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Background: An emerging body of research suggests that noncentral nervous system cancer may negatively impact the brain apart from effects of cancer treatment. However, studies assessing cognitive function in newly diagnosed cancer patients cannot exclude selection bias and psychological effects of cancer diagnosis. To overcome these limitations, we investigated trajectories of cognitive function of patients before cancer diagnosis.Methods: Between 1989 and 2013, a total of 2059 participants from the population-based Rotterdam Study were diagnosed with noncentral nervous system cancer. Cognitive assessments were performed every 3 to 5 years using a neuropsychological battery. The general cognitive factor was composed of individual cognitive tests to assess global cognition. Using linear mixed models, we compared change in cognitive function of cancer case patients before diagnosis with cognitive change of age-matched cancer-free control subjects (1:2). In addition, we performed sensitivity analyses by discarding assessments of control subjects 5 years before the end of follow-up to exclude effects from potential undiagnosed cancer. All statistical tests were two-sided.Results: The Word Learning Test immediate recall declined faster among case patients than among control subjects (-0.05, 95% confidence interval = -0.09 to -0.01 vs 0.01, 95% confidence interval = -0.01 to 0.03; P for difference = .003). However, this difference was not statistically significant in sensitivity analyses. Furthermore, no statistically significant differences were observed in change of other individual cognitive tests and of the general cognitive factor.Conclusions: In this study, we evaluated cognitive function in a large group of cancer patients prior to diagnosis, thereby excluding the psychological impact of cancer diagnosis and biased patient selection. In contrast to previous studies shortly after cancer diagnosis, we found no difference in change of cognitive function between cancer patients and control subjects. [ABSTRACT FROM AUTHOR]

Objective This cross-sectional study aimed to explore the level of knowledge and expectations people deciding on a future orthodontic treatment have about post-orthodontic retention and to investigate the influence of sociocultural characteristics. Material and methods A total of 227 consecutive people involved as legal decision maker (as patient, parent, or legal guardian) for a prospective orthodontic treatment (mean age 37.1 years; 37.3 per cent male) received before their first appointment a questionnaire to assess their knowledge and expectations about post-orthodontic retention. Data were analysed descriptively, whereas predictors were identified with logistic regressions at P value of less than or equal to 0.05. Results Among the 220 responders, 46.3 per cent (n = 99) knew that retention appliances are used after orthodontic treatment and 52.8 per cent (n = 113) believed perfect results can guarantee stability, whereas at the same time, 77.8 per cent (n = 168) knew that teeth can move on their own without any orthodontic appliances. The majority considered stability of the orthodontic result important or extremely important (94.5 per cent; n = 206), preferred bonded over removable retainers (67.2 per cent; n = 133), believed the orthodontist to be primarily responsible for a stable result (73.2 per cent; n = 158), and found it appropriate to charge for recall visits (72.9 per cent; n = 153). Participants' gender, age, education, nationality, and past orthodontic experiences within the close family significantly influenced answers. Limitations The setting of a single-centred survey conducted in one university moderates the generalizability of the portrayed results. Conclusions Although stability of orthodontic treatment results is very important to people deciding about a prospective orthodontic treatment, knowledge regarding the need for post-orthodontic retention varies and may at times be contradictious. Sociocultural factors seem to influence the level of knowledge and the expectations on post-orthodontic retention. [ABSTRACT FROM AUTHOR]

