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Abstract. Background: For people experiencing a suicidal crisis the emergency department (ED) is often the only option to find help. Aims: The aims of this study were (a) to identify predictors of patients' nonwillingness to return to the ED for help with a future suicidal crisis, and (b) whether nonwillingness to return was associated with follow-up appointment nonattendance. Method: This study utilized baseline data from the RESTORE online survey, and included 911 participants who had presented to an ED for suicidal crisis in the past 18 months, across participating local health districts in the Australian Capital Territory and New South Wales. Results: Patients who reported a more negative ED experience and longer triage wait times were less willing to return. Those who were less willing to return were also less likely to attend their follow-up appointment. Limitations: Due to the cross-sectional study design, causal inferences are not possible. Additionally, the self-report measures used are susceptible to recall bias. Conclusion: Patients' experience of service at EDs is a key indicator to drive improvement of patient outcomes for individuals experiencing a suicidal crisis.

The Collaborative Cohort of Cohorts for COVID-19 Research (C4R) is a national prospective study of adults at risk for coronavirus disease 2019 (COVID-19) comprising 14 established United States (US) prospective cohort studies. For decades, C4R cohorts have collected extensive data on clinical and subclinical diseases and their risk factors, including behavior, cognition, biomarkers, and social determinants of health. C4R will link this pre-COVID phenotyping to information on SARS-CoV-2 infection and acute and post-acute COVID-related illness. C4R is largely population-based, has an age range of 18-108 years, and broadly reflects the racial, ethnic, socioeconomic, and geographic diversity of the US. C4R is ascertaining severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 illness using standardized questionnaires, ascertainment of COVID-related hospitalizations and deaths, and a SARS-CoV-2 serosurvey via dried blood spots. Master protocols leverage existing robust retention rates for telephone and in-person examinations, and high-quality events surveillance. Extensive pre-pandemic data minimize referral, survival, and recall bias. Data are being harmonized with research-quality phenotyping unmatched by clinical and survey-based studies; these will be pooled and shared widely to expedite collaboration and scientific findings. This unique resource will allow evaluation of risk and resilience factors for COVID-19 severity and outcomes, including post-acute sequelae, and assessment of the social and behavioral impact of the pandemic on long-term trajectories of health and aging.

BACKGROUND The burden of mental health disorders is high and may be particularly alarming in developing countries. We assessed the prevalence of depressive and anxiety symptoms and their relationship with life-threatening events, tobacco dependence, and hazardous alcohol drinking in the Brazilian Amazon. METHODS Cross-sectional population-based study conducted in Manaus in 2019 with adults selected by probabilistic sampling. Depressive symptoms were measured by the PHQ-9 instrument (cut-off ≥9) and anxiety symptoms by the GAD-7 scale (cut-off ≥10). Prevalence ratios (PRs) of depressive and anxiety symptoms were calculated by Poisson regression with robust variance with 95% confidence intervals (CI) following a hierarchical model. Partial least squares structural equation modeling was used to investigate the relationship between the outcomes and risk behaviors. RESULTS Out of the 2,321 participants, 24.3% (95%CI 22.2-26.5%) had depressive and 21.6% (95%CI 19.6-23.7%) had anxiety symptoms. Depressive symptoms were more frequent in women (PR=1.32; 95%CI 1.08-1.61), lower social class (PR=1.59; 95%CI 1.11-2.27), life-threatening events (PR=2.66; 95%CI 2.00-3.54), tobacco dependence (PR=1.84; 95%CI 1.37-2.47), worse health statuses (p

Background This study explored the associations between different structural and functional supports with the quality of life (QOL) and mental well-being of pregnant women whose antenatal care was delayed due to the COVID-19 pandemic in Vietnam. Methods A multi-center cross-sectional study was performed on 868 pregnant women. The pregnant women's quality of life questionnaire (QOL-GRAV), the Edinburgh Postnatal Depression Scale (EPDS), and the Perinatal Infant Care Social Support (PICSS) instruments were employed. The satisfaction with care from different sources was measured. Multivariate Tobit Regression models were used. Results Seventy pregnant women (8.1%) reported that their antenatal care was influenced by the COVID-19. In this group, a higher level of satisfaction with the care of parents-in-law and a higher score of emotional support were associated with a better “Physical and Emotional changes” domain, while a higher level of appraisal support was related to poorer “Physical and Emotional changes” domain. A higher level of satisfaction with relatives’ care and a higher score of emotional support were correlated with a better “Life Satisfaction” domain. EPDS score was negatively correlated with satisfaction with parents-in-law care and appraisal support. Conclusions Our study highlighted that intervention programs to improve the QOL and psychological well-being of pregnant women in epidemics such as COVID-19 or other diseases in the future should involve other family members such as parents-in-law and relatives as sources of support. Limitations The cross-sectional design was unable to draw causal relationships. Recall bias might occur. The convenient sampling method might limit the generalizability of findings.

Coverage surveys for mass drug administration (MDA) rely on respondent recall and often permit proxy responses, whereby another household member is allowed to respond on behalf of an absent individual. In this secondary analysis of coverage surveys in Malawi, Burkina Faso, and Uganda, we explore the characteristics of individuals who require proxy responses and quantify the association between proxy responses and reported drug coverage. The adjusted logistic regression model found that men 11–39 years and women 11–18 years who were eligible for MDA had greater odds of requiring a proxy response compared with ineligible men and women in the same age groups. A hierarchical multivariable analysis found that proxy responses had 1.70 times the odds of reporting ingestion of MDA drugs compared with first-person responses, controlling for age and sex (95% CI: 1.17, 2.46). This finding is surprising, given that individuals absent during a coverage survey may also have been absent during the MDA, and suggests that proxy responses may be leading to an inflation of survey estimates of drug coverage. This study highlights the possibility for recall bias in proxy responses to MDA coverage; however, excluding absent individuals from coverage surveys would introduce a new bias. Further research is necessary to determine the best method for obtaining information on drug coverage when individuals are absent.

Background Vaccination coverage surveys in low- and middle-income countries typically estimate vaccination coverage using data from vaccination cards, parental recall, or a combination of the two. However, these surveys are often complicated by the pervasive absence of vaccination cards, forcing researchers to rely on parental recall. We assessed the validity of mothers’ recall against home-based vaccination cards using data from a community-based household survey in Nigeria. Methods A cross-sectional survey of 1,254 mothers of children aged 12–23 months was performed in Enugu State, Nigeria in July 2020. Data on vaccination status for BCG, OPV, DPT, Measles, Yellow fever, and Vitamin A supplement were collected using two data sources: home-based vaccination cards and mothers’ recall. We evaluated the level of agreement between the two data sources; estimated the sensitivity and specificity of mothers’ recalls; and computed multivariable regression models to identify socio-demographic factors associated with mothers’ recall bias. Results Out of 1,254 mothers interviewed, 578 (46.1%) mothers with vaccination cards were included in this analysis. Vaccination coverage levels were generally similar across data sources, though recall-based data generally underestimated the coverage. The level of agreement between the two data sources was high (≥91.0% for all vaccine types) with recall bias due to under-reporting generally higher than recall bias due to over-reporting. The sensitivity of parental recalls was high for all vaccine types, while the specificity was low across vaccine types. Across all vaccines, mothers recall bias was significantly associated with the rural residence and not receiving postnatal care. Conclusion In the absence of vaccination cards, mothers’ recall of their children’ vaccination status for BCG, OPV, DPT, Measles, Yellow fever and Vitamin A is a valid instrument for estimating childhood vaccination coverage in this setting in Nigeria. However, additional research is needed to confirm these findings at higher sub-national and national levels.

Purpose Stunting, which refers to low height-for-age, is one of the most important public health problems in Ethiopia, and it more accurately reflects nutritional deficiencies and illness that occur during the most critical periods for growth and development in early life. Given this, this paper aims at determining the magnitude and factors associated with stunting among 6–59 month old children in Ilubabor Zone, Southwest Ethiopia. Design/methodology/approach This paper opted for a descriptive study using an interviewer-administered questionnaire and anthropometric measurements of 617 children aged 6–59 months. A systematic random sampling technique was used to select the study participants. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25 and World Health Organization (WHO) Anthro software. Multivariate logistic regression analysis was used to identify independent predictors of stunting. Findings About 33.7% of children aged 6–59 months included in this study were stunted. The proportion of moderate and severe stunting among the stunted children was 26.4% and 7.3%, respectively. Large family size (AOR = 4.0; 95% confidence interval [CI]: 2.5, 6.4), low dietary diversity score (AOR = 7.8; 95% CI: 4.6, 13.0) and household food insecurity (AOR = 16.4; 95% CI: 10.0, 26.7) were independent predictors of stunting. Research limitations/implications Reporting and recall bias related to food groups consumed over the past seven days and seasonal variation may affect the findings related to factors associated with stunting. Practical implications Globally, it is estimated that nearly 165 million children under the age of five are stunted. Outcomes associated with stunting include increased risk of mortality, increased disease risk, developmental delays, diminished ability to learn and lower school achievement and reduced lifelong productivity. So, determining the level of stunting in a particular community is important to design strategies for curbing the contributing factors. Originality/value This study’s community-based design yields a representative sample of study subjects in the Hurumu district, which is valuable for intervention methods and actions. Standardized tools that are validated for use by the World Health Organization are used. Besides, anthropometric data were analyzed using the updated WHO Anthro software.

