identified. ConclusionHazardous alcohol consumption is more common in non-elderly hip fracture patients than in the general population. Considering both self-reported alcohol use and clinical evaluation, women have almost as high rate as men. DUDIT indicated drug related problems to be slightly more common than in the population. Still, a majority did not exhibit troublesome use of neither alcohol nor drugs. The two screening methods do not identify the same individuals, and further investigation in clinical practice is needed.

Sex differences in the roles of nicotine use and puberty on youth C-reactive protein levels: Effects above and beyond adversity

Inflammation likely mediates associations between nicotine use and negative health outcomes. Sex differences have been observed in nicotine use–inflammation links, and physiological processes during puberty might allow for these differences to arise. In this cross-sectional study of 498 youth (ages 8–13, 52% girls, 77% with history of child maltreatment (CM) investigation), sex-differentiated associations between self-reported nicotine use and high-sensitivity C-reactive protein (hs-CRP) were explored. Additionally, self-reported pubertal stage was investigated as a moderator of such nicotine use–hs-CRP links. Hierarchical generalized estimating equation models were adjusted for a wide range of adversity effects: CM investigation history derived from state records, self- and caregiver-report of traumatic life events, adversity-related demographic risk factors (i.e., identification with historically marginalized racial and ethnic groups, household income), and other characteristics that may influence the variables of interest (e.g., medication use, age, body mass index). Nicotine use had a negative main effect on hs-CRP among boys (β = −0.50, p = 0.02), and pubertal stage did not moderate this association (β = 0.06, p = 0.71). In contrast, pubertal stage moderated the association between nicotine use and hs-CRP among girls (β = 0.48, p = 0.02) such that a positive association between nicotine use and hs-CRP levels was stronger at more advanced pubertal stages (β = 0.45, SE = 0.21, 95% CI [0.03, 0.87]). Findings suggest that puberty may influence the effect of nicotine on inflammation in sex-differentiated ways and have implications for timing of prevention and treatment efforts geared toward reducing nicotine use and subsequent inflammation-related health risk among youth.

Estimating the Effect of COVID-19 Pandemic Restrictions on Self-reported Antiretroviral Therapy Use and Late Refill Visits Among People Living With HIV in Rural South Africa.

People living with HIV require reliable access to and adequate supply of antiretroviral therapy (ART) for viral suppression. The Deliver Health Study, a randomized trial conducted during the COVID-19 pandemic, found that home-delivered ART significantly increased viral suppression compared with clinic-based care. The effect of changing COVID-19 alert levels on self-reported ART use has not been quantified. KwaZulu-Natal, South Africa. Adults living with HIV were followed in the Deliver Health Study during October 2019-December 2020. We used difference-in-differences (DiD) to estimate the effect of changing COVID-19 alert levels during 3 distinct periods on self-reported missed ART doses (missed 0 vs. ≥1 doses in past week) for participants receiving home-delivered vs. clinic-based refills. We additionally estimated the effect of changing COVID-19 alert levels on late clinic ART refill visits (late vs. on-time). We used relative risk regression for both binary outcomes. Of 155 participants, 46% were women and the median age was 36 years. The mean number of missed weekly doses was 0.11, 0, and 0.12 in the home-delivery group and 0.09, 0.08, and 0.18 in the clinic group during periods 1, 2, and 3, respectively. There were no differences in relative risk of self-reported daily ART use between refill groups when comparing across periods [DiDperiod 2 vs. 1 = 1.05; 95% confidence interval: 0.97, 1.13 and DiDperiod 3 vs. 2 = 0.99; 95% confidence interval (CI): 0.91, 1.08]. In the clinic group, the risk of late refill visits was significantly higher during COVID-19 restrictions (vs. before alert level 5 implementation) and even after the COVID-19 alert level was downgraded to level 1 (RRperiod 2 vs. 1 = 1.83, 95% CI: 1.34, 2.51 and RRperiod 3 vs. 2 = 1.71; 95% CI: 1.43, 2.04). The COVID-19 pandemic did not differentially impact self-reported ART adherence by the method of ART refills, but the risk of late clinic refill visits was significantly higher during COVID-19 restrictions and sustained after restrictions were loosened.

Medicare Advantage customer service is used most by higher-need patients.

To examine characteristics of Medicare Advantage (MA) enrollees who use their plan's customer service to help plans understand how to better meet members' needs. National sample of 259,533 respondents to MA Consumer Assessment of Healthcare Providers and Systems survey enrolled in any of the 559 MA contracts in2022. We assessed the association between self-reported customer service use in the prior 6 months and enrollee demographic, coverage, health, and health care utilization characteristics. We used weighted linear regression models to test for bivariate and multivariate associations between customer service use and enrolleecharacteristics. Forty-two percent of MA enrollees reported using customer service in the prior 6 months. Use was 20percentage points (PP) higher for those in poor vs excellent/very good general health, 13 PP higher for those in poor vs excellent/very good mental health, and 14 PP higher for those reporting 3 or more vs no chronic conditions. Those using customer service more often had lower educational attainment, had limited income and assets, preferred another language to English, and had greater health careutilization. MA customer service supports a less healthy, higher-need population with greater-than-average barriers to health care, and so should be designed and staffed to effectively serve medically complex, high-need patients. Commercial plan evidence suggests that continuity in customer service support for a member or a given issue may be helpful. Customer service is an important mechanism for improving quality and addressing healthequity.