Background Slow gait speed and Timed Up-and Go (TUG) are often independent predictors of falls in regression analysis, although their ability to discriminate between fallers and non-fallers is questionable. Random forest plots can model complex interactions between predictor variables and have high classification accuracy. We compare the predictive and discriminative ability of UGS and TUG in predicting recurrent falls over 4 years using poisson regression and random forest plots. Methods Data from the first three waves of The Irish Longitudinal Study on Ageing (TILDA), a population-based study of community-dwelling adults aged ≥50 years were used. Baseline physical, neuro-cognitive, sensory and behavioural health were assessed. The outcome was recurrent (≥2) falls at Wave 2 or Wave 3. Poisson regression analysis was used to examine associations between UGS, TUG and falls adjusting for covariates. Random forest models were used. Predictive accuracy was calculated using 5 fold cross-validation and as there was class imbalance, the algorithm was trained using under-sampling of the larger class. Classification rate, area under the receiver operating characteristic curve (AUC) and area under the precision recall curve (PRROC) were obtained to assess predictive accuracy. Results In poisson regression analysis (n=4918), TUG predicted recurrent falls independent of covariates including UGS (IRR=1.06, 95% CI: 1.01, 1.12, p<0.05). The random forest model predicted 60.82% of participants correctly (61.85% of non-fallers; 55.37% of fallers). AUC was 0.63 and PRROC was 0.28. Conclusion Impaired mobility i.e. slower TUG performance, is an independent predictor of future recurrent falls, however it does not discriminate well between fallers and non-fallers. This is highlighted by the PRROC which provides a more conservative estimate of predictive accuracy than AUC as it accounts for the ability to identify both fallers and non-fallers. The analysis highlights the multifactorial nature and complexity of falls, and supports the need for comprehensive falls assessment. [ABSTRACT FROM AUTHOR]

Background The patient profile in a 160-bed rehabilitation hospital is evolving with increasing numbers of older adults admitted with falls and frailty. In 2018 a snapshot audit revealed over 60% of patients obtained scores indicative of cognitive impairment. Traditional falls prevention education delivered in a group format relies on attendees having an adequate level of sensory registration and cognitive abilities to comprehend and recall information given. The Occupational Therapists (OTs) proposed greater benefits from caregiver inclusion in such education to enhance understanding for both patients and caregivers on falls prevention and home environment modifications to facilitate safer home discharges. Methods A mixed-methods design was used. Quantitative data was gathered using a pre and post education 10-point Likert scale to assess attendees' perceived knowledge in four domains: (1) Falls risk factors (2) Modifiable environmental factors (3) Managing falls (4) Accessing support/information to reduce risk of falls Qualitative data was gathered through written feedback. Referrals were generated by OTs. Evening sessions facilitated increased caregiver attendance. OTs delivered a 45 minute PowerPoint presentation, demonstrated adaptive equipment and engaged in discussion with attendees. Information packs were provided to caregivers including a Home Safety Assessment Tool to aid with home environment modification. Results Data from April 2018-2019 was analysed using Microsoft Excel. 21 groups were facilitated with 385 attendees overall. Average percentage increase in knowledge in each of the four domains was 30%. Overall knowledge increased by 32%. Conclusion Increased knowledge of modifiable falls risk factors and supporting persons at risk of falls in the home was demonstrated. OTs reported reduced caregiver concerns regarding home environment modification. Home assessments completed after group attendance found caregivers had implemented recommendations made in the presentation. Further data could be collected to measure the degree of environmental modification completed prior to OT home assessments. Additional qualitative data is required to fully assess benefits to both patients and caregivers. [ABSTRACT FROM AUTHOR]

Aims This study examines the relationship between survey month completion and self-reported alcohol consumption in the last 12 months. It is hypothesized that respondents that complete the survey in the warmer months of the year will report greater alcohol consumption over the last 12 months compared with surveys completed in the colder months. Methods The alcohol consumption data was obtained from three waves of the National Drug Strategy Household Survey (NDSHS) from 2010, 2013 and 2016, between May and November each year (n = 74,252). The associations between month of survey completion and three measures of past-year alcohol consumption were examined using a mix of linear and logistic regression. All models were adjusted for survey year, mode of administration, state of residence, rurality, Socio-Economic Indexes for Areas (SEIFA), sex and age. Results Results varied by drinking measure. In general, there were higher estimates for respondents completing the survey in November and lower estimates in August and September. Conclusions The results in this study demonstrate the significant relationship between month of survey completion and alcohol consumption in the last 12 months. Seasonal variations in alcohol consumption have the potential to impact respondents' accurate recall of alcohol consumption in the last 12 months and changes to survey timing have the potential to bias trend estimates of drinking behaviour. [ABSTRACT FROM AUTHOR]

