Vision-related quality of life among 70-year-olds diagnosed with glaucoma

PURPOSE

To evaluate the effect of glaucoma on vision-related quality of life (VRQoL), lifestyle, physical factors and socioeconomic status in a 70-year-old population in Gothenburg, Sweden.

METHODS

Responses to questionnaires (N = 1182) between groups with and without self-reported glaucoma were analysed. Questionnaires included National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25), Short-Form Health Survey (SF-36), physical activity, socioeconomics, alcohol and tobacco consumption. Balance test and body mass index were also included. About half of the participants were randomized to ophthalmic examination (N = 560), variables were analysed separately according to known and confirmed glaucoma, ocular hypertension and/or cases of previously unknown glaucoma.

RESULTS

Both conventional and Rasch analysis of the NEI VFQ-25 showed that VRQoL was lower for individuals self-reporting glaucoma (p = 0.003/p = 0.024). Regarding general QoL, the participants did not differ apart from people self-reporting glaucoma reported worse general health (p = 0.01). Using logistic regression with lower VRQoL as the dependent variable glaucoma was not a significant predictor of poor VRQoL, odds ratio (OR) 1.83 (95% confidence interval (CI) 0.76-4.39, p = 0.18). Low household income was associated with lower VRQoL (OR 1.63, 95% CI 1.14-2.33, p = 0.01). Socioeconomics, physical activity and lifestyle factors were comparable between the groups (N = 915). Among participants who underwent ophthalmic examination no significant differences were found between glaucoma cases and non-glaucoma cases in relation to VRQoL (N = 560).

CONCLUSIONS

Patients with self-reported glaucoma assessed a lower VRQoL but not lower general quality of life. Poorer household income was associated with worse VRQoL. General health was reported low in the glaucoma population but lifestyle or physical factors did not diverge.

Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes

BACKGROUND

The routine measurement of patient-reported outcomes in cancer clinical care using electronic patient-reported outcome measures (ePROMs) is gaining momentum worldwide. However, a deep understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed.

OBJECTIVE

This study aims to identify the implicit mechanisms that underpin the effectiveness of ePROM interventions and develop program theories about how and when ePROM interventions improve health outcomes.

METHODS

A realist synthesis of the literature about ePROM interventions in cancer clinical care was performed. A conceptual framework of ePROM interventions was constructed to define the scope of the review and frame the initial program theories. Literature searches of Ovid MEDLINE, Ovid Embase, Scopus, and CINAHL, supplemented by citation tracking, were performed to identify relevant literature to develop, refine, and test program theories. Quality appraisal of relevant studies was performed using the Mixed Methods Appraisal Tool.

RESULTS

Overall, 61 studies were included in the realist synthesis: 15 (25%) mixed methods studies, 9 (15%) qualitative studies, 13 (21%) descriptive studies, 21 (34%) randomized controlled trials, and 3 (5%) quasi-experimental studies. In total, 3 initial program theories were developed regarding the salient components of ePROM interventions-remote self-reporting, real-time feedback to clinicians, and clinician-patient telecommunication. The refined theories posit that remote self-reporting enables patients to recognize and report symptoms accurately and empowers them to communicate these to clinicians, real-time feedback prompts clinicians to manage symptoms proactively, and clinician-patient telephone interactions and e-interactions between clinic encounters improve symptom management by reshaping how clinicians and patients communicate. However, the intervention may not achieve the intended benefit if ePROMs become a reminder to patients of their illness and are not meaningful to them and when real-time feedback to clinicians lacks relevance and increases the workload.

CONCLUSIONS

The key to improving health outcomes through ePROM interventions is enabling better symptom reporting and communication through remote symptom self-reporting, promoting proactive management of symptoms through real-time clinician feedback, and facilitating clinician-patient interactions. Patient engagement with self-reporting and clinician engagement in responding to feedback are vital and may reinforce each other in improving outcomes. Effective ePROM interventions might fundamentally alter how clinicians and patients interact between clinic encounters.

Pt-N Coordination Rendering the Chemotherapeutic Agent with Photoactivated ROS Generation and Self-Reporting Cell Uptake

The performance of chemotherapeutic agents has been largely restrained by the dose-dependent toxic side effects. In this work, cisplatin (CDDP) was endowed with the capability of photoactivated reactive oxygen species (ROS) generation and self-reporting cell uptake via coordination with a small organic molecule MSN. In the resultant MSN-Pt, the Pt-N coordination could obviously enhance the intermolecular charge transfer (ICT) process that allows the integration of fluorescence imaging, photogenerated ROS, and chemotherapeutic performance. The resultant MSN-Pt can recognize between normal and cancer cells and quickly penetrate the cancer cell membrane, self-reporting the cell uptake. Upon light illumination, mitochondria and nuclei were severely damaged. An in vivo mouse model demonstrated that MSN-Pt completely inhibited the tumor growth, exhibiting a higher efficacy compared with that of CDDP. This work provides a facile strategy to develop chemotherapy (CT) drugs for drug-resistant cancers.

Show no quarter: combating plausible lies with ex-ante honesty oaths

Misreporting—a form of lying—is common in online labor and remote work settings. We execute an experiment on Amazon MTurk to determine how ex-ante honesty oaths and worker beliefs impact lying behavior across a range of plausible and implausible lies. Using a novel quantile-style exposition of the types of lies reported, we find that oaths elicit more truthful behavior, reducing both small, plausible lies and large, implausible ones. Shirking is reduced under oath. Worker expectations of group reporting are positively related to individual reporting of plausible lies.

Validity of self-reported hypertension and related factors in the adult population: Preliminary results from the cohort in the west of Iran

This study aimed to investigate the validity of self-reported hypertension and related factors in the Dehgolan Prospective Cohort Study (DehPCS). Data were obtained from 3996 participants aged 35-70 years in the enrolment phase of DehPCS. Self-reported hypertension and sociodemographic factors were collected by well-trained interviewers before hypertension diagnosis based on the reference criteria. The history of anti-hypertensive medication use and/or systolic blood pressure ≥140 (mmHg), or diastolic blood pressure ≥90 (mmHg) were considered as hypertension. Disagreement between self-reported and reference measures was assessed using sensitivity, specificity, positive, and negative predictive values (PPV and NPV), and kappa values. Binary and multinomial logistic regressions were used to investigate the correlates of validity of self-reported hypertension. The hypertension prevalence based on self-reports and the reference criteria was 19.49% and 21.60%, respectively. An acceptable percentage of kappa agreement value of 68.7% and relatively good overall agreement of 89.8% were found. Self-reported hypertension was guaranteed moderate sensitivity of 72.0% and high specificity of 94.5%, as well as the NPV and PPV of 92/7% and 77/9%, respectively. The chances of false-positive and false-negative reporting increased with older age, higher BMI, and a family history of hypertension. Being female, older age, higher BMI, concurrent diabetes, and stronger family ties to hypertension patients significantly increased the chance of reporting true positives relative to true negatives. Although, self-reported hypertension has an acceptable validity and can be used as a valid tool for screening epidemiological studies, it needs to be investigated because its validity is affected by age, gender, family history of hypertension, and other socio-demographic characteristics.

Medication safety in the perioperative setting: A comparison of methods for detecting medication errors and adverse medication events

The purpose of this study was to evaluate perioperative medication-related incidents (medication errors (MEs) and/or adverse medication events (AMEs)) identified by 2 different reporting methods (self-report and direct observation), and to compare the types and severity of incidents identified by each method. We compared perioperative medication-related incidents identified by direct observation in Nanji et al's 2016 study[1] to those identified by self-report via a facilitated incident reporting system at the same 1046-bed tertiary care academic medical center during the same 8-month period. Incidents, including MEs and AMEs were classified by type and severity. In 277 operations involving 3671 medication administrations, 193 MEs and/or AMEs were observed (5.3% incident rate). While none of the observed incidents were self-reported, 10 separate medication-related incidents were self-reported from different (unobserved) operations that occurred during the same time period, which involved a total of 21,576 operations and approximately 280,488 medication administrations (0.004% self-reported incident rate). The distribution of incidents (ME, AME, or both) did not differ by direct observation versus self-report methodology. The types of MEs identified by direct observation differed from those identified by self-report (P = .005). Specifically, the most frequent types of MEs identified by direct observation were labeling errors (N = 37; 24.2%), wrong dose errors (N = 35; 22.9%) and errors of omission (N = 27; 17.6%). The most frequent types of MEs identified by self-report were wrong dose (N = 5; 50%) and wrong medication (N = 4; 40%). The severity of incidents identified by direct observation and self-report differed, with self-reported incidents having a higher average severity (P < .001). The procedure types associated with medication-related incidents did not differ by direct observation versus self-report methodology. Direct observation captured many more perioperative medication-related incidents than self-report. The ME types identified and their severity differed between the 2 methods, with a higher average incident severity in the self-reported data.