Background: We primarily aimed to explore the associations between duration of untreated illness (DUI), treatment response, and functioning in a cohort of patients with bipolar disorder (BD). Methods: 261 participants with BD were recruited. DUI was defined as months from the first affective episode to the start of a mood-stabilizer. The functioning assessment short test (FAST) scores and treatment response scores for lithium, valproate, or lamotrigine according to the Alda Scale Total Score (TS) were compared between patients with short (

OBJECTIVE The Accreditation Council for Graduate Medical Education specifies strict requirements for clinical work hours during residency training, with serious consequences for violations. Self-reporting of work hours by trainees can be inaccurate due to recall bias, giving program directors limited data to influence change. We aimed to assess the impact of a smart-phone based geofencing application on submission rates for work hours and reported violations in a general surgery residency program at a university-based medical center. We also examined resident perceptions surrounding implementation and use of the application. METHODS We compared clinical work hours submitted and violations reported during the pilot period (October-November 2019) with the months prior to the launch of the application (July-August 2019). PGY1 and PGY2 residents were eligible to use the application during and after this pilot period. Semi-structured interviews were used to assess resident perceptions. A retrospective review was conducted to compare reporting during the same time period from the prior academic year (2018-2019) for historical reference. Paired t-tests were used to analyze the data. RESULTS Twenty-six residents (15 PGY1, 11 PGY2) were eligible for the intervention and 23 residents (88%) used the application. The mean number of violations reported decreased significantly during the pilot period compared with the months prior to the intervention (4.5 vs. 11, p = 0.04). The total rate of submissions was not significantly different after the intervention (85% vs. 82%, p = 0.42). The PGY1 mean submission rate decreased during the pilot period (91%-75%, p = 0.21) while the PGY2 submission rate increased (77%-91%, p = 0.07). Compared with historical data, there was an increase in overall total submission rates between academic years 2018/2019 and 2019/2020 (74% vs. 79%, p = 0.047) and an associated decrease in the mean number of monthly violations (14 vs. 6.25, p = 0.004). Thirteen (50%) residents (8 PGY1, 5 PGY2) volunteered for semi-structured interviews. Most participants found the application useful for recording and reporting clinical work hours. They noted an ease in the administrative burden as well as more accurate reporting associated with automated logging. Use of the application was not perceived to limit engagement with patient care; however, there were privacy concerns and some technical barriers were identified. The messaging regarding the application's use was identified as critical for implementation. CONCLUSIONS The “real-time” data provided by a geofencing application in our program helped to reduce the number of work-hour violations reported and did not diminish resident engagement with patient care. Decreasing the administrative burden of recording work hours coupled with improving transparency and accuracy of submissions may be important mechanisms.

Objective Information on the oral health outcomes of childhood maltreatment in adulthood is limited and reliant on retrospective questionnaires that are subject to recall bias. There are no data from prospective studies using maltreatment reports to statutory agencies. We therefore assessed the effect on dental outcomes and oral health care at 30-year follow-up using both prospective agency notifications and retrospective self-reports of child maltreatment in the same birth cohort. Methods There were 2456 adults with data on dental outcomes and oral health care at follow-up. Information on self-reported abuse was collected using the Child Trauma Questionnaire and linked to child maltreatment notifications to statutory agencies. Results The prevalence of self- and agency-reported maltreatment was 599 (24.4%) and 142 (5.8%) respectively. At follow-up, 850 participants (34.6 %) had undergone a dental extraction for infection or decay, and 810 had experienced significant dental pain over their lifetime. One third had not visited a dental clinic in the previous two years and 40% failed to brush their teeth at least twice daily. On adjusted analyses, both self- and agency-reported maltreatment showed significant associations with dental extraction (OR = 1.47; 95%CI = 1.21-1.80 and OR = 1.44; 95%CI = 1.01-2.06 respectively). There were similar results for brushing frequency, while self-reported maltreatment was associated with dental pain. However, associations were weaker for dental clinic visits and some child maltreatment subtypes. Conclusions Child maltreatment is associated with adverse oral health consequences in adulthood, and is thus a dental, as well as wider public health issue.

Fatigue is a common symptom in various diseases, including multiple sclerosis (MS). The current standard method to assess fatigue is through questionnaires, which has several shortcomings; questionnaires are subjective, prone to recall bias, and potentially confounded by other symptoms like stress and depression. Thus, there is an unmet medical need to develop objective and reliable methods to evaluate fatigue. Our study seeks to develop an objective and ubiquitous monitoring tool for assessing fatigue. Leveraging a smartphone-based rapid tapping task, we conducted a two-week in-the-wild study with 35 MS patients. We explore the association between tapping derived metrics and perceived fatigue assessed with two standard clinical scales: fatigue severity scale (FSS) and fatigue scale for motor and cognitive function (FSMC). Our novel smartphone-based fatigue metric, mean tapping frequency, objectively ranks perceived fatigue with a mean AUCROC = .76, CI = [.71, .81] according to the FSMC, and a mean AUCROC = .81, CI = [.76, .86] according to the FSS. These results demonstrate that our approach is feasible and valid in uncontrolled environments. In this work, we provide a promising tool for objective fatigue monitoring to be used in clinical trials and routine medical care.

Background Retirement-related changes in depressive symptoms are not clear. This research examined short- and long-term changes in older adults’ depressive symptoms before, upon, and after retirement. It also tested if and how changes in depressive symptoms varied by different levels of negative self-perceptions of aging (nSPA) in men and women. Methods We analyzed longitudinal data from individuals who retired between 1994 and 2016 in the Health and Retirement Study (N = 9027). Using fixed-effect regression models, we examined changes in depressive symptoms from the 10-year preretirement phase through the 10-year postretirement phase. We also examined how changes in depressive symptoms during the retirement transition varied across four groups: low nSPA men, low nSPA women, high nSPA men, and high nSPA women. Results Both male and female retirees experienced increased short- and long-term depressive symptoms after retirement. However, the pattern of change varied by nSPA and gender. For both low nSPA men and women, there were no significant changes in depressive symptoms across different retirement phases. Adults with high nSPA showed important changes in depressive symptoms, but there were gender differences—High nSPA men experienced increases in depressive symptoms mainly in preretirement years and during the year of retirement; high nSPA women experienced symptoms increase during the year of retirement and the years after retirement. Limitations The use of self-report measures may lead to recall bias. Studies are needed to understand mechanisms behind the protective role of low nSPA. Conclusions The findings attest to the health benefits of low nSPA during later-life stages.

Background A growing body of literature suggests that early life circumstances can influence mental health throughout the lifespan. However, how these early life circumstances cumulatively contribute to depression in old age is not completely understood. The aim of this study was to examine the associations of eight factors with depression among community-dwelling older adults. Methods Data were from the China Health and Retirement Longitudinal Study. We included 8,239 community-dwelling individuals who were ≥60 years, completed the life history questionnaire, and had assessment of depression. An early life disadvantage index was established using risk factors that were significantly associated with depression. Logistic regression was used to examine the association of each early life risk factor and the index with depression. Results Of 8239 individuals included, 2,055 (24.9%) had depression. In bivariate analysis, each of eight early life risk factors was significantly associated with depression. Except for maternal and paternal education, all risk factors persisted to be associated with depression after multivariable adjustment. In the multivariable-adjusted model, a one-point higher in the early life disadvantage index (range: 0-6) was associated with a 45% (95% CI: 37%, 53%) higher odds of depression. Limitations Depressive symptoms were measured in our study only by the CES-D scale. Some early life experiences might not be fully reliable due to recall bias. Conclusion There was a strong association between early life environments and depressive symptoms among Chinese community-dwelling older adults. Adverse early life circumstances could contribute cumulatively to depression in old age.

>Goal-concordant care is a priority outcome for palliative care research, yet the field lacks consensus on optimal methods for measurement. We sought to 1) categorize methods used to measure goal-concordant care, and 2) discuss strengths and limitations of each method using empirical examples from palliative care research. We categorized measurement methods for goal-concordant care. We identified empirical examples of each method to illustrate the strengths, limitations, and applicability of each method to relevant study designs. We defined four methods used to measure goal-concordant care: 1) Patient- or Caregiver-Reported, 2) Caregiver-Reported After Death, 3) Concordance in Longitudinal Data, and 4) Population-Level Indicators. Patient or caregiver-reported goal-concordant care draws on strengths of patient-reported outcomes, and can be captured for multiple aspects of treatment; these methods are subject to recall bias or family-proxy bias. Concordance in longitudinal data is optimal when a treatment preference can be specifically and temporally linked to actual treatment; the method is limited to common life-sustaining treatment choices and validity may be affected by temporal variation between preference and treatment. Population-level indicators allow pragmatic research to include large populations; its primary limitation is the assumption that preferences held by a majority of persons should correspond to patterns of actual treatment in similar populations. Methods used to measure goal-concordant care have distinct strengths and limitations, and methods should be selected based on research question and study design. Existing methods could be improved, yet a future gold standard is unlikely to suit all research designs.