Smoking incurs heavy financial costs for direct medical expenditures and lost productivity related to premature death. The Alaska Tobacco Prevention and Control Program designed a media campaign called 'The Real Cost' to raise awareness of the economic cost of smoking to all Alaskans, regardless of their smoking status. The campaign presented this information through television and radio ads between December 2012 and March 2013. The first ad, 'Dream Scene', focused on overall cost of smoking to Alaska. The second ad, 'Oil Change', focused on lost productivity. We conducted three cross-sectional telephone surveys, one prior to the campaign and one after each ad was run to assess changes in beliefs associated with the main campaign messages. At Survey 2, we observed increased adjusted odds of agreement with the main campaign message, 'I am affected financially by other people's smoking' (adjusted odds ratio = 4.5, 95% confidence interval = 3.0–6.7). At Survey 3, we observed elevated adjusted odds of agreement for beliefs related to all campaign messages. This campaign was successful in raising knowledge and awareness of the cost of smoking on a societal level among adult, nonsmoking residents of Alaska. [ABSTRACT FROM AUTHOR]

Background The aetiology of temporomandibular disorders (TMD) is controversial and post-orthodontic long-term TMD data of Class II populations are scarce. Objectives To analyse the long-term (≥15 years) effects of Herbst-multibracket appliances (MBA) Class II treatment (Tx) on signs and symptoms of TMD. Subjects and methods All patients (University of Giessen, Germany) who underwent Herbst-MBA Tx (end of active Tx ≥ 15 years ago), could be located and agreed to participate in a recall. Available records from before (T0) and after (T1) active Tx were used for comparison with the recall data (T2). All findings were classified according to research diagnostic criteria for temporomandibular disorders (RDC/TMD) and diagnostic criteria for temporomandibular disorders (DC/TMD) as well as the Helkimo index. Results Seventy-two out of 152 patients participated at age 33.7 ± 3.0 years. Complete TMD data-sets (T0 + T1 + T2) were available for 33 participants. Participants and non-participants did not differ significantly at T0 or T1 in terms of general clinical data, occlusal relationship or TMD prevalence. At all time-points, 79–91 per cent of the patients were free of TMD signs and symptoms (RDC/TMD and DC/TMD). The TMD prevalence fluctuated: 21 per cent (T0), 9 per cent (T1), 15 per cent (T2). Similar findings with a trend towards improvement during T0-T1 and recurrence during T1-T2 were seen for the Helkimo index. There were no statistically significant differences. Limitations The participation rate of only 62 per cent, the disparate availability of records (T0, T1), the fact that the patients were not treated at exactly the same time period and that no untreated control group is available. Conclusion In the long-term (≥15 years) Herbst-MBA Class II Tx neither seems to increase nor decrease the risk for developing TMD. [ABSTRACT FROM AUTHOR]

Aim To investigate the outcome quality and the long-term (≥15 years) post-treatment (Tx) changes after Class II:2 Herbst-multibracket appliance (MBA) Tx. Subjects and Methods In this longitudinal observational study, a recall of Class II:2 patients who had been treated by a Herbst-MBA during adolescence was conducted. Study models from before and after active Tx, after retention and after recall were assessed using standard occlusal variables and the peer assessment rating index (PAR). These data were compared to historical untreated Class I controls. Results Twenty out of 33 patients (61%) could be located and participated at age 33.9 ± 2.7 years. When comparing their data to the 13 patients who did not participate, the pre- and post-Tx occlusal findings did not differ systematically; however, the PAR scores of the non-participants were by 3.3–8.2 points higher at all times and the non-participants were 2.1–2.5 years older. Pre-Tx at age 14.4 ± 2.7 years, the participants showed the following mean values: PAR = 15.0 ± 7.0, Class II molar relationship (MR) = 0.8 ± 0.3 cusp widths (cw), overbite = 5.3 ± 1.3 mm. After Tx, a PAR score of 2.9 ± 1.3 and a super Class I MR (−0.1 ± 0.1 cw) with normal overbite (1.2 ± 0.8 mm) existed. At recall, a PAR score increase to 5.9 ± 3.6 points had occurred, mainly caused by an increase of overbite to 2.5 ± 1.5 mm. The average MR remained Class I (0.0 ± 0.2 cw). For all variables, the untreated controls exhibited similar findings. Conclusion The occlusal outcome of Class II:2 Herbst-MBA Tx exhibited very good long-term stability. While mild post-Tx changes occurred, the long-term findings are similar to untreated Class I controls. [ABSTRACT FROM AUTHOR]