Self-Reporting Joule Heating Modulated Stiffness of Polymeric Nanocomposites for Shape Reconfiguration

Shape reconfigurable devices, e.g., foldable phones, have emerged with the development of flexible electronics. But their rigid frames limit the feasible shapes for the devices. To achieve freely changeable shapes yet keep the rigidity of devices for user-friendly operations, stiffness-tunable materials are desired, especially under electrical control. However, current such systems are multilayer with at least a heater layer and a structural layer, leading to complex fabrication, high cost, and loss of reprocessability. Herein, we fabricate covalent adaptable networks-carbon nanotubes (CAN-CNT) composites to realize Joule heating controlled stiffness. The nanocomposites function as stiffness-tunable matrices, electric heaters, and softening sensors all by themselves. The self-reporting of softening is used to regulate the power control, and the sensing mechanism is investigated by simulating the CNT-polymer chain interactions at the nanoscale during the softening process. The nanocomposites not only have adjustable mechanical and thermodynamic properties but also are easy to fabricate at low cost and exhibit reprocessability and recyclability benefiting from the dynamic exchange reactions of CANs. Shape and stiffness control of flexible display systems are demonstrated with the nanocomposites as framing material, where freely reconfigurable shapes are realized to achieve convenient operation, wearing, or storage, fully exploiting their flexible potential.

Accuracy of Pressure Ulcer Events in US Nursing Home Ratings

BACKGROUND

The US government relies on nursing home-reported data to create quality of care measures and star ratings for Nursing Home Compare (NHC). These data are not systematically validated, and some evidence indicates NHC's patient safety measures may not be reliable.

OBJECTIVE

The objective of this study was to assess the accuracy of NHC's pressure ulcer measures, which are chief indicators of nursing home patient safety.

RESEARCH DESIGN

For Medicare fee-for-service beneficiaries who were nursing home residents between 2011 and 2017, we identified hospital admissions for pressure ulcers and linked these to the nursing home-reported data at the patient level. We then calculated the percentages of pressure ulcers that were appropriately reported by stage, long-stay versus short-stay status, and race. After developing an alternative claims-based measure of pressure ulcer events, we estimated the correlation between this indicator and NHC-reported ratings.

SUBJECTS

Medicare nursing home residents with hospitalizations for pressure ulcers.

MEASURES

Pressure ulcer reporting rates; nursing home-level claims-based measure of pressure ulcer events.

RESULTS

Reporting rates were low for both short-stay (70.2% of 173,043 stage 2-4 pressure ulcer hospitalizations) and long-stay (59.7% of 137,315 stage 2-4 pressure ulcer hospitalizations) residents. Black residents experienced more severe pressure ulcers than White residents, however, this translated into having slightly higher reporting rates because higher staged pressure ulcers were more likely to be reported. Correlations between our claims-based measure and NHC ratings were poor.

CONCLUSIONS

Pressure ulcers were substantially underreported in data used by NHC to measure patient safety. Alternative approaches are needed to improve surveillance of health care quality in nursing homes.

Self-Report versus Neuropsychological Tests for Examining Executive Functions in Youth Soccer Athletes-A Cross-Sectional Study

Cognitive diagnostics, especially the measurement of executive functions (EFs) in the context of sports and talent diagnostics, is a popular research topic. However, research is lacking on how self-reports are sufficient to examine the EFs of youth athletes for performance diagnostics. Thus, the current study aims to evaluate the relationships between neuropsychological tasks (3-back task, cued Go/NoGo task, flanker task, and number-letter task) and a self-report for examining EFs (BRIEF-SB). Furthermore, it should be investigated whether it is possible to predict the outcome of EF tasks using a self-report inventory. Therefore, 68 young professional soccer players (Mage = 14.26 ± 1.35 years) from a national youth academy were included in the study. The weak-to-moderate correlations (r = 0.000, p = 0.999 to r = −0.442, p < 0.01) and the results of sensitivity analysis (0.125 to 0.538) do not support using a self-report of EFs for cognitive performance diagnostics. The inventory is only suitable for identifying executive dysfunctions in athletes recovering from head injuries or concussions.

Invited Commentary: The Need for Repeated Measures and Other Methodological Considerations When Investigating Discrimination as a Contributor to Health

To determine potential measurement error related to the assessment of lifetime discrimination, Van Dyke et al. (Am J Epidemiol. 2022;191(3):370-378) investigated inconsistencies in reporting of racial, socioeconomic status, and sex discrimination over time among Black and White adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. The authors found that "ever" reports of discrimination (as assessed by the Experiences of Discrimination Scale) decreased over time and that populations who most experience discrimination (i.e., Black/African-American people, younger persons, persons of low socioeconomic status, and women) were often also the most likely to inconsistently report discrimination over the course of the study period (from 1992 to 2010). The authors have raised an important issue related to the potential underestimation of lifetime discrimination that may depend on when discrimination is assessed, as well as the social identity of individuals surveyed. With implications for health inequities, these findings highlight study design and methodological issues that should be addressed to accurately estimate the true burden discrimination places on health. In this commentary, we further illuminate potential methodological challenges and opportunities to consider when investigating the impact of discrimination on health.

Self-Propelled Asymmetrical Nanomotor for Self-Reported Gas Therapy

Gas therapy has emerged as a new therapeutic strategy in combating cancer owing to its high therapeutic efficacy and biosafety. However, the clinical translation of gas therapy remains challenging due to the rapid diffusion and limited tissue penetration of therapeutic gases. Herein, a self-propelled, asymmetrical Au@MnO₂ nanomotor for efficient delivery of therapeutic gas to deep-seated cancer tissue for enhanced efficacy of gas therapy, is reported. The Au@MnO₂ nanoparticles (NPs) catalyze endogenous H₂ O₂ into O₂ that propels NPs into deep solid tumors, where SO₂ prodrug is released from the hollow NPs owing to the degradation of MnO₂ shells. Fluorescein isothiocyanate (FITC) is conjugated onto the surface of Au via caspase-3 responsive peptide (DEVD) and the therapeutic process of gas therapy can be optically self-reported by the fluorescence of FITC that is turned on in the presence of overexpressed caspase-3 as an apoptosis indicator. Au@MnO₂ nanomotors show self-reported therapeutic efficacy and high biocompatibility both in vitro and in vivo, offering important new insights to the design and development of novel nanomotors for efficient payload delivery into deep tumor tissue and in situ monitoring of the therapeutic process.

Patient-Reported Outcomes From Patients With Heart Failure Participating in the Future Patient Telerehabilitation Program: Data From the Intervention Arm of a Randomized Controlled Trial

Background

More than 37 million people worldwide have been diagnosed with heart failure, which is a growing burden on the health sector. Cardiac rehabilitation aims to improve patients’ recovery, functional capacity, psychosocial well-being, and health-related quality of life. However, cardiac rehabilitation programs have poor compliance and adherence. Telerehabilitation may be a solution to overcome some of these challenges to cardiac rehabilitation by making it more individualized. As part of the Future Patient Telerehabilitation program, a digital toolbox aimed at enabling patients with heart failure to monitor and evaluate their own current status has been developed and tested using data from a patient-reported outcome questionnaire that the patient filled in every alternate week for 1 year.

Objective

The aim of this study is to evaluate the changes in quality of life and well-being among patients with heart failure, who are participants in the Future Patient Telerehabilitation program over the course of 1 year.