Background Vaginismus has an unknown etiology, is comorbid with anxiety, and is the most common sexual dysfunction in sexual dysfunction outpatient clinics in Turkey. Aim This study aimed to determine the frequency of adult separation anxiety disorder (ASAD) and styles of attachment in patients with vaginismus and to investigate its relationship with female sexual dysfunction. Methods Sixty women with vaginismus and 60 healthy controls were compared using the Relationship Scales Questionnaire, Female Sexual Function Index (FSFI), and Adult Separation Anxiety Questionnaire (ASA-27). Outcomes We report the results of the questionnaires with their implication on the etiology of vaginismus. RESULTS Separation anxiety and fearful and dismissive avoidance attachment style in the vaginismus group were significantly higher than in the control group. Both total FSFI scores and arousal, pain, and satisfaction subscale scores were higher in the control group. Clinical Implications ASAD should be evaluated and addressed separately, when necessary, in the treatment of vaginismus. Strengths & Limitations The relationship between ASAD and vaginismus has been shown for the first time. Study limitations included the assessment of factors influencing the study results based on self-reporting and possible recall bias. CONCLUSION Attachment and comorbidity research in vaginismus needs to shift from just reporting disturbances, to identify various clinical variables, such as the severity of the vaginismus, response to therapy, and differences in therapeutic modalities, in terms of outcome.

Background Genito-pelvic pain/penetration disorder, which consists of a combination of vaginismus and dyspareunia, is considered a new diagnosis in the latest version of the Diagnostic and Statistical Manual of Mental Disorders. Although the etiology of this diagnosis is not well known, a history of abuse has been suggested to be a primary factor in the emergence of this disorder. Aim This systematic review and meta-analysis aimed to determine the association of abuse history with vaginismus and dyspareunia diagnosis. Methods Related keywords were used to search articles in PubMed, PsycArticles, PsycINFO, Scopus, Web of Science, and the Turkish scientific information database (TRDizin). All articles published in English and Turkish until August 2020 were systematically reviewed. A total of 14 case-control studies, including 1428 participants, were included in the final analysis. The fixed-effects model was used to pool odd ratios (ORs) and 95% confidence intervals (CIs) of the studies. Heterogeneity was evaluated using the I2 statistic. Outcomes Case-control studies that reported vaginismus or dyspareunia outcomes in individuals with or without a history of abuse. RESULTS A significant relationship was found between a history of sexual (1.55 OR; 95% CI, 1.14–2.10; 12 studies) and emotional abuse (1.89 OR; 95% CI, 1.24–2.88; 3 studies) and the diagnosis of vaginismus. A significant relationship was found between sexual abuse and dyspareunia (1.53 OR; 95% CI, 1.03–2.27; 6 studies). No statistically significant relationship was observed between physical abuse, vaginismus, and dyspareunia. No significant difference was found between sexual or physical abuse in terms of assessment methods for the diagnosis of vaginismus and dyspareunia. Clinical Implications This systematic review and meta-analysis points out that in the assessment of vaginismus patients, the risk of sexual and emotional abuse and in the assessment for dyspareunia patients, the risk of sexual abuse should be questioned and addressed in its treatment. Strenght and Limitations The strength of the current meta-analysis is the inclusion of all forms of abuse, and studies published in Turkish and English with a broad and reproducible search strategy. The limitations of this meta-analysis are the exclusion of sources and design other than journal articles and case-control studies, including studies both childhood and adult abuse, which in some studies were not differentiated, having potential language and recall bias. CONCLUSION The study analysis suggests an association of vaginismus with sexual and emotional abuse and dyspareunia with sexual abuse. However, both disorders showed no association with physical abuse.

Background The World Health Organization recommends a 24-h recall period to estimate breastfeeding practice of mothers of infants aged younger than six-months. Though 24-h recall was preferred for its low recall bias and for practical reasons, it can overestimate exclusive breastfeeding practice (EBF). Validating this indicator will help account for the deviation from the true estimate. This prospective cohort study measured accuracy of the 24-h recall method and validates a week recall as an alternative approach for use in a small sample population. Method The study was conducted from March to April 2018 involving 408 mother-infant pairs living in Butajira Health and Demographic Surveillance Site (HDSS), Southern Ethiopia. Participants were prospectively followed for 14 consecutive days; where their breastfeeding practice in the past 24 h was measured daily. Exclusive breastfeeding prevalence estimate obtained using the 24-h recall method and recall periods spanning a varying number of days (short period recalls) was compared against the cumulative of the responses from a prospectively measured repeated 24-h recalls over the course of 14 days. McNemar statistics was used to assess statistical significance of the difference in the EBF prevalence estimates of the single 24-h recall and the reference standard. Sensitivity, specificity, positive predictive value and negative predictive values were calculated to determine the level of accuracy. Receiver Operating Characteristics curve was used to measure the difference in performance between the two methods. Result The highest prevalence (71.4%) of exclusive breastfeeding practice was estimated using the single 24-h recall method whereas the lowest breastfeeding practice (47.1%) was obtained from a cumulative of 14 repeated 24-h recalls. A week recall (a recall over 7 days’ period), resulted in the smallest discrepancy in estimate (7.1%) as compared to cumulative estimate of 14 repeated 24-h recalls. Comparing against our reference standard, a week recall had 96.7% sensitivity and 83.5% specificity in estimating exclusive breastfeeding practice. Conclusions Using single 24-h recall method overestimated exclusive breastfeeding prevalence. However, a week recall gave an estimate close to the estimate from the standard method. A week recall has a potential to balance the tradeoff between the accuracy of EBF estimates and the resource implication of using multiple prospective measurements that have a proven superior accuracy.

Background Childhood maltreatment has long-lasting psychological effects, which often manifest in adulthood. Previous studies have suggested that the effects of childhood maltreatment are not only direct but also indirect, being mediated by other factors. In this study, we hypothesized that the effects of childhood maltreatment on state anxiety in adulthood are mediated by interpersonal sensitivity and the evaluation of life events, and investigated this possibility by covariance structure analysis. Subjects and Methods Self-administered questionnaires (Child Abuse and Trauma Scale, State-Trait Anxiety Inventory Form Y, Life Experiences Survey, and Interpersonal Sensitivity Measure) were distributed to adult community volunteers in Japan, and 404 eligible responses were collected. A structural equation model was constructed to analyze the direct and indirect effects of childhood maltreatment on state anxiety, with interpersonal sensitivity and the evaluation of life events as potential mediators. Results Our model showed that childhood maltreatment increases state anxiety in adulthood both directly and indirectly via interpersonal sensitivity. In addition, interpersonal sensitivity mediated the effects of childhood maltreatment on the negative evaluation of life events, and the negative evaluation of life events mediated the effects of interpersonal sensitivity on anxiety symptoms. Limitations There may be possible recall bias owing to the self-administration of the questionnaire. In addition, this study had a cross-sectional design, and hence the results should be validated by a prospective study. Conclusion The effects of childhood maltreatment on the state anxiety of adult volunteers are not only direct but are also mediated by interpersonal sensitivity. Our results suggest that assessing interpersonal sensitivity may help to determine optimal treatments for patients with anxiety who experienced maltreatment in childhood.

Background Current validated tools to measure upper limb dysfunction after breast cancer treatment, such as questionnaires, are prone to recall bias and do not enable comparisons between patients. This study aimed to test the feasibility of wearable activity monitors (WAMs) for achieving a continuous, objective assessment of functional recovery by measuring peri-operative physical activity (PA). Methods A prospective, single-center, non-randomized, observational study was conducted. Patients undergoing breast and axillary surgery were invited to wear WAMs on both wrists in the peri-operative period and then complete upper limb function (DASH) and quality-of-life (EQ-5D-5L) questionnaires. Statistical analyses were performed to determine the construct validity and concurrent validity of WAMs. Results The analysis included 39 patients with a mean age of 55 ± 13.2 years. Regain of function on the surgically treated side was observed to be an increase of arm activity as a percentage of preoperative levels, with the greatest increase observed between the postoperative days 1 and 2. The PA was significantly greater on the side not treated by surgery than on the surgically treated side after week 1 (mean PA, 75.8% vs. 62.3%; p < 0.0005) and week 2 (mean PA, 91.6% vs. 77.4%; p < 0.005). Subgroup analyses showed differences in recovery trends between different surgical procedures. Concurrent validity was demonstrated by a significant negative moderate correlation between the PA and DASH questionnaires (R = −0.506; p < 0.05). Conclusion This study demonstrated the feasibility and validity of WAMs to objectively measure postoperative recovery of upper limb function after breast surgery, providing a starting point for personalized rehabilitation through early detection of upper limb physical morbidity.

Purpose of Review The present paper provides an accessible overview on the potential of digital phenotyping and mobile sensing not only shedding light on the nature of Internet Use Disorders (IUD), but also to provide new ideas on how to improve psycho-diagnostics of mental processes linked to IUD. Recent Findings In detail, the psycho-diagnostic areas of prevention, treatment, and aftercare in the realm of IUDs are focused upon in this work. Before each of these areas is presented in more specificity, the terms digital phenotyping and mobile sensing are introduced against the background of an interdisciplinary research endeavor called Psychoinformatics. Obstacles to overcome problems in this emerging research endeavor—sensing psychological traits/states from digital footprints—are discussed together with risks and chances, which arise from the administration of online-tracking technologies in the field of IUDs. Summary Given the limited validity and reliability of traditional assessment via questionnaires or diagnostic interviews with respect to recall bias and tendencies to answer towards social desirability, digital phenotyping and mobile sensing offer a novel approach overcoming recall bias and other limitations of usual assessment approaches. This will not only set new standards in precisely mapping behavior, but it will also offer scientists and practitioners opportunities to detect risky Internet use patterns in a timely manner and to establish tailored feedback as a means of intervention.