Background: Tomosynthesis approximates a 3D mammogram of the breast, reducing parenchymal overlap that masks cancers or creates false "lesions" on 2D mammography, and potentially enabling more accurate detection of breast cancer. We compared breast cancer screening detection and recall in asymptomatic women for tomosynthesis vs 2D mammography.Methods: A systematic review and random effects meta-analysis were undertaken. Electronic databases (2009-July 2017) were searched for studies comparing tomosynthesis and 2D mammography in asymptomatic women who attended population breast cancer screening and reporting cancer detection rate (CDR) and recall rate. All statistical tests were two-sided.Results: Seventeen studies (1 009 790 participants) were included from 413 citations. The pooled incremental CDR for tomosynthesis was 1.6 cancers per 1000 screens (95% confidence interval [CI] = 1.1 to 2.0, P < .001, I2 = 36.9%). Incremental CDR was statistically significantly higher for European/Scandinavian studies, all using a "paired" design where women had both tests (2.4 per 1000 screens, 95% CI = 1.9 to 2.9, P < .001, I2 = 0.0%) compared with US ("unpaired") studies (1.1 per 1000 screens, 95% CI = 0.8 to 1.5, P < .001, I2 = 0.0%; P < .001 between strata). The recall rate for tomosynthesis was statistically significantly lower than for 2D mammography (pooled absolute reduction = -2.2%, 95% CI = -3.0 to -1.4, P < .001, I2 = 98.2%). Stratified analyses showed a decrease in US studies (pooled difference in recall rate = -2.9%, 95% CI = -3.5 to -2.4, P < .001, I2 = 92.9%) but not European/Scandinavian studies (0.5% increase in recall, 95% CI = -0.1 to 1.2, P = .12, I2 = 93.5%; P < .001 between strata). Results were similar in sensitivity analyses excluding studies with overlapping cohorts.Conclusions: Tomosynthesis improves CDR and reduces recall; however, effects are dependent on screening setting, with greater improvement in CDR in European/Scandinavian studies (biennial screening) and reduction in recall in US studies with high baseline recall. [ABSTRACT FROM AUTHOR]

Aims: To assess the effectiveness of mass media messages to reduce alcohol consumption and related harms using a systematic literature review. Methods: Eight databases were searched along with reference lists of eligible studies. Studies of any design in any country were included, provided that they evaluated a mass media intervention targeting alcohol consumption or related behavioural, social cognitive or clinical outcomes. Drink driving interventions and college campus campaigns were ineligible. Studies quality were assessed, data were extracted and a narrative synthesis conducted. Results: Searches produced 10,212 results and 24 studies were included in the review. Most campaigns used TV or radio in combination with other media channels were conducted in developed countries and were of weak quality. There was little evidence of reductions in alcohol consumption associated with exposure to campaigns based on 13 studies which measured consumption, although most did not state this as a specific aim of the campaign. There were some increases in treatment seeking and information seeking and mixed evidence of changes in intentions, motivation, beliefs and attitudes about alcohol. Campaigns were associated with increases in knowledge about alcohol consumption, especially where levels had initially been low. Recall of campaigns was high. Conclusion: Mass media health campaigns about alcohol are often recalled by individuals, have achieved changes in knowledge, attitudes and beliefs about alcohol but there is little evidence of reductions in alcohol consumption. Short summary: There is little evidence that mass media campaigns have reduced alcohol consumption although most did not state that they aimed to do so. Studies show recall of campaigns is high and that they can have an impact on knowledge, attitudes and beliefs about alcohol consumption. [ABSTRACT FROM AUTHOR]