Methods

In total, 140 patients were enrolled in the Future Patient Telerehabilitation program and randomized into either the telerehabilitation group (n=70) or the control group (n=70). Of the 70 patients in the telerehabilitation group, 56 (80.0%) answered the patient-reported outcome questionnaire and completed the program, and these 56 patients comprised the study population. The patient-reported outcomes consisted of three components: (1) questions regarding the patients’ sleep patterns assessed using the Spiegel Sleep Questionnaire; (2) measurements of physical limitations, symptoms, self-efficacy, social interaction, and quality of life assessed using the Kansas City Cardiomyopathy Questionnaire in 10 dimensions; and (3) 5 additional questions regarding psychological well-being that were developed by the research group.

Results

The changes in scores during 1 year of the study were examined using 1-sample Wilcoxon signed-rank tests. There were significant differences in the scores for most of the slopes of the scores from the dimensions of the Kansas City Cardiomyopathy Questionnaire (P<.05).

Conclusions

There was a significant increase in clinical and social well-being and quality of life during the 1-year period of participating in a telerehabilitation program. These results suggest that patient-reported outcome questionnaires may be used as a tool for patients in a telerehabilitation program that can both monitor and guide patients in mastering their own symptoms.

Trial Registration

ClinicalTrials.gov NCT03388918; https://clinicaltrials.gov/ct2/show/NCT03388918

A Patient-Centered Study Examining Self-Identification of Mental Health Challenges Among Female Military Officers

Due to the expansion of leadership roles in the military for women, female military personnel now face stressors equal to, and yet unique from, their male counterparts. This pilot study surveyed 73 female U.S. Army officers regarding their experiences of leadership and mental wellness within the military. A mixed-methods survey was distributed via 2 private Facebook groups for female Army officers following an anonymized convenience sampling. This anonymous, patient-centered protocol was used to protect against known stigma surrounding disclosing mental health concerns in the military. Respondents were asked a series of questions including perceived mental health status and access to behavioral health services. Most respondents reported feelings of stress related to their roles as officers (86.6%). Self-reported feelings of anxiety (83.6%) and depression (65.7%) were high. In contrast, only 30.1% had ever received a formal diagnosis of anxiety or depression by a mental health professional. Our survey confirmed a large percentage, 65.7% of respondents, reported avoiding mental/behavioral health services. Female military officers are able to recognize their feelings as symptoms of anxiety and depression; however, many take active steps to hide these symptoms from their family members and senior officers and avoid seeking professional care.

Athletes' Self-Assessment of Urine Color Using Two Color Charts to Determine Urine Concentration

Our objective was to determine self-reported accuracy of an athletic population using two different urine color (Uc) charts (8-color vs. 7-color Uc chart). After approval by the Institutional Review Board, members of an athletic population (n = 189, 20 (19–22) year old student- or tactical athletes and coaches, with n = 99 males and n = 90 females) scored their Uc using two charts. To determine the diagnostic value of Uc, results were compared with urine concentration (osmolality and urine specific gravity, USG). Uc was scored slightly darker with the 8-color vs. 7-color Uc chart (2.2 ± 1.2 vs. 2.0 ± 1.2, respectively, p < 0.001), with a moderate correlation between charts (r = 0.76, 95% CI: 0.69–0.81). Bland-Altman analysis showed a weak reporting bias (r = 0.15, p = 0.04). The area under the curve for correct urine sample classification ranged between 0.74 and 0.86. Higher accuracy for both methods was found when Uc scores were compared to USG over osmolality, indicated by 4.8–14.8% range in difference between methods. The optimal Uc cut-off value to assess a low vs. a high urine concentration for both Uc charts varied in this study between 1 and ≤2 while accuracy for charts was similar up to 77% when compared to USG.

Robust Damage-Reporting Strategy Enabled by Dual-Compartment Microcapsules

Dye-filled microcapsules are an attractive way to identify microscopic damage of materials by the naked eye. However, there are many disadvantages in traditional microcapsule-based self-reporting materials, such as a poor self-reporting effect. A new concept for the design of self-reporting microcapsules is presented here. Our work develops a novel kind of dual-compartmental microcapsule via Pickering emulsion photopolymerization, which can encapsulate two interacting species ("pro-dye" and "developer") separately in a single microcapsule. In our strategy, SiO₂ microspheres encapsulating polyetheramine (PEA, developer) were first prepared and employed as a Pickering emulsifier to stabilize oil-in-water emulsions, in which the oil phase consisted of 2',7'-dichlorofluorescein (DCF, pro-dye) and a monomer. After the monomer polymerization, a dual-compartment microcapsule, which encapsulated the pro-dye in the core and the developer in the shell, was obtained. Upon the rupture of the microcapsule, the pro-dye and the developer were released simultaneously and reacted to yield a pronounced chromogenic response. Compared with traditional double-microcapsule systems, this dual-compartment microcapsule system demonstrated a more efficient and pronounced self-reporting effect. This is the first time that a double-encapsulation scheme involving the compartmentalized release of two interacting species within a single microcapsule has been demonstrated for self-reporting, which overcomes the tough problems of the uneven distribution of the traditional double-microcapsule systems.

Compliance and Self-Reporting During the COVID-19 Pandemic: A Cross-Cultural Study of Trust and Self-Conscious Emotions in the United States, Italy, and South Korea

The coronavirus COVID-19 pandemic is an unprecedented health crisis. Many governments around the world have responded by implementing lockdown measures of various degrees of intensity. To be effective, these measures must rely on citizens' cooperation. In the present study, we drew samples from the United States (N = 597), Italy (N = 606), and South Korea (N = 693) and examined predictors of compliance with social distancing and intentions to report the infection to both authorities and acquaintances. Data were collected between April 6th and 8th 2020. We investigated the role of cultural orientations of horizontal and vertical individualism and collectivism, self-conscious emotions of shame and guilt related to the infection and trust in the government's action. Across all countries, vertical collectivism (VC) predicted stronger shame, whereas horizontal collectivism predicted stronger trust in the government. Only in the United States, VC was associated with stronger trust. Stronger feelings of shame predicted lower compliance and intentions to report the infection to both authorities and acquaintances. In contrast, guilt was associated with stronger intentions to report the infection to the authorities. Finally, trust was associated with stronger compliance and intentions to report the infection to the authorities. Unlike Italy and South Korea, the association between trust on compliance was not statistically significant in the United States, implications of the findings, and directions for future research are discussed.

Uptake of the Ithaka mobile application in Johannesburg, South Africa, for human immunodeficiency virus self-testing result reporting

Background

Human immunodeficiency virus self-testing (HIVST) can reduce facility-based HIV testing barriers; however, no proven applications exist with widespread uptake for self-reporting or linkage to care. Mobile health (mHealth) applications (apps) have shown high usability and feasibility scores, so Ithaka was developed for South Africans to self-report HIVST results outside clinical settings.

Objectives

This study investigated the use of Ithaka as a support tool for HIVST users, specifically the ability to self-report results.

Method

This cross-sectional study was conducted from November 2018 to June 2019. At existing HIVST distribution sites, individuals were given HIVST kits and then invited to use Ithaka. Participants could test at home and report their results through the app anytime. Ithaka tracked when people logged-on, registered, received counselling and reported results. Post-study surveys on user experience were also conducted.

Results

Of 751 participants, 531 (70.7%) logged onto the app, 412 (54.9%) registered, 295 (39.3%) received counselling and 168 (22.4%) self-reported results. Participants strongly agreed that Ithaka was useful and that it was easy to upload results. Forty-one participants completed a post-test survey, and 39/41 (95.1%) completed the app journey. Most participants (36/41;87.8%) had no challenges, although 2/41 (4.9%) cited perceived data costs, 2/41 (4.9%) difficulty uploading results and 1/41 (2.4%) language, as challenges.

Conclusion

Despite the small sample size, this study has shown that HIVST participants under pragmatic conditions were willing and able to self-report results via the app, whilst also identifying areas of improvement for scaling up.