Background Lung disease caused by exposure to chemical substances such as polyhexamethylene guanidine (PHMG) used in humidifier disinfectants (HDs) has been identified in Korea. Several researchers reported that exposure classification using a questionnaire might not correlate with the clinical severity classes determined through clinical diagnosis. It was asserted that the lack of correlation was due to misclassification in the exposure assessment due to recall bias. We identified the cause of uncertainty to recognize the limitations of differences between exposure assessment and clinical outcomes assumed to be true value. Therefore, it was intended to check the availability of survey using questionnaires and required to reduce misclassification error/bias in exposure assessment. Methods HDs exposure assessment was conducted as a face-to-face interview, using a questionnaire. A total of 5245 applicants participated in the exposure assessment survey. The questionnaire included information on sociodemographic and exposure characteristics such as the period, frequency, and daily usage amount of HDs. Based on clinical diagnosis, a 4 × 4 cross-tabulation of exposure and clinical classification was constructed. When the values of the exposure rating minus the clinical class were ≥ 2 and ≤ − 2, we assigned the cases to the overestimation and underestimation groups, respectively. Results The sex ratio was similar in the overestimation and underestimation groups. In terms of age, in the overestimation group, 90 subjects (24.7%) were under the age of 10, followed by 52 subjects (14.2%) in their 50s. In the underestimation group, 195 subjects (56.7%) were under the age of 10, followed by 80 subjects (23.3%) in their 30s. The overestimation group may have already recovered and responded excessively due to psychological anxiety or to receive compensation. However, relatively high mortality rates and surrogate responses observed among those under 10 years of age may have resulted in inaccurate exposure in the underestimation group. Conclusions HDs exposure assessment using a questionnaire might not correlate with adverse health effects due to recall bias and various other causes such as recovery of injury and psychological anxiety. This study revealed exposure misclassification and characteristics affected by HDs and proposed a questionnaire-based exposure assessment methodology to overcome the limitations of past exposure assessment.

The da Vinci® single-port (SP) and multiport (Xi) approaches to robotic-assisted radical prostatectomy (RARP) are described by different authors in the literature, primarily comparing short-term outcomes of both modalities. To our knowledge, this is the first article comparing the surgical perspective and satisfaction of patients who underwent RARP with the SP and Xi platforms. To determine the patient surgical perspective and satisfaction in terms of pain control, return to normal activity, and overall results of surgery for two groups who underwent SP and Xi radical prostatectomy. The data from 71 consecutive patients who underwent SP RARP in a single center from June 2019 to April 2020 was compared to 875 patients who underwent Xi RARP in the same period. A single surgeon performed all procedures with a transperitoneal technique. After a propensity score match, two groups of 71 patients (SP and Xi) were selected and compared in the study. Patients were contacted by phone by two interviewers and a questionnaire was administered in English or Spanish. Patients were instructed not to disclose the type of robotic surgery they underwent, as interviewers were blinded to that information. A validated Surgical Satisfaction Questionnaire (SSQ-8) was used, along with an additional question from our institution asking about the satisfaction with the number of incision sites (GRI-1). Data were analyzed as continuous and discrete variables to compare the differences between the Xi and SP cohorts. A response rate of 85.9% (n = 61) in the Xi group and 73.2% (n = 52) in the SP group was captured. Overall satisfaction with surgical results was 80% and 88% in the Xi and SP cohorts, respectively. No statistical difference in responses was found between the Xi and SP cohorts for SSQ-8. However, GRI-1 demonstrated a statistically significant difference (P

Background Early trauma (ET) is a risk factor for adult psychiatric disorders. ET exposure is known to cause structural brain alterations, particularly in the fronto-temporo-limbic circuitry. ET-related effects on brain development may differ based on individual characteristics and cause different psychiatric outcomes. We investigated the interaction effect of ET exposure and panic disorder (PD) on cortical thickness. Methods Sixty-six participants with PD and 66 healthy controls were enrolled. High-resolution T1-weighted images were acquired, and a whole-brain vertex-based analysis was performed to estimate cortical thickness. The Early Trauma Inventory Self Report-Short Form, Anxiety Sensitivity Inventory-Revised, Panic Disorder Severity Scale, Beck Depression Inventory-II, and Beck Anxiety Inventory were administered. Results There was a significant interaction between ET exposure and PD on the mean cortical thickness in the bilateral insula and right pars triangularis. An exploratory correlational analysis revealed a positive correlation between the mean cortical thickness in the left insula and severity of anxiety sensitivity to cardiovascular symptoms in participants with PD. Limitations Our findings may be affected by recall bias because this study is limited by its retrospective cross-sectional design. Conclusions Our findings suggest that ET exposure may affect brain structures differently based on a diagnosis of PD. Furthermore, individual variations in brain alterations after ET may confer trait vulnerability that triggers the development of PD. Future longitudinal studies are warranted to elucidate the neurobiological mechanisms underlying ET and psychiatric outcomes.

Background The association between sexual and physical abuse and subsequent depression is well-established, but the associations with specific depressive symptoms and sex differences remain relatively understudied. We investigated the associations of sexual and physical abuse with depressive symptoms in men and women in a large population cohort. Methods Observational study based on 151,396 UK Biobank participants. Exposures included self-reported experiences of childhood physical abuse and sexual abuse. Mid-life outcomes included current depressive symptoms score, individual depressive symptoms, and lifetime depression. We used logistic regression to test associations of childhood sexual/physical abuse with depressive outcomes. Results Recalled childhood sexual and physical abuse were both associated with current depressive symptoms score in adults. Results for individual symptoms-based analyses suggest that sexual and physical abuse are associated with all depressive symptoms, particularly suicidal behaviours. The associations between lifetime depression and sexual/physical abuse were not fully explained by current depressive symptoms score, indicating that these findings may not be fully attributable to recall bias. There was no indication of differential risk for specific depressive symptoms among men and women. Conclusions Sexual and physical abuse are robust risk factors for depression/depressive symptoms regardless of sex. Higher risk of suicidal behaviours associated with childhood sexual/physical abuse are of particular concern. Longitudinal research into sex-specific associations for individual depressive symptoms is required.

Childhood maltreatment is considered a risk factor for substance use disorders (SUD), but this is largely based on retrospective self-reports that are subject to recall bias, designs that do not control for familial confounding, or both. The specific contribution of childhood maltreatment to SUD risk thus remains unclear. Here, we evaluated this contribution in a prospective cohort with objectively recorded childhood maltreatment, using a design that allows controlling for familial confounding. We used medical records and registers to study 525 young adults (20-37 years) with prospectively and objectively documented severe maltreatment exposure, 1979 clinical controls (unexposed former child and adolescent psychiatry patients), 1388 matched healthy controls; and their siblings and cousins. We examined the association between maltreatment and SUD using Cox regression models in the population, as well as stratified within siblings in the same family. SUD risk was significantly increased with childhood maltreatment exposure (crude HR: 6.61, 95% CI: 5.81-7.53; HR adjusted for sex, birthyear, externalizing problems, parents SUD and socioeconomic factors: 3.50, 95% CI 2.95, 4.16). An approximately threefold elevated SUD risk remained when comparing exposed individuals with their unexposed siblings (adjusted HR: 3.12, 95% CI 2.21, 4.42). We provide estimates of the association between childhood maltreatment and SUD accounting for possible confounds of both recall bias and familial factors. When familial confounding is controlled for, SUD risk attributable to severe childhood maltreatment is decreased, but nevertheless considerable. These findings establish a specific contribution of childhood maltreatment to SUD, underscoring the need for SUD prevention in young people exposed to maltreatment. Funding Agencies|Swedish Research CouncilSwedish Research CouncilEuropean Commission [2013-2024, 2013-07434]; Medical Training and Research Agreement in ostergotland Region [ALF 2017: LIO-599451, ALF 2018: LIO-692621, ALF 2019: LIO-791581]; Systembolagets alkoholforskningsrad [2016-0018, 2017-0075, 2018-0030]

Background: The 31-gene expression profile (31-GEP) test uses 31 genetic markers obtained from the initial biopsy of a melanoma to assess melanoma-specific survival and sentinel lymph node positivity. Objective: To assess the professional understanding, opinions, and clinical usage of the 31-GEP test by dermatologists. Methods: Data from 589 unique dermatologists were collected during 2 virtual, nation-wide dermatology conferences via an 18-question survey on practice demographics and their clinical use and opinion of the 31-GEP test. Results: Participants reported that integrating the 31-GEP test may benefit patients by increasing knowledge and understanding (72.5%), personalizing treatment options (58.8%), and easing uncertainty about the future (59.7%). Benefits of using the 31-GEP test included identifying true negative patients in high-risk populations (65.6%) as well as true positives in low-risk populations (70.6%).A majority of participants also noted that if a patient received a 31-GEP Class 2B result, they would escalate subsequent management even if the lesions were classified as T1 (61.4%) or AJCC8 Stage I (59.0%). 84.9% of participants were somewhat to very likely to use 31-GEP testing for patient management or recommend this test to a colleague. Limitations: Potential respondent-selection and recall bias. Conclusion: Dermatologists are increasingly integrating the 31-GEP test into their melanoma clinical management decisions. As the 31-GEP test becomes more prevalent in practice, patients may benefit from decreased anxiety and uncertainty from enhanced prognosis, decreased need for unwarranted procedures such as sentinel lymph node biopsy and optimized allocation of healthcare resources.