Patient misunderstandings of healthcare-related instructions result in significant health, social and economic consequences. Pushing the boundaries of traditional academic methods may offer strategies that promote new ways to improve communication and understanding between healthcare providers, caregivers and patients. Comics can be an educational tool, offering an innovative strategy to communicate health-related information. Our study objective was to compare parents' understanding of health-related instructions (i.e. prescription labels, medical instructions and emergency situation scenarios) that were presented using two different formats--sequential pictorial instructions (SPIs) versus written text instructions (WRIs). This was a cross-sectional study to compare parents' understanding of health-related instructions for pediatric patients using structured SPIs versus WRIs. Parents (n=359, 18-82 years old) of pediatric patients were given a card with instructions that were presented as SPIs (n=195, 54.3%) or WRIs (n=164, 45.7%), and then they completed a questionnaire. Total (14 questions) and grouped scores (10 questions) for parental comprehension of prescription and medical emergency instructions were significantly higher among participants viewing the SPIs than those viewing the WRIs in both English and Spanish. The mean understanding of instructions significantly increased from 6% to 12.2% when comparing the WRI versus the SPI. Our initial findings indicate that parents and caregivers of pediatric patients had significantly better understanding and recall of instructions delivered using SPIs than using WRIs. [ABSTRACT FROM AUTHOR]

Aim: To investigate the long-term (≥15 years) post-treatment (Tx) occlusal changes and outcome quality after Class II:1 Tx. Subjects and Methods: Herbst-MBA Tx had been performed at age 12.8 ± 2.7 years in 119 patients. A recall was conducted and study models from before and after active Tx, after retention as well as after recall were evaluated using standard occlusal variables and the PAR index. These data were compared to 31 untreated Class I controls. Results: 52 out of 119 patients could be located and participated at 33.6 ± 3.1 years. Compared to the 67 patients who did not participate in the recall, the pre- and post-Tx occlusal data of the participants did not differ systematically; however, the PAR scores were higher by 3.0-4.7 points at all times. Pre-Tx, the mean values of the 52 participants were: PAR = 27.2 ± 7.6, Class II molar relationship (MR) = 0.7 cusp widths (cw), overjet = 8.2 mm, overbite = 4.1 mm. After Tx, the PAR score was 3.4 ± 2.2. A Class I MR (0.0 ± 0.1 cw) with normal overjet (2.3 ± 0.7 mm) and overbite (1.3 ± 0.7 mm) existed. At recall, a mild PAR score increase to 8.2 ± 5.5 points had occurred; this was mainly due to increased overjet and overbite values (3.6 ± 1.1 and 2.8 ± 1.6 mm) while the MR was stable (0.0 ± 0.2 cw). For all these variables, similar findings were made in the untreated controls. Conclusion: The occlusal outcome of Class II:1 Tx showed very good long-term stability. While mild changes occur post-Tx, the long-term result is similar to untreated Class I controls. [ABSTRACT FROM AUTHOR]

Effects of caffeine on women's health are inconclusive, in part because of inadequate exposure assessment. In this study we determined 1) validity of a food frequency questionnaire compared with multiple 24-hour dietary recalls (24HDRs) for measuring monthly caffeine and caffeinated beverage intakes; and 2) validity of the 24HDR compared with the prior day's diary record for measuring daily caffeinated coffee intake. BioCycle Study (2005–2007) participants, women (n = 259) aged 18–44 years from western New York State, were followed for 2 menstrual cycles. Participants completed a food frequency questionnaire at the end of each cycle, four 24HDRs per cycle, and daily diaries. Caffeine intakes reported for the food frequency questionnaires were greater than those reported for the 24HDRs (mean = 114.1 vs. 92.6mg/day, P = 0.01) but showed high correlation (r = 0.73, P < 0.001) and moderate agreement (К = 0.51, 95% confidence interval: 0.43, 0.57). Women reported less caffeinated coffee intake in their 24HDRs compared with their corresponding diary days (mean = 0.51 vs. 0.80 cups/day, P < 0.001) (1 cup = 237 mL). Although caffeine and coffee exposures were highly correlated, absolute intakes differed significantly between measurement tools. These results highlight the importance of considering potential misclassification of caffeine exposure. [ABSTRACT FROM PUBLISHER]