The Impact of Accountability-Oriented Control Aspects of Variance Investigation on Budgetary Slack and Moderating Effect of Moral Development

Variance investigation (VI) has been identified as an effective mechanism to reduce budgetary slack at the ex ante budgeting stage. This paper focuses on two further research questions: (1) the extent to which two different accountability-oriented control aspects (i.e., external investigation and self-reporting) of VI affect budgetary slack and (2) the extent of the moderating effect of moral development on the relationship between these two accountability-oriented control aspects and budgetary slack. Our experimental results show that both external investigation and self-reporting can reduce the propensity of creating slack at the ex ante budgeting stage. More specifically, the effect of external investigation on reducing the propensity of creating budgetary slack is greater than that of self-reporting. This study further reveals that moral development moderates the effect of external investigation on budgetary slack. When comparing subordinates with low moral development with those with high moral development, our results show that the effect of external investigation on budgetary slack is stronger among the former group than the latter group. This study does not find any moderating effect of moral development on the relationship between self-reporting and budgetary slack. Our study sheds some new light on varying effects of two accountability-oriented control aspects of VI on budgetary slack, which are also moderated by different levels of subordinates’ moral development. These results may be considered in the design and implementation of management control systems.

Self-Reporting and Photothermally Enhanced Rapid Bacterial Killing on a Laser-Induced Graphene Mask

Wearing face masks has been widely recommended to contain respiratory virus diseases, yet the improper use of masks poses a threat of jeopardizing the protection effect. We here identified the bacteria viability on common face masks and found that the majority of bacteria (90%) remain alive after 8 h. Using laser-induced graphene (LIG), the inhibition rate improves to ∼81%. Combined with the photothermal effect, 99.998% bacterial killing efficiency could be attained within 10 min. For aerosolized bacteria, LIG also showed superior antibacterial capacity. The LIG can be converted from a diversity of carbon precursors including biomaterials, which eases the supply stress and environmental pressure amid an outbreak. In addition, self-reporting of mask conditions is feasible using the moisture-induced electricity from gradient graphene. Our results improve the safe use of masks and benefit the environment.

Validity of self-reporting depression in the Tabari cohort study population

Aims

Depression is a common cause of mortality and morbidity worldwide. To detect depression, we compared BDI‐II scoring as a valid tool with participants' self‐reporting depression.

Methods

The sample size was determined to include 155 participants with positive self‐reporting of depression in a total of 1300 samples with 310 healthy participants were included in the study through random selection. In order to evaluate the diagnostic value of self‐reporting, BDI‐II was completed by blind interviewing to the case group as well as to another group who reported that they were not depressed, as control.

Results

Sensitivity, specificity, accuracy, false positive, false negative, positive, and negative predictive values of self‐reporting were calculated 58.4%, 79.1%,73.4%, 20.8%, 41.6%, 51.8%, and 83.2% for the total population, respectively, as well as, sensitivity, specificity, accuracy, positive, and negative predictive values of self‐report in males were 83.3%, 77.2%, 77.1%, 43.8%, and 95.6% and 53.7%, 78.1%, 71.2%, 49.2%, and 81.1% for females, respectively.

Conclusion

The positive predictive value and sensitivity of self‐reporting are insufficient in total population and females, and therefore self‐reporting cannot detect depressed patients, but regarding to its average positive predictive value, perhaps, it can be used to identify nondepressant individuals.

The positive predictive value and sensitivity of self‐reporting are insufficient in total population and females, and therefore self‐reporting cannot detect depressed patients, but regarding its average positive predictive value, perhaps, it can be used to identify nondepressant individuals.

App-Based Tracking of Self-Reported COVID-19 Symptoms: Analysis of Questionnaire Data

BACKGROUND

COVID-19 is an infectious disease characterized by various clinical presentations. Knowledge of possible symptoms and their distribution allows for the early identification of infected patients.

OBJECTIVE

To determine the distribution pattern of COVID-19 symptoms as well as possible unreported symptoms, we created an app-based self-reporting tool.

METHODS

The COVID-19 Symptom Tracker is an app-based daily self-reporting tool. Between April 8 and May 15, 2020, a total of 22,327 individuals installed this app on their mobile device. An initial questionnaire asked for demographic information (age, gender, postal code) and past medical history comprising relevant chronic diseases. The participants were reminded daily to report whether they were experiencing any symptoms and if they had been tested for SARS-CoV-2 infection. Participants who sought health care services were asked additional questions regarding diagnostics and treatment. Participation was open to all adults (≥18 years). The study was completely anonymous.

RESULTS

In total, 11,829 (52.98%) participants completed the symptom questionnaire at least once. Of these, 291 (2.46%) participants stated that they had undergone an RT-PCR (reverse transcription-polymerase chain reaction) test for SARS-CoV-2; 65 (0.55%) reported a positive test result and 226 (1.91%) a negative one. The mean number of reported symptoms among untested participants was 0.81 (SD 1.85). Participants with a positive test result had, on average, 5.63 symptoms (SD 2.82). The most significant risk factors were diabetes (odds ratio [OR] 8.95, 95% CI 3.30-22.37) and chronic heart disease (OR 2.85, 95% CI 1.43-5.69). We identified chills, fever, loss of smell, nausea and vomiting, and shortness of breath as the top five strongest predictors for a COVID-19 infection. The odds ratio for loss of smell was 3.13 (95% CI 1.76-5.58). Nausea and vomiting (OR 2.84, 95% CI 1.61-5.00) had been reported as an uncommon symptom previously; however, our data suggest a significant predictive value.

CONCLUSIONS

Self-reported symptom tracking helps to identify novel symptoms of COVID-19 and to estimate the predictive value of certain symptoms. This aids in the development of reliable screening tools. Clinical screening with a high pretest probability allows for the rapid identification of infections and the cost-effective use of testing resources. Based on our results, we suggest that loss of smell and taste be considered cardinal symptoms; we also stress that diabetes is a risk factor for a highly symptomatic course of COVID-19 infection.

Understanding Time Series Patterns of Weight and Meal History Reports in Mobile Weight Loss Intervention Programs: Data-Driven Analysis

Background

Mobile apps for weight loss provide users with convenient features for recording lifestyle and health indicators; they have been widely used for weight loss recently. Previous studies in this field generally focused on the relationship between the cumulative nature of self-reported data and the results in weight loss at the end of the diet period. Therefore, we conducted an in-depth study to explore the relationships between adherence to self-reporting and weight loss outcomes during the weight reduction process.

Objective

We explored the relationship between adherence to self-reporting and weight loss outcomes during the time series weight reduction process with the following 3 research questions: “How does adherence to self-reporting of body weight and meal history change over time?”, “How do weight loss outcomes depend on weight changes over time?”, and “How does adherence to the weight loss intervention change over time by gender?”

Methods

We analyzed self-reported data collected weekly for 16 weeks (January 2017 to March 2018) from 684 Korean men and women who participated in a mobile weight loss intervention program provided by a mobile diet app called Noom. Analysis of variance (ANOVA) and chi-squared tests were employed to determine whether the baseline characteristics among the groups of weight loss results were different. Based on the ANOVA results and slope analysis of the trend indicating participant behavior along the time axis, we explored the relationship between adherence to self-reporting and weight loss results.

Results

Adherence to self-reporting levels decreased over time, as previous studies have found. BMI change patterns (ie, absolute BMI values and change in BMI values within a week) changed over time and were characterized in 3 time series periods. The relationships between the weight loss outcome and both meal history and self-reporting patterns were gender-dependent. There was no statistical association between adherence to self-reporting and weight loss outcomes in the male participants.

Conclusions

Although mobile technology has increased the convenience of self-reporting when dieting, it should be noted that technology itself is not the essence of weight loss. The in-depth understanding of the relationship between adherence to self-reporting and weight loss outcome found in this study may contribute to the development of better weight loss interventions in mobile environments.

Credibility of self-reported health parameters in elderly population

AIM

Examining the credibility of self-reported height, weight, and blood pressure by the elderly population using a tablet in a retirement residence, and examining the influence of health beliefs on the self-reporting credibility.

BACKGROUND

Obesity is a major problem with rising prevalence in the western world. Hypertension is also a significant risk factor for cardiovascular diseases. Self-report, remotely from the clinic, becomes even more essential when patients are encouraged to avoid visiting the clinic as during the COVID-19 pandemic. Self-reporting of height and weight is suspected of leading to underestimation of obesity prevalence in the population; however, it has not been well studied in the elderly population.The Health Belief Model tries to predict and explain decision making of patients based on the patient's health beliefs.

METHODS

Residents of a retirement home network filled a questionnaire about their health beliefs regarding hypertension and obesity and self-reported their height, weight, and blood pressure. Blood pressure, height, and weight were then measured and compared to the patients' self-reporting.