BACKGROUND: Maternal recall of infant feeding practices is used frequently in epidemiologic studies to identify the relationship between the dose and exposure of mothers’ own milk (MOM) and subsequent health outcomes. Maternal recall has been identified as a potential source of measurement bias. OBJECTIVE: To describe maternal recall certainty of the dose and exposure of MOM feedings at four sequential time periods post birth. MATERIALS AND METHODS: In this secondary analysis of data from a larger study, mothers of children 4–36 months of age were asked to (1) describe infants’ MOM dose and exposure at four sequential time periods post birth and (2) rate the certainty of their recall. RESULTS: Eighty mothers provided complete data. MOM was the first feeding for 78.5% of infants and was received by 83% during the first week, 85% during the first month, and 62% during the fourth month. Maternal ratings of recall certainty were >95% for each of the four time periods. Although reported recall certainty was significantly different for the four time periods (Χ(2) =9.67, p=0.02), no two time periods were significantly different in post hoc analyses. Maternal recall certainty was highest with the infants’ first feed, with no relationship for other time periods. CONCLUSION: Maternal recall certainty of infant feeding at four sequential time periods post birth was high regardless of elapsed time. The measurement of maternal recall certainty may be useful in clinical practice and subsequent studies linking MOM exposure to later health outcomes.

Aim To investigate the correlation of readiness for hospital discharge, the chronic illness resources, and postdischarge outcomes of diabetic foot ulcer patients, which can be help for discharged patient rehabilitation. Design A cross‐sectional study. Methods One hundred and seventy‐nine patients were recruited from the Endocrinology units of two tertiary hospitals between November 2018–September 2019, in Guangdong, China. The methods used were Readiness for Hospital Discharge Scale, The Chronic Illness Resources Survey and one‐on‐one telephone interviews. Results Pearson correlation coefficients indicated moderate correlation between the readiness for discharge and resource availability for chronic illnesses (r = .446, p

Background Polygenic risk score (PRS) is a method of revealing multiple genes effect. The study of PRS and childhood trauma (CT) and resilience on adolescent depressive symptoms are fewer reported, especially the functional mechanism of resilience among them. Methods 718 Chinese adolescents aged 10-14 years were surveyed including CT, resilience, depressive symptoms, and phenotype data in three years of the cohort study. PRS was calculated by the weighted accumulation effects of alleles on depressive symptoms. Their relationships were analyzed by the mediation and moderation models. Results PRS and CT were risk factors for depressive symptoms. Interaction (PRS × CT) on depressive symptoms had no statistical significance. Resilience acted as the protective mediator from CT (emotional abuse, emotional neglect, physical neglect) to depressive symptoms and moderator from CT (emotional abuse) to depressive symptoms. Limitations The sample size was a little small so that the inference were drawn prudently. Except gene data, other were collected by self-reported questionnaire instruments which inevitably brought recall bias. Conclusions PRS and CT could have adverse impact on depressive symptoms, resilience could alleviate these risk effects as a moderator and a mediator. The findings have important implications for prevention and intervention in adolescent depressive symptoms.

Dear Editor, A potential association between rituximab and more severe COVID-19 outcomes has been previously raised, based on case reports, retrospective studies and mostly declarative registries.1–4 To further investigate this association, we focused on patients with inflammatory arthritides (IA) receiving intravenous biological agents at day hospitals to limit selection and recall bias, as well as missing data. All patients with IA treated in day hospitals with intravenous biological agents (rituximab, abatacept, infliximab or tocilizumab) in seven clinical centres in France (Strasbourg, Colmar, Mulhouse, Nancy, Reims, Clermont-Ferrand and Saint-Antoine hospitals in Paris) were enrolled in the study. Data were collected from 1 September 2019 (5 months before the outbreak of the epidemic in France, so that all enrolled patients had been exposed to a biologic prior to the start of the epidemic) to 1 January 2021.3 In each centre, we obtained the list of all patients receiving intravenous biological agents from the hospital pharmacist. Therefore, all patients receiving one of the four drugs within the time frame of the study were enrolled in each centre. The occurrence of hospitalised COVID-19 was the primary outcome criterion, that is, SARS-CoV-2 presence confirmed by PCR and resulting in hospitalisation or death. Data were analysed with Bayesian methods in univariate and multivariate analyses …

Background Pruritus is a common symptom that can significantly reduce quality of life through sleep disruption. Objective To examine features of disturbed sleep in patients with chronic pruritic dermatoses and test the hypothesis that systemic inflammation may serve as a biomarker for impaired sleep in these patients. Methods Cross-sectional analysis of the National Health and Nutrition Examination Survey investigating systemic inflammation using C-reactive protein (CRP) levels. Logistic regression was used to compare patients with and without sleep disturbances, adjusting for demographics (model 1) and medical comorbidities (model 2). Results Chronic pruritic dermatoses were associated with multiple sleep disturbances, including nighttime awakenings (model 1: odds ratio [OR], 1.646; 95% confidence interval [CI], 1.031-2.627; model 2: OR, 1.329; 95% CI, 0.888-1.989) and early morning awakening (model 1: OR, 1.669, 95% CI, 1.118-2.493; model 2: OR, 1.582; 95% CI, 1.008-2.481). Mean CRP levels were 52.8% higher among patients with pruritic dermatoses reporting trouble sleeping compared with those who did not (0.663 vs 0.434 mg/dL; P = .034). Trouble sleeping was also positively correlated with CRP levels (β = 0.142, P = .025). Limitations Potential recall bias among participants. Conclusions In addition to confirming sleep disturbances with pruritic dermatoses, we found these disturbances are more likely to present with elevated CRP levels. Clinicians should consider the potential risk for sleep-related and cardiac comorbidities in patients diagnosed with itchy skin conditions.

Background: COVID-19 is significantly impacting healthcare delivery worldwide. Chen et al anecdotally reported the impact on dermatology outpatient care at the outbreak epicenter in Wuhan, China, but nothing has yet been assessed for the US. The purpose of this study was to determine the magnitude of the ongoing impact of COVID-19 on US dermatology outpatient care. Methods: After pre-validation, 2 surveys comparing outpatient volumes and scheduling issues for the weeks of February 17th versus the week of March 16th, 2020 (Survey 1) and April 13th, 2020 (Survey 2) and for estimation of trends in the next several weeks was emailed to 9,891 US Dermatologists on 3/21(Survey 1) and 4/18(Survey 2)(Tables S1a & S1b). Because of the importance of this information and the need for rapid dissemination, only data from the first 1,000 respondents (collected in the initial 36 hours) were included in each survey. In Survey 1, 30 responses were removed due to ineligible geography or errors in survey entry, leaving 970 for the analysis. Survey 2 consisted of 1,000 eligible respondents. Demographics (Table 1) representativeness with AAD membership was confirmed (Table S2). Statistical significance was calculated using chi-square, difference-of-proportions, and two-tailed independent t-tests. Results: COVID-19 impact was material (Table 2). From the 3rd week in February to the 3rd week in March to the 3rd week in April, the average number of patients seen fell from 149.4 to 63.4 to 28.2(p50% decrease in patient volume in the coming 2 weeks (18.9% completely closing practices) and, disturbingly, 47.2% of respondents in the 2nd survey estimated an additional 50%+ decrease in patient volume in the next 2 weeks. 54.6% (Survey 1) of postponed appointments were for >4 weeks with an additional 25.4% not rescheduled. Discussion: A greater negative impact was found in US “hotspot” regions (36% (Survey 1) and 34% (Survey 2) of respondents-Figure S1) for week 3/16-20 for practice days (3.0 hotspots vs. 3.3 non-hotspots) and patients seen (56.2 in hotspots vs. 70.0 in non-hotspots); and for week 4/13-18 (3.4 in hotspots vs 3.5 in non-hotspots) and patients seen (25.3 in hotspots vs 29.7 in non-hotspots). No significant differing telemedicine usage (39.5% hotspots vs 37.2% non-hotspots) or practice closure (21.0% hotspots vs 17.6% non-hotspots) was found in Survey 1 (March); however, a significant difference in telemedicine usage (54.5% hotspots vs 45.5% non-hotspots) and practice closure (25.4% hotspots vs 16.4% non-hotspots, when compared to a typical April week) was found in Survey 2 (April). Mean estimated telemedicine visits overall for the next 2 weeks was 37.8% (Survey 1) and 45.9% (Survey 2). Academic/University/Institutional dermatologists were significantly more likely to use telemedicine (Survey 1=57.1%, Survey 2=68.6%) than private practitioners (Survey 1=35.5%, Survey 2=46.2%). Telemedicine usage was less likely for dermatologists with >30 practice years (>30=32.4% vs 40.0%) and this trend continued in April with only 37.2% of more experienced dermatologists using telemendine. However, telemedicine usage does not have an impact on the deferred/postponed biopsies that had already occurred during the March (mean=10.7) or April (mean=7.9) weeks as well as those predicted to be subsequently postponed. Limitations include that this study reflects a “snapshot” which could materially change given the dynamically evolving situation. Estimations could have led to recall bias and the 10.1% response rate could have introduced sampling and non-response bias. Those with lower work volumes could have been more likely to have time to respond, but this bias was minimized by weekend-only data collection. However, the large sample size and representative distribution mitigate selection bias and standard statistical testing demonstrated significance. Conclusion: Our findings demonstrate the significant early impact of COVID-19 on US dermatologic care and can help better understand national trends. With an estimated 49.9 million annual US dermatology office visits, the 50%+ decrease in predicted visits could be devastating. Beyond telemedicine, other innovative approaches will need to be developed and implemented to help delivery of essential dermatology care during this crisis.