To date, Web-based 24-hour recalls have not been validated using objective biomarkers. From 2006 to 2009, the validity of 6 Web-based DietDay 24-hour recalls was tested among 115 black and 118 white healthy adults from Los Angeles, California, by using the doubly labeled water method, and the results were compared with the results of the Diet History Questionnaire, a food frequency questionnaire developed by the National Cancer Institute. The authors performed repeated measurements in a subset of 53 subjects approximately 6 months later to estimate the stability of the doubly labeled water measurement. The attenuation factors for the DietDay recall were 0.30 for blacks and 0.26 for whites. For the Diet History Questionnaire, the attenuation factors were 0.15 and 0.17 for blacks and whites, respectively. Adjusted correlations between true energy intake and the recalls were 0.50 and 0.47 for blacks and whites, respectively, for the DietDay recall. For the Diet History Questionnaire, they were 0.34 and 0.36 for blacks and whites, respectively. The rate of underreporting of more than 30% of calories was lower with the recalls than with the questionnaire (25% and 41% vs. 34% and 52% for blacks and whites, respectively). These findings suggest that Web-based DietDay dietary recalls offer an inexpensive and widely accessible dietary assessment alternative, the validity of which is equally strong among black and white adults. The validity of the Web-administered recall was superior to that of the paper food frequency questionnaire. [ABSTRACT FROM PUBLISHER]

Maternal diet during pregnancy may be associated with cancer in offspring. Intake of individual foods, as well as dietary patterns, can be used when examining these relations. Here, the authors examined associations between maternal dietary intake patterns and pediatric germ cell tumors (GCTs) using principal components analysis and logistic regression. Mothers of 222 GCT cases aged less than 15 years who were diagnosed at a Children's Oncology Group institution between 1993 and 2001 and those of 336 frequency-matched controls completed a self-administered food frequency questionnaire of diet during early pregnancy. Four dietary patterns were identified: “Western,” “fruits and vegetables,” “protein,” and “healthful.” With adjustment for birth weight, parity, and vitamin use, the fruits and vegetables pattern was significantly associated with a lower odds for GCTs (odds ratio (OR) = 0.83, 95% confidence interval (CI): 0.69, 0.99; 2 sided). Upon stratification, the fruits and vegetables pattern was significantly associated with a lower odds in males (OR = 0.66, 95% CI: 0.47, 0.92) but not females (OR = 0.91, 95% CI: 0.72, 1.14). A quantitative assessment of assumed nondifferential reporting error indicated no notable deviations from unadjusted odds ratio estimates. Results of this exploratory analysis suggest that maternal prenatal dietary patterns could be considered in future studies of GCTs in offspring. [ABSTRACT FROM PUBLISHER]

A validation study of children's dietary reporting provided an opportunity to investigate whether cognitive ability is a source of systematic error in dietary recalls. From the fall of 2004 through the spring of 2007, fourth-grade children (n = 374) in Columbia, South Carolina, were observed eating school meals and interviewed to obtain 24-hour dietary recalls; subsequently, measures of dietary reporting error were calculated. The common factor extracted from 4 subject-area achievement tests (scores on which were provided by the school district for 362 children) was used as a measure of cognitive ability. For the 325 children who reported school meals that met the criteria to be reports about school meals, as cognitive ability increased, dietary reporting error decreased; the relation between cognitive ability and dietary reporting performance was stronger among girls than among boys. The mean cognitive ability for 37 children who reported no meals that satisfied the criteria for being reports about school meals was significantly lower than that for the 325 children who reported meals that satisfied these criteria. These findings indicate that cognitive ability is a source of systematic error in children's dietary recalls. More generally, the quality of epidemiologic survey data may depend systematically on the cognitive ability of respondents. [ABSTRACT FROM PUBLISHER]

This project studied the convergent validity of current recall of tobacco-related health behaviors, compared with prospective self-report collected earlier at two sites. Cohorts were from the Oregon Research Institute at Eugene (N = 346, collected 19.5 years earlier) and the University of Pittsburgh, Pennsylvania (N = 294, collected 3.9 years earlier). Current recall was examined through computer-assisted interviews with the Lifetime Tobacco Use Questionnaire from 2005 through 2008. Convergent validity estimates demonstrated variability. Validity estimates of some tobacco use measures were significant for Oregon subjects (age at first cigarette, number of cigarettes/day, quit attempts yes/no and number of attempts, and abstinence symptoms at quitting; all P < 0.03). Validity estimates of Pittsburgh subjects’ self-reports of tobacco use and abstinence symptoms were significant (P < 0.001) for all tobacco use and abstinence symptoms and for responses to initial use of tobacco. These findings support the utility of collecting recalled self-report information for reconstructing salient lifetime health behaviors and underscore the need for careful interpretation. [ABSTRACT FROM PUBLISHER]