FINDINGS

Ninety residents, aged 84.90 ± 5.88, filled the questionnaire. From a clinical perspective, the overall gap between the measured and the self-reported BMI (M = 1.43, SD = 2.72), which represents an absolute gap of 0.74 kilograms and 2.95 centimeters, is expected to have only a mild influence on the physician's clinical evaluation of the patient's medical condition. This can allow the physician to estimate their patient's BMI status before the medical consultation and physical examination upon the patient's self-reporting. Patients' dichotomous (normal/abnormal) self-report of their blood pressure condition was relatively credible: positive predictive value (PPV) of 77.78% for normal blood pressure (BP) and 78.57% for abnormal BP. The relatively high PPV of BP self-reporting demonstrates an option for the physician to recognize patients at risk. Regression analysis found no correlation between the anthropometric parameters and the Health Belief Model.

A Facile Strategy To Prepare Smart Coatings with Autonomous Self-Healing and Self-Reporting Functions

Herein, we report a smart coating with autonomous self-healing and self-reporting functions by simple integration of one-component microcapsules into the matrix without external intervention. The microcapsules containing hexamethylene diisocyanate (HDI) solution of aggregation-induced emission luminogens (AIEgens) were synthesized, and their properties, such as their composition, thermal stability, morphology, and damage-indicating ability, were investigated systematically. The AIEgen/HDI microcapsule-embedded coatings display adaptive self-repair of scratches and simultaneous high-contrast indication of the healed damage. Two commercialized AIEgens, tetraphenylethylene (TPE) and its derivative with dimethoxyl and benzylidene-methyloxazolone moieties (DM-TPE-BMO), were utilized as examples to demonstrate the feasibility of this concept in diverse polymer matrixes (including blue autofluorescent matrixes). It was found that the content of AIEgens can even be lowered to 0.05 wt %. This facile, economical, and feasible strategy toward the dual functions of self-repairing and self-sensing provides a new route for enhancing the longevity and reliability of polymer coatings, which is appealing and of great importance in practical applications.

Validity of self-reported anthropometrics in Arabic-speaking adults in Australia

ISSUE ADDRESSED

Body mass index (BMI) is generally accepted as a useful measurement for monitoring risk factors in adults. Although self-reported anthropometric measurements are deemed to be more cost-effective, its accuracy has been debated. While BMI based on self-reported measures may have to be relied on, accuracy of reporting such measures among culturally and linguistically diverse groups is unknown.

METHODS

Face-to-face surveys were conducted among 272 adults of Arabic-speaking backgrounds living in south western Sydney using non-probability sampling to collect data for directly measured and self-reported BMI. Agreement between both measures was determined by the Cohen's kappa coefficient analyses. The Wilcoxon matched-pairs signed-ranks and Mann-Whitney U tests were used to compare the differences in median values between both measures. The Bland-Altman analysis was conducted to identify the limits of agreement between both measurements.

RESULTS

There was substantial agreement between both self-reported and directly measured data (kappa = 0.70). Significant small median differences were found between both direct and self-reported overall BMI measure (27.58 vs 27.34; P < .0001) with a significantly greater median difference for females compared to males (0.76 vs 0.38 kg/m² ; P = .05). However, the 95% limits of agreement were moderately large for BMI (-5.1 and 6.4).

CONCLUSION

Self-reported data for height and weight are generally appropriate for calculating BMI for health promotion interventions among adults from Arabic-speaking backgrounds but should be used cautiously when assessing BMI status at the individual level. SO WHAT?: When limited resources are available for accomplishing health promotion interventions, self-reporting measures may be used as a proxy for assessing BMI.

Subtype-Dependent Reporting of Stroke With SGLT2 Inhibitors: Implications From a Japanese Pharmacovigilance Study

Volume depletion as an adverse events (AE) caused by sodium-glucose cotransporter-2 inhibitors (SGLT2i) because of their diuretic effect may raise the concern about the risk of lacunar stroke; however, an earlier meta-analysis reported no significant increase in the incidence of stroke without clearly distinguishing stroke subtypes. Here, aiming to investigate subtype-wise reporting of stroke potentially related to SGLT2i treatment, we conducted a disproportionality analysis using the Japanese Adverse Drug Event Report database, which contains approximately 500 000 cases recorded between April 2004 and March 2019 to detect stroke as AE signals associated with SGLT2i treatment by calculating the reporting odds ratio (ROR). As a result, we identified 532 stroke event reports with the use of SGLT2i. The SGLT2i showed varying degrees of significantly higher reporting (lower 95% ROR > 1) for all ischemic stroke (ROR, 12.7), thrombosis (ROR, 21.7), lacunar infarction (ROR, 48.9), and embolism (ROR, 2.51), but no significantly higher reporting for hemorrhagic stroke. Current pharmacovigilance results showed that the RORs for stroke following SGLT2i use differ greatly depending on the stroke subtypes. It suggests the need for an observational cohort study to be conducted to investigate the incidence of each stroke subtype as the effect of SGLT2i.

Adjusting Expectations: Hearing Abilities in a Population-Based Sample Using an SSQ Short Form

The German short form of the Speech, Spatial, and Qualities of Hearing Scale (SSQ) was administered in a cross-sectional study based on stratified random samples complemented by audiometric tests and a general interview. Data from 1,711 unaided adults aged 18 to 97 years were analyzed in order to determine a distribution of hearing abilities considered as normal and the main factors that impact self-assessments. An innovative mathematical approach was used to overcome the constraints of statistics based on the mean. Quantile regression analysis yielded a benchmark distribution of SSQ scores that might support audiologists in setting realistic SSQ score targets and estimated how the effect of auditory and nonauditory factors changes across the distribution of SSQ scores. Regression models showed significant effects for nonauditory factors on SSQ ratings when controlled for pure-tone hearing and interaural asymmetry. Self-reporting of hearing difficulties, when asked in general terms, was substantially related to SSQ ratings. This effect was observed in both high and low scoring participants and led to a considerable score decrease in all SSQ subscales. Gender, educational level, and self-reporting of health issues also were significantly related to SSQ ratings, but the corresponding effects were regularly unbalanced across the score distribution and particularly large at lower quantiles. The estimated effects of age, however, were mostly small in size, inconsistent regarding the direction, and failed significance for all SSQ items. Overall, the results suggest that nonauditory factors and cumulative effects must be considered when evaluating rehabilitative interventions against an ideal outcome.

Lung Cancer App (LuCApp) study protocol: a randomised controlled trial to evaluate a mobile supportive care app for patients with metastatic lung cancer

INTRODUCTION

Mobile health technologies may enhance patient empowerment and data integration along the whole care continuum. However, these interventions pose relatively new regulatory, organisational and technological challenges that limit appropriate evaluation. Lung Cancer App (LuCApp) is a mobile application developed by researchers and clinicians to promote real-time monitoring and management of patients' symptoms. This protocol illustrates a clinical trial designed to evaluate the usability, effectiveness and cost-effectiveness of LuCApp versus standard of care.

METHODS AND ANALYSIS

This is a 24-week two-arm non-blinded multicentre parallel randomised controlled trial. A total of 120 adult patients diagnosed with small or non-small cell lung cancer and eligible for pharmaceutical treatments will be allocated 1:1 to receiving either standard care or LuCApp in addition to standard care at three oncology sites in Northern Italy. During the treatment period, LuCApp allows daily monitoring and grading of a list of symptoms, which trigger alerts to the physicians in case predefined severity thresholds are met. Patients will complete a baseline assessment and a set of valid and reliable patient-reported outcome measures every 3±1 weeks, and up to 24 weeks. The primary outcome is the change in the score of the Trial Outcome Index in the Functional Assessment of Cancer Therapy (Lung) questionnaire from baseline to 12 weeks. Secondary outcomes are the Lung Cancer Subscale, the EuroQoL 5D-5L questionnaire, the Hospital Anxiety and Depression Scale, the Supportive Care Needs Survey Short Form, the app usability questionnaire and the Zarit Burden Interview for the main caregiver.

ETHICS AND DISSEMINATION

The trial received ethical approval from the three clinical sites. Trial results will be disseminated through peer-reviewed publications and conference presentations.

CONCLUSIONS

This trial makes a timely contribution to test a mobile application designed to improve the quality of life and delivery of care for patients with lung cancer.