Background Sudden unexpected death in epilepsy (SUDEP) is a rare but fatal risk that patients, parents, and professional societies clearly recommend discussing with patients and families. However, this conversation does not routinely happen. Objectives This pilot study aimed to demonstrate whether computerized decision support could increase patient communication about SUDEP. Methods A prospective before-and-after study of the effect of computerized decision support on delivery of SUDEP counseling. The intervention was a screening, alerting, education, and follow-up SUDEP module for an existing computerized decision support system (the Child Health Improvement through Computer Automation [CHICA]) in five urban pediatric primary care clinics. Families of children with epilepsy were contacted by telephone before and after implementation to assess if the clinician discussed SUDEP at their respective encounters. Results The CHICA–SUDEP module screened 7,154 children age 0 to 21 years for seizures over 7 months; 108 (1.5%) reported epilepsy. We interviewed 101 families after primary care encounters (75 before and 26 after implementation) over 9 months. After starting CHICA–SUDEP, the number of caregivers who reported discussing SUDEP with their child's clinician more than doubled from 21% (16/75) to 46% (12/26; p = 0.03), and when the parent recalled who brought up the topic, 80% of the time it was the clinician. The differences between timing and sampling methodologies of before and after intervention cohorts could have led to potential sampling and recall bias. Conclusion Clinician–family discussions about SUDEP significantly increased in pediatric primary care clinics after introducing a systematic, computerized screening and decision support module. These tools demonstrate potential for increasing patient-centered education about SUDEP, as well as incorporating other guideline-recommended algorithms into primary and subspecialty cares. Clinical Trial Registration clinicaltrials.gov, NCT03502759.

Background While reports of mobility problems are common with aging, their relationship to new onset of slow gait is unknown. Our objective was to examine the validity of subjective motoric complaints for predicting the incidence of slow gait. Methods Ambulatory community-residing participants (mean age 76.6, 55% women) with gait speeds in the normal range enrolled in an aging cohort. Five subjective motoric complaints were assessed. Incident slow gait (walking speed 1 SD below age and sex means) was the primary outcome. Results Of the 548 participants at baseline, 90 had prevalent slow gait and 253 participants (73.7%) reported one or more subjective motoric complaints. Subjective motoric complaints were more common in women than men (1.78 vs 1.23). Over a median follow-up of 3.34 years, 68 participants developed new onset slow gait. All 5 questions predicted incident slow gait (adjusted hazard ratios varying from 2.26 to 4.44). More subjective motoric complaints were associated with increased risk of developing incident slow gait (hazard ratio per complaint 1.81). Predictive validity of subjective motoric complaints for incident slow gait was unchanged when using alternate outcome definitions, accounting for diagnostic misclassification, recall bias, or adjusting for multiple confounders. Conclusions Subjective motoric complaints are a harbinger of mobility disability, and can help improve clinical risk assessments and identify high-risk individuals for interventions to prevent onset of slow gait.

Background Vaccination is integral to preventive healthcare. Despite numerous guidelines on equine vaccination, evidence of current vaccination practices is lacking. Objectives To describe current vaccination practices advised by vets treating horses in the United Kingdom (UK) and compare practices with manufacturer datasheets and current guidelines. Study design Cross‐sectional survey. Methods An online questionnaire was distributed using email addresses acquired through professional registration listings and social media, targeting vets who treat horses in the UK. The questionnaire collected demographic data and information regarding vaccination practices and vaccine hesitancy. Descriptive statistical analysis was performed. Results Questionnaires were completed by 304 UK vets working with horses used for leisure (97.4%, n = 296/304), competition (86.2%, n = 262/304), stud‐work (47.7%, n = 145/304) and racing (40.5%, n = 123/304). Variation was identified in vaccine protocols for competition and noncompetition horses. Fifty‐seven per cent (n = 170/298) of respondents reported variation in advised ‘booster’ frequency; most commonly (n = 118) advising a 6‐monthly vaccination in competition horses and annual vaccination in noncompetition horses. Most common vaccination guidelines volunteered were British Horseracing Authority (68.8%, n = 172/250) and Federation Equestre Internationale (66.4%, n = 166/250). Most vaccination practices were not consistent with datasheet guidance. Only 7.7% (n = 23/300) of respondents complied with datasheet timeframes between the second and third vaccination. Adverse events following vaccination in the previous year were encountered by 66% (n = 199/304) of respondents, representing 2760 adverse events; but only 526 (19.1%) cases were reported to the Veterinary Medicines Directorate. Most common reactions were transient, including stiffness (931), localised swelling (835), lethargy (559) and pyrexia (355). 86.4% respondents reported vaccine hesitancy from horse owners, most commonly due to perception of over‐vaccination, cost and concern regarding adverse events. Main limitations Potential selection, respondent and recall bias. The recent Equine Influenza (EI) and Equine Herpes Virus (EHV) outbreaks in the UK may have altered responses. Conclusions Current equine vaccination practices, although complying with competition rules, are mostly noncompliant with datasheet guidelines, potentially risking suboptimal immunity.

The West China Health and Aging Trends study (WCHAT) is intended to focus on the research that will guide efforts to reduce disability, maximize health and independent functioning, and enhance quality of life at older ages in different ethnicities. And provide the basis for understanding trends and dynamics in late-life functioning, how these differ in various ethnic subgroups, and the economic or social consequences of aging and disability in western China.The cohort enrolled 7536 participants and 7439 participants aged 50 years and older in the baseline in 2018 and every year would be followed up. Finding to date: The data in WCHAT were prospectively collected from Yunnan, Guizhou, Sichuan and Xinjiang by 7 medical institutions. A number of age-related outcome measures were collected though corresponding geriatric assessments. Blood testing, saliva, urine and feces testing are available for all cohort participants. Future plans: The data in WCHAT can be used for various types of epidemiological research, particularly for examining how the culture specific life styles and diet influences geriatrics related outcomes. We are initially planning cohort studies and established a sample biobank in relation to the risk and prognosis of frailty, sarcopenia and other geriatric syndromes. Strengths and limitations of this study: It is a first multi-ethnic cohort study in West China that aimed to investigate the influence of culture specific life styles, diet and living environment on the prevalence of geriatric syndromes like frailty, sarcopenia and so on. This is a prospective multi-center observational study, which will be conducted in various ethnic groups gathering places. This study collected information that related to fatigue, falls, and cognition were obtained through self-reports, which might have recall bias and grouping errors. This study has problems such as the interviewees' refusal to visit, death, going out, and large population mobility may lead to high loss of visit rates. This study collected information from a comparatively healthier elderly population in which external validity was limited.

Digital tools may help to study socioeconomic aspects of agricultural development that are difficult to measure such as the effects of new policies and technologies on the intra-household allocation of time. As farm technologies target different crops and tasks, they can affect the time-use of men, women, boys, and girls differently. Development strategies that overlook such effects can have negative consequences for vulnerable household members. In this paper, the time-use patterns associated with different levels of agricultural mechanization during land preparation in smallholder farming households in Zambia were investigated. A novel data collection method was used: a pictorial smartphone application that allows real-time recording of time-use, which eliminates recall bias. Existing studies analyzing the intra-household allocation of resources often focus on adult males and females. This study paid particular attention to boys and girls as well as adults. The study addressed seasonal variations. Compositional data analysis was used to account for the co-dependence and sum constraint of time-use data. The study suggests a strong gender differentiation for land preparation activities among mechanized households; for households using manual labor, such differentiation was not found. There is some evidence that the surplus time associated with mechanization is used for off-farm and domestic work. The study cannot confirm concerns about negative second-round effects: mechanized land preparation is not associated with a higher workload for women and children during weeding and harvesting/processing. The study provides a proof-of-concept that smartphone applications can be used to collect socioeconomic data that are difficult to measure but of high relevance.