Tracking falls among elders is challenging. In this reliability study, which took place between October 2007 and February 2008, the authors compared participants’ daily recordings of falls on calendars with a telephone survey of recall of falls over the previous 3 months within the population-based MOBILIZE Boston Study cohort, a cohort of 765 elders. From the cohort, 218 participants were randomly selected. Falls were tracked prospectively on daily calendars (mailed back monthly). Telephone recalls of falls over the previous 3 months were conducted in January and February 2008. Agreement, sensitivity, and specificity were calculated to compare the occurrence of falls as determined by 3-month recall with falls recorded by daily calendar (gold standard) during the same 3-month period. Results showed good agreement between recall and calendars: 27 persons reported a fall by both methods. However, while the 3-month recall correctly classified persons who did not fall (164 persons by both methods), it missed 25% of participants who fell (of 36 participants with a calendar-reported fall, 9 did not report a fall by telephone recall). Kappa was 0.74 (95% confidence interval: 0.68, 0.80), sensitivity was 75%, and specificity was 96%. Retrospective 3-month recall of falls resulted in underreporting of falls by as much as 25% compared with daily calendars. Calendars should be considered the preferred method of ascertaining falls in longitudinal studies. [ABSTRACT FROM PUBLISHER]

Few studies have evaluated the validity of adolescent diet recall after many decades. Between 1943 and 1970, yearly diet records were completed by parents of adolescents participating in an ongoing US study. In 2005–2006, study participants who had been 13–18 years of age when the diet records were collected were asked to complete a food frequency questionnaire regarding their adolescent diet. Food frequency questionnaires and diet records were available for 72 participants. The authors calculated Spearman correlation coefficients between food, food group, and nutrient intakes from the diet records and food frequency questionnaire and deattenuated them to account for the effects of within-person variation measured in the diet records on the association. The median deattenuated correlation for foods was 0.30, ranging from −0.53 for a beef, pork, or lamb sandwich to 0.99 for diet soda. The median deattenuated correlation for food groups was 0.31 (range: −0.48 for breads to 0.70 for hot beverages); for nutrient intakes, it was 0.25 (range: −0.08 for iron to 0.82 for vitamin B12). Some dietary factors were reasonably recalled 3–6 decades later. However, this food frequency questionnaire did not validly measure overall adolescent diet when completed by middle-aged and older adults on average 48 years after adolescence. [ABSTRACT FROM PUBLISHER]

Life-course epidemiologic studies frequently obtain data on perinatal and childhood factors through adult self-report. Data from a prospective US birth cohort of 262 women, born between 1959 and 1963 (average age at adult follow-up, 41.8 years), were used to assess the validity of self-reported birth weight category by sociodemographic characteristics. The effect of reporting error on the associations of birth weight with childhood and adult body mass index was evaluated by comparing the estimates of associations from linear regression analyses. The level of agreement between the birth weight category reported by 85% of the participants and the birth weight recorded at the time of birth was moderate to good (sensitivity = 73%, weighted kappa = 0.67). The validity varied by birth weight category (sensitivity range = 58%–81% for the lowest and highest birth weight category, respectively) and was highest for participants who were white, of lower childhood family income, and born to older mothers. Despite this moderate to good validity, the associations of birth weight with childhood and adult body mass index were attenuated and no longer statistically significant when self-reported birth weight was used. In conclusion, birth weight reported in middle adult life is measured with error, limiting its utility for detecting modest associations with health in later life periods. [ABSTRACT FROM PUBLISHER]

Epidemiologic research shows that pets influence human health, demonstrating both protective and deleterious health risks; therefore, valid definitions of pet exposure would enhance research. The authors determined how well young adults aged 18 years report their early childhood pets. Subjects in an established birth cohort from Detroit, Michigan, born in 1987–1989 (n = 820) were asked a series of questions about pets in the home during their first 6 years of life. Pet recall was compared with annual prospectively collected parental report from 12–18 years prior. Exposure to cats was correctly reported on average 86.3% of the time (95% confidence interval: 85.0, 87.5) and dogs 79.2% (95% confidence interval: 77.7, 80.6) of the time (P < 0.01). Cats and dogs were more likely to be underreported than overreported, from as few as 1.8-fold to as many as 8.3-fold (P < 0.05). Reporting differed by sex of the respondent and current pet ownership. No differences were found in reporting by those who experienced allergy symptoms near dogs or cats. Findings suggest good reliability of young adult pet reporting for ages 0–6 years but that childhood pet exposure may need to be assessed separately depending on the participant's sex and the outcome of interest. [ABSTRACT FROM PUBLISHER]