TRIAL REGISTRATION NUMBER

NCT03512015; Pre-results.

Self-Reporting Inhibitors: A Single Crystallization Process To Obtain Two Optically Pure Enantiomers

Collection of two optically pure enantiomers in a single crystallization process can significantly increase the chiral separation efficiency but this is difficult to realize. Now a self-reporting strategy is presented for visualizing the crystallization process by a dyed self-assembled inhibitor made from the copolymers with tri(ethylene glycol)-grafting polymethylsiloxane as the main chain and poly(N⁶ -methacryloyl-l-lysine) as side chains. When applied with seeds together for the fractional crystallization of conglomerates, the inhibitors can label the formation of the secondary crystals and guide the complete separation process of two enantiomers with colorless crystals as the first product and red crystals as the second. This method leads to high optical purity of d/l-Asn⋅H₂ O (99.9 % ee for d-crystals and 99.5 % for l-crystals) in a single crystallization process. It requires a small amount of additives and shows excellent recyclability.

Barriers to Self-Reporting Patient Safety Incidents by Paramedics: A Mixed Methods Study

BACKGROUND

A minimal amount of research exists examining the extent to which patient safety events occur within paramedicine and even fewer studies investigating patient safety systems for self-reporting by paramedics. The purpose of this study was to identify barriers to paramedic self-reporting of patient safety incidents (PSIs).

METHODS

We randomly distributed paper-based surveys among 1,153 paramedics in an Ontario region in Canada. The survey described one of 5 different PSI clinical scenarios (near miss, adverse event, and minor, major or critical patient care variances) and listed 18 potential barriers to self-reporting PSIs as statements presented for rating on a 5-point Likert scale (very significant = 1 - very insignificant = 5). We invited comments on PSI self-reporting with 2 open-ended questions. We analyzed data with descriptive statistics, chi-square tests and Kruskal-Wallis H test. We used an inductive approach to qualitatively analyze emerging themes.

RESULTS

We received responses from 1,133 paramedics (98.3%). Almost one third (28.4%) were Advanced Care Paramedics and 45.1% had >10 years' experience. The top 5 barriers to PSI self-reporting (very significant or significant, %) were the fear of being: punished (81.4%), suspended (79.6%), terminated (79.1%), investigated by Ministry of Health and Long-Term Care (78.4%), and decertified (78.0%). Overall, 64.1% responded they would self-report a given PSI. Intention to self-report a PSI varied according to scenario (22.8% near miss, 46.6% adverse event, 74.4% minor, 92.6% major, 95.6% critical). No association was found between level of training (p = 0.55) or years of experience (p = 0.10) and intention to self-report a PSI. Seven themes to improve PSI self-reporting by paramedics emerged from the qualitative data.

CONCLUSIONS

A high proportion of fear-based barriers to self-reporting of PSIs exist among this study population. This suggests that a culture change is needed to facilitate the identification of future patient safety threats.

A Multimodal Deep Log-Based User Experience (UX) Platform for UX Evaluation

The user experience (UX) is an emerging field in user research and design, and the development of UX evaluation methods presents a challenge for both researchers and practitioners. Different UX evaluation methods have been developed to extract accurate UX data. Among UX evaluation methods, the mixed-method approach of triangulation has gained importance. It provides more accurate and precise information about the user while interacting with the product. However, this approach requires skilled UX researchers and developers to integrate multiple devices, synchronize them, analyze the data, and ultimately produce an informed decision. In this paper, a method and system for measuring the overall UX over time using a triangulation method are proposed. The proposed platform incorporates observational and physiological measurements in addition to traditional ones. The platform reduces the subjective bias and validates the user’s perceptions, which are measured by different sensors through objectification of the subjective nature of the user in the UX assessment. The platform additionally offers plug-and-play support for different devices and powerful analytics for obtaining insight on the UX in terms of multiple participants.

ROS-Activated Ratiometric Fluorescent Polymeric Nanoparticles for Self-Reporting Drug Delivery

Reactive oxygen species (ROS)-responsive theranostic nanomedicines have attracted wide interest in recent years because ROS stress is implicated in some pathological disorders such as inflammatory diseases and cancers. In this article, we report a kind of innovative ROS-responsive theranostic polymeric nanoparticles that are able to load hydrophobic drugs and to fluorescently self-report the in vitro or intracellular drug release under ROS triggering. The fluorescent nanoparticles were formed by amphiphilic block copolymers consisting of a poly(ethylene glycol) (PEG) segment and an oxidation-responsive hydrophobic block. The copolymers with different hydrophobic block lengths were synthesized by the atom transfer radical polymerization of a phenylboronic ester-containing acrylic monomer with a small fraction of a ROS-activatable 1,8-naphthalimide-based fluorescent monomer, using PEG-Br as the macroinitiator. The copolymer nanoparticles were stable in neutral phosphate buffer but degraded upon H₂O₂ triggering, with the degradation rate depending on the hydrophobic block length and the concentration of H₂O₂. The degradation of nanoparticles was accompanied by a colorimetric change of the fluorophore from blue to green, which affords the nanoparticles the ability to detecting H₂O₂ by a ratiometric fluorescent approach. Moreover, the nanoparticles could encapsulate doxorubicin (DOX) and the H₂O₂-triggered DOX release was well associated with the change in ratiometric fluorescence. Confocal laser scanning microscope results reveal that the fluorescent nanoparticles were internalized into A549 cells through the endocytosis pathway. The ROS-stimulated degradation of the nanoparticles and intracellular DOX release and the fate of the degraded polymers could be monitored by ratiometric fluorescent imaging. Finally, the naked nanoparticles and the degradation products are cytocompatible, whereas the DOX-loaded ones exhibit concentration-dependent cytotoxicity. Of importance, the stimulation with exogenous H₂O₂ or lipopolysaccharide enhanced obviously the cell-killing capability of the DOX-loaded nanoparticles because of the ROS-enhanced intracellular DOX release.

Is the Definition of Roma an Important Matter? The Parallel Application of Self and External Classification of Ethnicity in a Population-Based Health Interview Survey

The Roma population is typified by a poor and, due to difficulties in ethnicity assessment, poorly documented health status. We aimed to compare the usefulness of self-reporting and observer-reporting in Roma classification for surveys investigating differences between Roma and non-Roma populations. Both self-reporting and observer-reporting of Roma ethnicity were applied in a population-based health interview survey. A questionnaire was completed by 1849 people aged 18–64 years; this questionnaire provided information on 52 indicators (morbidity, functionality, lifestyle, social capital, accidents, healthcare use) indicators. Multivariate logistic regression models controlling for age, sex, education and employment were used to produce indicators for differences between the self-reported Roma (N = 124) and non-Roma (N = 1725) populations, as well as between observer-reported Roma (N = 179) and non-Roma populations (N = 1670). Differences between interviewer-reported and self-reported individuals of Roma ethnicity in statistical inferences were observed for only seven indicators. The self-reporting approach was more sensitive for two indicators, and the observer-reported assessment for five indicators. Based on our results, the self-reported identity can be considered as a useful approach, and the application of observer-reporting cannot considerably increase the usefulness of a survey, because the differences between Roma and non-Roma individuals are much bigger than the differences between indicators produced by self-reported or observer-reported data on individuals of Roma ethnicity.

Implementation and Use of a Patient Symptom Diary During Chemotherapy: A Mixed-Methods Evaluation of the Nurse Perspective

PURPOSE/OBJECTIVES

To gain a deeper understanding of nurses' experience working with a patient diary for tracking and treating side effects during chemotherapy.
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DESIGN

A mixed-methods design was used to learn about oncology nurses' use and perceptions of a symptom diary. 
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SETTING

Six oncology wards and two outpatient clinics at the University Hospitals Leuven, Belgium.
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SAMPLE

79 nurses completed a survey, and 14 nurses participated in focus group discussions.
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METHODS

First, a survey sampled nurses' use and perceptions of the diary. Next, focus group discussions were held with the aim of arriving at a deeper understanding of the survey results.
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MAIN RESEARCH VARIABLES

Use and perceptions of a symptom diary.
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FINDINGS

Most nurses reported performing diary-related behavior to some extent. The survey and focus groups indicated that many nurses strongly believed in the value of the diary, but some were still hesitant or had concerns about patients' perceptions of the diary. The focus group results showed that nurses' use of the diary in daily practice was influenced by their personal beliefs about the value of the diary, the team's, and those of their patients.
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CONCLUSIONS

Although a positive trend was noted, nurses' use of the symptom diary was suboptimal six months after its implementation.
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IMPLICATIONS FOR NURSING

This study highlights important issues that need to be addressed to advance the successful implementation of the symptom diary.