Background: Cancer rehabilitation often includes manual assessment and interventions to address cancer treatment related side effects The effect of reduced access to rehabilitative care due to COVID-19 is currently unknown Objective/Purpose: To assess distress and quality of life (QOL) for women receiving care for breast cancer related impairments during closure of rehabilitation services due to COVID-19 Methods: Preexisting patients returning to rehabilitation services after a COVID-19 associated interruption of treatment were asked to complete a survey regarding their distress, function, and QOL levels at the suspension of rehabilitation services and at the resumption of those services Setting and Patients: Outpatient cancer rehabilitation clinic treating breast cancer survivors at an accredited cancer center Measurements: Distress thermometer, FACT-G (Functional Assessment of Cancer Therapy General) survey, and visual analog scale questions regarding sleep, fatigue, and physical activity as part of reassessment by the clinician Utility of telehealth was also explored Results: Fifteen women (age range, 38-76 years) with primary complaints of shoulder stiffness, pain, and lymphedema completed surveys, and 33% received telehealth Reported distress levels at the time of closure were significantly higher than self-reported levels at reopening (t14 = 4 69, P = 000) Increases in distress at the time of closure were correlated with reduced physical activity (r = -0 602, P = 018) Reduced levels of distress following return to rehabilitation were correlated with reduced levels of fatigue (r = 0 575, P = 025) No statistically significant relationships between distress and sleep quality were found Limitations: Self-report via surveys, recall bias, and the multifactorial characteristics of distress limit study findings Conclusion: Closure of rehabilitation services during COVID-19 created distress, resulting in reduced physical activity and QOL in breast cancer survivors Cancer survivorship communities will need to assess the effect of disrupted service across cancer rehabilitation centers Further research is needed to validate optimal interventions including telehealth best practice to manage distress and QOL in a COVID-19 context

Background Because diagnosing asthma in school-aged children is challenging, a variety of proxies for asthma are used in clinical practice and research settings as indicators of this disease. We aimed to provide insight into the agreement between various asthma indicators based on parental report, medical diagnosis and spirometry. Methods Children from the WHISTLER birth cohort performed spirometry and were followed up with parental ISAAC (International Study of Asthma and Allergies in Childhood) questionnaires about asthma at 5 and 8 years of age. Medical data were extracted from primary care records. We compared 15 asthma indicators based on parental report, medical diagnosis and spirometry using positive agreement, κ statistics and latent class cluster analysis. Results At 5 years of age, 1007 children completed a study visit, while 803 children visited at 8 years of age. Depending on the indicator, the responder and child's age, the asthma prevalence ranged from 0.2% to 26.6%. Cluster analysis revealed classes related to the presence of recent symptoms and a decreased lung function. Agreement between parents and doctors was generally low with κ coefficients ranging from 0.07 (recent wheeze) to 0.52 (recent asthma medication). Additionally, parental report showed to be sensitive to recall bias over time. Conclusions Dependent on the asthma indicator, the responder and the age of the child, substantial differences in agreement were observed between commonly used indicators associated with asthmatic disease in school-aged children. Most agreement between parents and doctors was seen for objective and recent indicators such as the recent use of asthma medication. We advocate caution when literature with different asthma indicators is compared., A variety of clinical definitions are used as indicators of asthma. There are substantial differences in agreement between parents, doctors and lung function. Caution is needed when literature with different asthma indicators is compared. https://bit.ly/2VxDH8p

Objectives Energy-based devices have gained momentum as minimally invasive procedures to treat both medical and cosmetic pelvic floor disorders including genitourinary syndrome of menopause, vaginal laxity, stress urinary incontinence, dyspareunia, and vulvar disorders such as lichen diseases and vestibulitis. However, the FDA recently issued a statement cautioning patients and providers that the safety and efficacy of energy-based devices for the treatment of vaginal symptoms has not been well established. Additionally, the FDA sent letters to the manufactures of energy-based devices with notifications that they could be violating the marketing standards of the FDA. The existing data on side effects is insufficient and limited to observational studies. We sought to characterize the safety events of vaginal energy-based devices by analysis of surveillance data from the FDA Manufacturer and User Facility Device Experience (MAUDE) database and specifically look at those events that occurred prior to the July 30, 2018 warning. Methods The MAUDE database was queried between September 30, 2013 and October 31, 2019 for all vaginal energy-based devices. The incidence of safety events was reported for these devices and the most common complaints were described and characterized. Event reporting was analyzed before and after July 30, 2018. Results Forty-two unique and relevant medical device reports (MDRs) were retrieved. The Mona Lisa Touch had the highest number of MDRs (40.5%) followed by ThermiVa (16.7%) and Viveve (14.2%). Each medical device report was associated with a single patient experience and within the 42 medical device reports, there were 85 complaints. A majority of the MDR complaints (52.9%) were also indications for energy-based devices procedures, which include vaginal pain, dyspareunia, lichen sclerosis, and urinary frequency. Two-thirds of the complaints (68.2%) were related to pain, but serious adverse events such as third-degree burns (3.5%) were rare. Most of the reportable events occurred before July 30, 2018 (83.3%), but most were reported after July 30, 2018 (78.6%). Conclusions MAUDE-reported data suggests that the majority of patient complaints after vaginal energy-based device treatment include vaginal pain, bladder pain, and urinary symptoms. This study suggests that the majority of complaints are not severe, and some may be related to progression of the disease. The few severe adverse events reported in the MAUDE database may have contributed to the FDA warning regarding energy-based devices. Recall bias after the FDA warning, as well as the potential for litigation, may have prompted an increase in adverse event reporting after July 30, 2018. : Video Summary:http://links.lww.com/MENO/A650.

Purpose The purpose of this study was to assess the prevalence of low self-esteem among college students and how exogenous and endogenous factors, such as experiences of discrimination and psychological distress, respectively, impact such an outcome. Design/methodology/approach General education courses were used to conduct a quantitative cross-sectional study among undergraduate college students. The primary outcome variable of interest in this study was self-esteem, which was measured using the Rosenburg’s self-esteem scale. Primary independent variable was psychological distress (measured using Kessler 6 scale). Discrimination experiences were measured using the Everyday Discrimination Scale (EDS). Descriptive, bivariate and multiple linear regressions were conducted to find associations among such variables. Findings Among 308 young adults in this study, psychological distress was significantly related to low self-esteem (ß = −6.50, p < 0.001). In addition, increasing EDS score (ß = −0.37, p = 0.019) and women gender (ß = −1.29, p = 0.038) were also associated with low self-esteem. Research limitations/implications The study was cross-sectional and thus cannot provide causal relationship. The self-reported data is susceptible to recall bias. College students continue to face negative social experiences that impact their self-esteem, and discrimination plays a substantial role. Practical implications Gender-specific self-esteem coaching is needed among college students with psychological distress and among those with experiences of discrimination. Social implications The results of the current study provide information for understanding the role of discrimination and psychological well-being on self-esteem of college students, and thus further address the importance of social determinants of health and well-being. Originality/value This study provides a unique insight into the disparities faced by college students. Understanding self-esteem at the individualistic and collectivistic levels will allow for the planning and implementation of comprehensive interventions that address gender differences and psychological distress that will increase the positive health outcomes and decrease the negative health outcomes.

Objectives A questionnaire which provides desirable reliability and validity has been previously developed to assess the disease awareness of diagnosed chronic kidney disease (CKD) patients. However, conventional paper questionnaires often have disadvantages, including recall bias. To substantially improve this, we therefore aimed to explore the feasibility of developing a smartphone-based electronic version (e-version) based upon its original paper version and subsequently tested its validity, reliability, and applicability. Methods A pilot study was conducted at Guangdong Provincial Hospital of Chinese Medicine in Guangzhou, China, during August 2019. The e-version had identical content to the paper version and was adapted in terms of layout and assisted functions via the Wechat-incorporated Wen-Juan-Xing platform. Eligible patients with diagnosed CKD were invited to participate and were assigned the e-version. Randomly selected respondents received a test-retest of the same e-version 2 weeks after their first completion. In some instances, psychometric properties, including validity and reliability of the e-version, were examined. In others, its clinical application was also tested, which included comparisons among the clinical profiles of patients who had/had not responded to the questionnaire as well as patients with above or below average questionnaire scores. Results Of the 225 patients screened, 217 were enrolled to participate, with a response rate of 52.5%. Desirable reliability (Cronbachα = 0.962, ICC for total scores = 0.948), while good convergent validity (Cronbachα = 0.962) and low discriminant validity (one extracted component), of the e-version were detected. Performing inter-group comparisons highlighted statistical differences in terms of higher education level (z = -2.436, P = 0.015) and earlier CKD stages (z = -1.978, P = 0.048), with these patients often preferring to respond. No significant differences were detected in the clinical profiles between respondents who obtained an above or below average questionnaire score. Conclusion The e-version is reliable but was not shown to be a valid approach. Audiences with higher education levels and less advanced disease condition may prefer to respond to the e-version. Adaptation of this e-questionnaire, from its original paper version, may not be a direct transition and meticulous modifications may be required during the transition process. Trial registration Chinese Clinical Trial Registry (ChiCTR1900024633).