Factors associated with the willingness to provide telerehabilitation by physiotherapists treating older adults or people with neurological diseases during the COVID-19 pandemic in Sweden.

While telerehabilitation is a promising alternative to traditional rehabilitation, previous studies suggest that it is still underutilised by physiotherapists. The purpose of this study was to identify factors associated with the willingness, and use of, telerehabilitation among physiotherapists. An online survey, covering self-reported use of, and attitudes toward telerehabilitation during the COVID-19 pandemic, was distributed to physiotherapists who were members of the Swedish Association of Physiotherapists and working in geriatrics or neurology in Sweden. A total of 307 responding physiotherapists were included, most of whom were female (n = 277, 90.2%), working full-time (n = 225, 73.3%), had a bachelor's degree in physiotherapy as their highest education (n = 238, 77.8%) and working in community care settings (n = 131, 43.0%). Overall, 42.3% responded that they would be willing to work with telerehabilitation daily and 47% responded that they had previously worked with telerehabilitation to some degree during the COVID-19 pandemic. Logistic regression analysis revealed that feeling comfortable using digital tools (OR = 1.81, P = .043), believing that telerehabilitation increases the accessibility of rehabilitation (OR = 2.27, P = .009), and that patients will appreciate it (OR = 2.10, P = .025), were significantly associated with willingness to work daily with telerehabilitation. Working in primary care or rehabilitation centres (OR = 3.48, P < .012), having previously used telerehabilitation (OR = 55.86, P < .001), and perceiving the workplace reimbursement system as facilitating telerehabilitation (OR = 8.24, P = .003), were factors significantly associated with reported use of telerehabilitation during the COVID-19 pandemic. Among physiotherapists in Sweden, willingness to use telerehabilitation is largely associated with personal attitudes towards it, whereas reported use of telerehabilitation appears to be related to organisational factors. These findings could be used to shape future implementation of telerehabilitation practices in geriatric and neurorehabilitation in Sweden and contribute to the broader understanding of telerehabilitation among physiotherapists across different contexts.

Association of psychiatric and substance use disorders with cannabis use and cannabis use disorder during early pregnancy in northern California.

To estimate the strength of association between psychiatric disorders and substance use disorders (SUD), and cannabis use and cannabis use disorder (CUD)during early pregnancy. Observational study. Kaiser Permanente Northern California, USA. 299 496 pregnancies from 227 555 individuals screened for cannabis use by self-report and a urine toxicology test at entrance to prenatal care in Kaiser Permanente Northern California during January 2011-December 2021 (excepting year 2020). The sample was 62.5% non-White, with a mean (standard deviation) age of 31.1 (5.5) years; 6.8% used cannabis; 0.2% had a CUD. Exposure variables included electronic health record-based psychiatric diagnoses of attention deficit hyperactivity, anxiety, bipolar, depressive, personality, posttraumatic stress and psychotic disorders; and alcohol, opioid, stimulant and tobacco use disorders, during the two years prior to pregnancy up to the day before the prenatal substance use screening date. Outcome variables were any cannabis use, frequency of self-reported cannabis use and CUD during early pregnancy. Psychiatric disorder prevalence ranged from 0.2% (psychotic) to 14.3% (anxiety), and SUD ranged from 0.3% (stimulant/opioid) to 3.8% (tobacco). Psychiatric disorders were associated with cannabis use and CUD, with the strongest association for any use found for bipolar disorder (adjusted odds ratio [aOR] = 2.83; 95% confidence interval [CI] = 2.53-3.17) and the strongest association for CUD found for psychotic disorders (aOR = 10.01, 95% CI = 6.52-15.37). SUDs were associated with cannabis use and CUD, with the strongest association for any use found for tobacco use disorder (aOR = 4.03, 95% CI = 3.82-4.24) and the strongest association for CUD found for stimulant use disorder (aOR = 21.99, 95% CI = 16.53-29.26). Anxiety, bipolar, depressive disorders and tobacco use disorder were associated with greater odds of daily than monthly or less cannabis use. Psychiatric disorders and substance use disorders appear to be associated with elevated odds of any and frequent cannabis use as well as cannabis use disorder during early pregnancy. In most cases, the associations with cannabis outcomes were stronger for substance use disorders than other psychiatric disorders.