Assessment of sleep in subjects with visual impairment: Comparison using subjective and objective methods

The objective of the present study was to verify the agreement between objective and subjective measures of sleep in people with and without visual impairment. Thirty-seven subjects with visual impairment participated in the study (19 blind without light perception and 18 low-vision), as well as 34 subjects with normal vision, with paired age and gender characteristics. For the subjective sleep evaluation, we used the Sleep Quality Index-PSQI and for the objective evaluation we used the ActiGraph GT3X+. Among the three analyzed groups, the blind was the only ones who presented differences between subjective and objective sleep duration (p = 0.021). Furthermore, the concordance between subjective and objective sleep duration (ICC = 0.388; p = 0.108) was not observed in blind subjects, and a greater variability of differences in sleep duration between the two methods was observed by the Bland Altman scatter plot. We concluded that the sleep duration obtained by PSQI did not show agreement for the objective sleep duration in blind subjects without light perception.

Designing a Safety Reporting Smartphone Application to Improve Patient Safety After Total Hip Arthroplasty

This paper presents a safety reporting smartphone application which is expected to reduce the occurrence of postoperative adverse events after total hip arthroplasty (THA). A user-centered design approach was utilized to facilitate optimal user experience. Two main implemented functionalities capture patient pain levels and well-being, the two dimensions of patient status that are intuitive and commonly checked. For these and other functionalities, mobile technology could enable timely safety reporting and collection of patient data out of a hospital setting. The HCI expert, and healthcare professionals from the Haukeland University Hospital in Bergen have assessed the design with respect to the interaction flow, information content, and self-reporting functionalities. They have found it to be practical, intuitive, sufficient and simple for users. Patient self-reporting could help recognizing safety issues and adverse events.

Leveraging Multi-Modal Sensing for Mobile Health: A Case Review in Chronic Pain

Active and passive mobile sensing has garnered much attention in recent years. In this paper, we focus on chronic pain measurement and management as a case application to exemplify the state of the art. We present a consolidated discussion on the leveraging of various sensing modalities along with modular server-side and on-device architectures required for this task. Modalities included are: activity monitoring from accelerometry and location sensing, audio analysis of speech, image processing for facial expressions as well as modern methods for effective patient self-reporting. We review examples that deliver actionable information to clinicians and patients while addressing privacy, usability, and computational constraints. We also discuss open challenges in the higher level inferencing of patient state and effective feedback with potential directions to address them. The methods and challenges presented here are also generalizable and relevant to a broad range of other applications in mobile sensing.

Validity of Self-Reported Medication Use Compared With Pharmacy Records in a Cohort of Older Women: Findings From the Women's Health Initiative

Inaccurate self-reported data on medication exposure lead to less reliable study findings. From 2013 to 2015, we assessed the validity of information on medication use collected via a mailed medication inventory among 223 Women's Health Initiative participants who were members of a health-care delivery system. Self-reported information on medication use was compared with pharmacy records for statins, calcium channel blockers, β-blockers, and bisphosphonates. We assessed sensitivity, specificity, and positive predictive value (PPV) for current medication use. We assessed agreement on duration of use (<2, 2, 3, 4, or ≥5 years) by means of the weighted κ statistic. The mean age of participants was 77 years. Statins, β-blockers, and calcium channel blockers were each reported by over 15% of women, and bisphosphonates were reported by 4.5%. Compared with pharmacy records, the sensitivity, specificity, and PPV for self-reported use of statins, β-blockers, and calcium channel blockers were all 95% or greater. The sensitivity and PPV for bisphosphonate use were both 80% (95% confidence interval: 44, 97), and specificity was 99% (95% confidence interval: 97, 100). The κ statistic for duration of use was 0.87 or greater for all 4 medication classes. Compared with pharmacy records, self-reported information on current medication use and duration of use collected via mailed medication inventory among older women had almost perfect agreement for use of statins, β-blockers, and calcium channel blockers.

Lack of Transmission among Close Contacts of Patient with Case of Middle East Respiratory Syndrome Imported into the United States, 2014

In May 2014, a traveler from the Kingdom of Saudi Arabia was the first person identified with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States. To evaluate transmission risk, we determined the type, duration, and frequency of patient contact among health care personnel (HCP), household, and community contacts by using standard questionnaires and, for HCP, global positioning system (GPS) tracer tag logs. Respiratory and serum samples from all contacts were tested for MERS-CoV. Of 61 identified contacts, 56 were interviewed. HCP exposures occurred most frequently in the emergency department (69%) and among nurses (47%); some HCP had contact with respiratory secretions. Household and community contacts had brief contact (e.g., hugging). All laboratory test results were negative for MERS-CoV. This contact investigation found no secondary cases, despite case-patient contact by 61 persons, and provides useful information about MERS-CoV transmission risk. Compared with GPS tracer tag recordings, self-reported contact may not be as accurate.

Autonomous Indication of Mechanical Damage in Polymeric Coatings

High-resolution in situ autonomous visual indication of mechanical damage is achieved through a microcapsule-based polymeric material system. Upon mechanical damage, ruptured microcapsules release a liquid indicator molecule. A sharp color change from light yellow to bright red is triggered when the liberated indicator 2',7'-dichlorofluorescein reacts with the polymeric coating matrix.

Validity of the self-reported number of natural teeth in Japanese adults

AIM

The aims of this research were to assess the validity of self-reporting of the number of teeth by comparing the number with that obtained through clinical dental examinations, and to investigate factors affecting the discordance between the two measures.

METHODS

Self-administered questionnaires and dental examinations were conducted among 1152 dentate community residents in Japan. The validity of the patients' reports of the number of teeth was assessed by comparing the self-reported number with that determined at the clinical examination. Factors affecting the absolute value of the difference between the self-reported number of teeth and the number at clinical examination were investigated using a multivariate analysis.

RESULTS

Overall, 47.5% of participants had perfect agreement in their self-report with the clinical examination. There was a slight tendency toward underestimation of the number of natural teeth by self-reporting. Pearson's correlation coefficient was 0.80, and the intraclass correlation coefficient was 0.78 for all patients. Decayed, filled, sound teeth, and fixed prosthetic pontics were significantly associated with the absolute value of the difference between self-reports and clinical examinations.

CONCLUSIONS

Patients' reported number of remaining teeth, the data for which were collected via the questionnaire, provided reasonably valid data on the actual number of teeth within a population group.

Sexual-risk behaviour among sexually active first-year students at the University of the Western Cape, South Africa

In South Africa, new HIV infections are concentrated among persons aged 15-24 years. The university population falls within this age group and are prone to higher-risk behaviours that place them at risk of acquiring HIV. In a study to assess this risk among sexually active students, we classified higher-risk sexual behaviours as not using condoms at every instance of sex, having had more than one sexual partner during the preceding 12 months, a relatively young age at first sexual intercourse (7-16 years), and experience of sexual violence and/or transactional sex. In total, 796 first-year students at the University of the Western Cape in Cape Town, South Africa, completed a self-administered questionnaire in 2006. The sample included 263 sexually active, unmarried students, aged 16 to 24 years. The responses showed that 62% did not use a condom for every instance of sex, 39% had two or more sexual partners in the previous 12 months, 53% had initiated sexual intercourse at a younger age (7-16 years), and 2% had ever exchanged money or gifts for sexual intercourse. Eight percent of the respondents said they did not give their consent or permission at initiation of first sexual intercourse. One in every 10 respondents claimed that they had ever been forced to have sexual intercourse, and 4% said that they had ever forced someone to have sexual intercourse. The sexually active students who reported an earlier age of initiation of sexual intercourse and having only one sexual partner during the last year were more likely to not use a condom every time, whereas the sexually active students that had experienced initiation of sexual intercourse while in an older age group (17-24 years) and who had two or more sexual partners in the last year were more likely to use a condom every time. Sexually active university students are in need of particular HIV-prevention interventions given their tendencies for poor condom usage and having multiple sexual partners.