Aims Measurement of self-reported lower urinary tract symptoms (LUTS) typically uses a recall period, for example, "In the past 30 days…." Compared to averaged daily reports, 30-day recall is generally unbiased, but recall bias varies by item. We examined the associations between personal characteristics (eg, age, symptom bother) and 30-day recall of LUTS using items from the Symptoms of Lower Urinary Tract Dysfunction Research Network Comprehensive Assessment of Self-reported Urinary Symptoms questionnaire. Methods Participants (127 women and 127 men) were recruited from 6 US tertiary care sites. They completed daily assessments for 30 days and a 30-day recall assessment at the end of the study month. For each of the 18 tested items, representing 10 LUTS, the average of the participant's daily responses was modeled as a function of their 30-day recall, the personal characteristic, and the interaction between the 30-day recall and the characteristic in separate general linear regression models, adjusted for sex. Results Nine items representing 7 LUTS exhibited under- or overreporting (recall bias) for at least 25% of participants. Bias was associated with personal characteristics for six LUTS. Underreporting of incontinence was associated with older age, lower anxiety, and negative affect; overreporting of other LUTS was associated with, symptom bother, symptom variability, anxiety, and depression. Conclusions We identified under- or overreporting that was associated with personal characteristics for six common LUTS. Some cues (eg, less bother and lower anxiety) were related to recall bias in an unexpected direction. Thus, providers should exercise caution when making judgments about the accuracy of a patient's symptom recall based on patient demographic and psychosocial characteristics.

Background Most questionnaires currently used for assessing symptomatology of vestibular disorders are retrospective, inducing recall bias and lowering ecological validity. An app-based diary, administered multiple times in daily life, could increase the accuracy and ecological validity of symptom measurement. The objective of this study was to introduce a new experience sampling method (ESM) based vestibular diary app (DizzyQuest), evaluate response rates, and to provide examples of DizzyQuest outcome measures which can be used in future research. Methods Sixty-three patients diagnosed with a vestibular disorder were included. The DizzyQuest consisted of four questionnaires. The morning- and evening-questionnaires were administered once each day, the within-day-questionnaire 10 times a day using a semi-random time schedule, and the attack questionnaire could be completed after the occurrence of a vertigo or dizziness attack. Data were collected for 4 weeks. Response rates and loss-to-follow-up were determined. Reported symptoms in the within-day-questionnaire were compared within and between patients and subgroups of patients with different vestibular disorders. Results Fifty-one patients completed the study period. Average response rates were significantly higher than the desired response rate of > 50% (p Conclusion The DizzyQuest is able to capture vestibular symptoms within their psychosocial context in daily life, with little recall bias and high ecological validity. The DizzyQuest reached the desired response rates and showed different disease profiles between subgroups of patients with different vestibular disorders. This is the first time ESM was used to assess daily symptoms and quality of life in vestibular disorders, showing that it might be a useful tool in this population.

OBJECTIVE Anchor-based methods to calculate the minimal clinically important difference (MCID) of a patient-reported outcome measure (PROM) may suffer from recall bias. This has never been investigated for otolaryngic PROMs. We sought to identify evidence of recall bias in calculation of MCIDs of PROMs for patients with chronic rhinosinusitis (CRS). DESIGN Retrospective analysis of data from two previous studies calculating the MCID of the 22-item Sinonasal Outcome Test (SNOT-22) and 5-dimensonal EuroQol questionnaire (EQ-5D) in CRS patients. SETTING Tertiary rhinology clinic. PARTICIPANTS Adults with CRS. MAIN OUTCOME MEASURES SNOT-22 score, and EQ-5D visual analog scale scores (EQ-5D VAS) and health utility values (EQ-5D HUV) before and after medical treatment for CRS. After treatment, participants were asked to rate the change in sinonasal symptoms and general health (the anchor question) as "Much worse," "A little worse," "About the same," "A little better" or "Much better." Participants' responses to the anchor question were checked for association with post-treatment and pre-treatment scores using ordinal regression. RESULTS On univariate association, post-treatment SNOT-22 and EQ-5D scores were associated with respective participants' anchor question responses (P

BACKGROUND Self-reported consumption is pervasive in alcohol research, though retrospective recall bias is a concern. Fine-grained methods are designed to limit retrospection; yet, discrepancies can arise when comparing responses on fine-grained surveys with responses to retrospective surveys across weeks or months. Many fine-grained studies use both repeated daily surveys (RDS) and end-of-day (EOD) summaries, but little research has examined whether these survey types are consistent. The purpose of this study was to quantify the magnitude and directionality of discrepancy between EOD summaries and RDS and identify alcohol-related predictors of discrepancy. METHODS As a part of a larger study, college student alcohol and cannabis users (N = 341; 53% women; Mage = 19.79 years) were recruited to complete 56 days of data collection, including 5 daily assessments of their substance use and related constructs, one of which included an EOD summary of the previous day. Generalized linear mixed-effects models were used to examine between- and within-person predictors of a 5-category, discrepancy outcome: no discrepancy, low discrepancy where RDS

Several epidemiological studies reported associations of radiofrequency radiation (RFR) exposures with glioma, acoustic neuroma, and other tumors. Other research did not indicate such associations or reported a reduced cancer risk. Epidemiological research is known to be associated with selection and recall bias. A moderate incidence increase of certain tumors has been out of proportion to the rapid expansion of mobile phones, being explainable by improvements in the diagnostic imaging. In some experiments, RFR was associated with the incidence increase of certain age-related tumors but, at the same time, with a longer survival of exposed animals. Potential thermal and non-thermal effects of RFR are overviewed here. In conclusion, there is neither convincing evidence nor theoretic plausibility of a cause-effect relationship between RFR and cancer. Reliable evidence can be obtained by large-scale animal experiments. To make experiments less expensive, it would suffice to maintain large animal groups in equal conditions and to record the life span.

Background The United Kingdom Working Party's (UKWP) criteria were developed to improve epidemiological research in atopic dermatitis (AD), but have not been validated in an exclusively adult European population. Objective To validate the UKWP criteria for AD in adults. Methods In this cross-sectional study, three independent samples of adult individuals were drawn and interviewed: patients with a hospital diagnosis of AD or plaque psoriasis in adulthood, and general population controls. Various versions of the UKWP criteria for AD were utilized. Results A total of 3490 (general population), 3834 (AD) and 4016 (psoriasis) adult individuals were enrolled in the study. The best combination of the UKWP criteria leads to a sensitivity of 0.71 and a specificity of 0.96 in the general population. The criteria better captured 'AD ever' compared with 'AD within the past 12 months' and had a higher sensitivity in patients with moderate (87.2-97.7%) or severe (95.8-100%) AD at the time of interview compared with those who where asymptomatic (12.6-36.8%). The UKWP criteria also captured high proportions of psoriasis patients (19.7-47.7%) when applied in a cohort of unique psoriasis patients. Conclusions It remains a challenge to accurately diagnose a history of AD in adulthood since symptoms are shared with other skin conditions and AD may have resolved or can be waxing and waning, in turn leading to recall bias. The UKWP criteria performed well in the general population for the purpose of determining the prevalence, but should be used cautiously when studying comorbidity.

To investigate external factors that trigger manic and hypomanic relapses and how this is associated with personality and clinical outcome measured as number of affective episodes over a seven-year period.This is a prospective cohort study of 204 meticulously characterized Swedish bipolar disorder patients. Personality was evaluated at baseline using the Swedish universities Scales of Personality in 170 patients, and 90 patients were followed up after approximately seven years in order to evaluate clinical outcomes.We found that 44% of the patients reported trigger factors, including sleep disturbance, work or family related issues, medication, and illicit drug use. There were no significant differences in any of the personality traits when comparing the 74 patients that reported triggers with the 90 patients that did not. At seven-year follow-up, there was no difference between the groups in number of affective episodes (depressive, hypomanic, manic or mixed), involuntary commitments, suicide attempts, or self-harm incidents since baseline.Around 40% of the patients reported external triggers for manic and hypomanic episodes. However, this was neither associated with personality traits nor number of affective episodes at seven-year follow-up.Around 40% of all bipolar disorder patients reported trigger factors for manic or hypomanic episodes. Reporting trigger factors was not associated with personality Reporting trigger factors was not associated with outcomes over a seven-year period. Limitations Patients had on average long duration of illness and may be less sensitive to external stressors than persons with recent onset. Trigger factors were identified retrospectively, and may thus be prone to recall bias. The number of affective episodes might be a too crude outcome measure as most subjects had not suffered any affective episodes at follow-up.

Salmonella Heidelberg and Salmonella Typhimurium are among the most common serotypes responsible for human salmonellosis in Ontario. Introduction of the Ontario Investigation Tools (OIT) in 2014 allowed for standardized case investigation and reporting. This study compared the risk factors and symptomatology for sporadic S. Heidelberg and S. Typhimurium cases reported in Ontario in 2015, following implementation of the OIT. Multilevel logistic regression models were applied to assess associations between serotype and individual-level demographic characteristics, exposures and symptoms for sporadic confirmed cases of S. Heidelberg and S. Typhimurium in Ontario in 2015. There were 476 sporadic cases of S. Typhimurium (n = 278) and S. Heidelberg (n = 198) reported in Ontario in 2015. There were significant associations between the odds of the isolate from a case being one of these serotypes, and travel, consumption of sprouts (any type), contact with reptiles and development of malaise, fever or bloody diarrhoea. The S. Typhimurium and S. Heidelberg cases differed in both symptom presentation and risk factors for illness. Case-case comparisons of Salmonella serotypes have some advantages over case-control studies in that these are less susceptible to selection and recall bias while allowing for rapid comparison of cases to identify potential high-risk exposures that are unique to one of the serotypes when compared to the other. Comparing cases of two different Salmonella serotypes can help to highlight risk factors that may be uniquely associated with one serotype, or more strongly associated with one serotype compared to another. This information may be useful for understanding relative source attribution between common serotypes of Salmonella.