Correlates of highly active antiretroviral therapy adherence among urban Ethiopian clients

There has been a massive expansion of highly active antiretroviral therapy (HAART) services in Ethiopia since 2005. To assess clients' self-reported adherence to HAART medication, a descriptive, comparative cross-sectional study was carried out among adults receiving HAART medication at the Zewditu Memorial Hospital ART clinic in Addis Ababa. Of 1 808 clients eligible for the study, 1 722 agreed to participate. The data were collected over six weeks in February and March 2010. Ordered and binary logistic regression models were applied to analyse the data. The majority of participants were over age 30 years, most were females, and 90% had some formal education. More than half reported being 'extremely sure' about their ability to take most or all of their medication. Self-reported adherence to the medication was generally good, as 62% said they had never missed a dose. The most commonly cited reason for missing medication was being busy (57.5%). The odds of ever missing a dose of HAART were lower for males (adjusted odds ratio [AOR]: 1.44; 95% confidence interval [CI]: 1.15-1.79), older persons (AOR: 0.98; 95% CI: 0.97-0.99), and those who did not drink alcohol regularly. Similarly, the odds of being self-confident about taking the medication properly were higher for males and for those who did not drink alcohol regularly (AOR: 0.48; 95% CI: 0.35-0.64). The odds of self-confidence in taking the medication were lower among those in lower income group. Those who reported an expenditure income of Birr 501-999 (AOR: 0.35; 95% CI: 0.24-0.49) or Birr 1 000-1 999 (AOR: 0.41; 95% CI: 0.29-0.60) had less self-confidence in taking their medication properly as compared to those who had an expenditure income of Birr 2 000 or more. There is a need to design and implement targeted adherence interventions that could lead to better treatment outcomes.

Reducing survey burden: feasibility and validity of PROMIS measures in multiple sclerosis

BACKGROUND

Patient-reported outcomes are important for clinical research and care, yet administering and scoring the questionnaires requires considerable effort and time. The Patient Reported Outcomes Measurement Information System (PROMIS) could considerably reduce administrative obstacles and lessen survey burden for participants.

OBJECTIVE

Assess the feasibility and validity of PROMIS, compared to commonly-used legacy measures for multiple sclerosis (MS).

METHODS

In this cross-sectional survey, 133 participants with confirmed MS completed legacy surveys and PROMIS Computerized Adaptive Tests (CATs) for depression, anxiety, pain, fatigue and physical function. We conducted a multi-trait, multi-method analysis and verified results with confirmatory factor analysis.

RESULTS

The correlations between PROMIS and the corresponding legacy measures were large (0.67 to 0.87). The multi-trait, multi-method criteria were generally well met, providing good evidence of the validity of PROMIS measures. PROMIS surveys asked fewer questions and required substantially less time to complete than the legacy scales.

CONCLUSIONS

Our results provide evidence of the construct validity of PROMIS for use with MS patients. Several aspects of the PROMIS CATs made them an important resource, including: (a) less time was required to complete them; (b) missing data was reduced; and (c) the automatic scoring referenced the general population. Our findings support the use of PROMIS in MS research and may have broader implications for clinical care, as well.

The optimal process of self-sampling in fisheries: lessons learned in the Netherlands

At-sea sampling of commercial fishery catches by observers is a relatively expensive exercise. The fact that an observer has to stay on-board for the duration of the trip results in clustered samples and effectively small sample sizes, whereas the aim is to make inferences regarding several trips from an entire fleet. From this perspective, sampling by fishermen themselves (self-sampling) is an attractive alternative, because a larger number of trips can be sampled at lower cost. Self-sampling should not be used too casually, however, as there are often issues of data-acceptance related to it. This article shows that these issues are not easily dealt with in a statistical manner. Improvements might be made if self-sampling is understood as a form of cooperative research. Cooperative research has a number of dilemmas and benefits associated with it. This article suggests that if the guidelines for cooperative research are taken into account, the benefits are more likely to materialize. Secondly, acknowledging the dilemmas, and consciously dealing with them might lay the basis to trust-building, which is an essential element in the acceptance of data derived from self-sampling programmes.

Factors influencing the patient with rheumatoid arthritis in their decision to seek podiatry

INTRODUCTION

Despite the level of foot involvement in rheumatoid arthritis (RA), and the literature to support early assessment of foot care needs, local referral of patients to podiatry has been occurring too late to instigate certain preventative interventions. Preliminary fieldwork has highlighted that the primary responsibility for the instigation of this lies with the patient. The present study describes the factors that influence the patient with RA in their decision to self-report foot problems.

METHOD

A case study research strategy was employed. Nine patients attending the outpatient rheumatology department participated in the study and data were gathered through semi-structured interviews. This information was analysed using a framework approach.

RESULTS

The key themes derived from the data suggested that there are a variety of factors influencing the patient's decision to self-report foot concerns. Some will act to encourage the action and others will act to oppose it. Other factors can influence the decision either way, depending on the individual patient (psychological state, previous experience, body image changes). In addition, age, gender, and cultural and social aspects are also significant.

CONCLUSION

Due to the multitude of factors influencing the individual's decision to seek help, the patient cannot be given sole responsibility for their foot health if we wish to achieve timely and appropriate podiatry, as recommended in the literature. Responsibility should be three-way; the patient, the members of the rheumatology team and, once in the podiatry service, the podiatrist should maintain this.

Histological confirmation of breast cancer registration and self-reporting in England and Wales: a cohort study within the UK Collaborative Trial of Ovarian Cancer Screening

BACKGROUND

In research studies, accurate information of cancer diagnosis is crucial. In women with breast cancer (BC), we compare cancer registration (CR) in England/Wales and self-reporting with independent confirmation.

METHODS

In the UK Collaborative Trial of Ovarian Cancer Screening, notification of BC diagnosed between randomisation and 31 December 2009 was obtained through (1) CR (17 October 2011) and (2) self-reporting using postal-questionnaire. Breast cancer was confirmed using a detailed questionnaire (BC questionnaire BCQ) completed by the treating clinician (gold standard). Apparent sensitivity and positive-predictive value of CR/self-reporting vs BCQ were calculated.

RESULTS

Of 1065 women with possible BC notification, diagnosis was confirmed in 932 (87.5%). A total of 3.1% (28 out of 918) of BC CR and 12.4% (128 out of 1032) of women with self-reported BC only had in-situ carcinoma on BCQ. Another 4.6% (43 out of 932) of BCQ-confirmed cancer did not have a BC registration, and 3.6% (34 out of 932) did not self-report BC. Apparent sensitivity of CR and self-reporting vs BCQ were 95.4 and 96.4%, respectively. Positive-predictive value of self-reporting (87.1%) was significantly lower than that of CR (96.8%). Women aged<65 were more likely to over report in-situ carcinoma as BC. Overall, 73 (6.8%) women would have been misclassified/missed if CR, and 167 (15.6%) if self-reporting data alone was used.

CONCLUSION

This study confirms the reliability of BC registration in England/Wales and highlights the fact that 1 in 10 women self-reporting BC might only have in-situ breast carcinoma.

Validity of the self-reported smoking status of schizophrenia patients, taking gender-related differences into consideration

Abstract Objective. It is unclear whether self-reported smoking status reflects the true smoking status in schizophrenia patients. This study aims to evaluate the consistency in smoking status in schizophrenia patients, as determined using self-reported questionnaires and objective measurements, while considering gender-related differences. Methods. The study involved 158 Japanese schizophrenia patients (79 men and 79 women), who were diagnosed according to DSM-IV-TR criteria. The patients answered questions about their smoking status and daily cigarette consumption. The carbon monoxide (CO) level in the expired air was measured to confirm the self-reported answers. We descriptively analysed the data and assessed the proportion of results showing consistency between the self-reported smoking status and measured CO levels. Results. The self-reported smoking status was consistent with the objective measurement results in both genders. Among the various cut-off CO levels considered, 7 ppm was found to be the optimal level in both men and women. Conclusions. Our study showed that self-reporting is a reliable method for evaluating the smoking status of schizophrenia patients, regardless of gender. However, for precise assessment on the basis of CO levels in expired air, lower cut-off points may be better than the recommended ones.