Background Q fever is a zoonotic disease caused by Coxiella burnetii. Primary infection can progress to persistent infection irrespective of initial symptomatology. Our aim is to describe the clinical features, treatment, risk of progression, use of prophylaxis, and outcomes of Coxiella burnetii infection at our institution. Methods We did a retrospective review of all adult patients with positive Coxiella burnetii serology at Mayo Clinic, Rochester from 1st January 2012 to 31st December 2018. Centers for Disease Control and Prevention (CDC) case definition and classification were used to group the patients into confirmed and probable acute Q fever, and confirmed and probable chronic/persistent Q fever. Data on demographics, clinical presentation, comorbid conditions, exposure history, risk factors associated with progression, serology, treatment and outcomes were collected. Results We found 266 patients with positive titres of Coxiella IgG or IgM greater than 1:16, of which 49 patients met the CDC case definition for Q fever. Median age at presentation was 62 years. 45/49 (91. 8%) were men, while 4/49 (8%) were women. 20/49 (40. 8%) patients presented with acute Q fever of which 5 (25%) patients progressed to persistent infection. 29/49 (59%) patients presented with persistent Q fever of which 4 patients could recall symptoms suggestive of acute Q fever. The most common presentation of acute Q fever was acute febrile illness (65%). Endocarditis (11/29) was the most common presentation of chronic/persistent Q fever. Of the 5 patients with acute Q fever that progressed to persistent infection, 3/5(60%) progressed despite being on doxycycline and hydroxychloroquine. 8/29 patients with persistent Q fever had serological resolution at last follow-up. 2/4(50%) deaths were attributable to Q fever. Conclusion Minority of the patients tested met the case definition. 25% of patients with acute disease progressed to chronic Q fever out of which 60%(3/5) progressed despite prophylaxis. Endocarditis and vascular infections were the most common chronic cases. Interestingly we found 4 cases of MPGN in association with Q fever. Prosthetic valves are the most important risk factors for progression (P = 0.02). Serological cure often lags behind clinical cure (27% vs. 68% in persistent infection)(Table 4). Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Measles, rubella, and maternal and neonatal tetanus have been verified to be eliminated in Haiti, but a diphtheria outbreak has been ongoing since 2014. To evaluate progress toward maintaining vaccine preventable disease (VPD) elimination and control, we conducted the first survey to estimate immunity to these VPDs among children in Haiti. Methods We conducted a nationally representative, two-stage cluster survey in 2017, stratifying Haiti into 2 regions: (1) West Region, the highly urban West department that includes one-third of Haiti's population; (2) Non-West Region (all other departments). We sampled 4,286 households to recruit at least 910 children aged 5–7 years. We obtained vaccination history and dried blood spots from one eligible child per household. Antibody concentrations to VPDs were measured on a multiplex bead assay. We compared seroprotection and vaccination coverage estimates. Results Among 1146 enrolled children, tetanus (83%, 95% CI: 80%–86%) and diphtheria (83%, 95% CI: 81%–85%) seroprotection were higher than coverage with ≥3 doses of tetanus and diphtheria containing vaccine (DTP3) (68%, 95% CI: 61%–74%). No participants had antibody concentrations consistent with long-term immunity to tetanus or diphtheria. Measles (87%, 95% CI: 85%–89%) and rubella (84%, 95% CI: 81%–87%) seroprotection were higher than or similar to coverage with at least one dose of measles-rubella (MR) vaccine (84%, 95% CI: 80%–87%) (Figure 1). MR second-dose coverage was 20% (95% CI: 16%–24%). Seroprotection in the West Region was lower than in the non-West region for all VPDs. Conclusion Discordance between DTP3 coverage and seroprotection might be due to underestimating vaccination coverage by recall. Lack of long-term protection against tetanus or diphtheria is consistent with declining antibody concentrations by school-age after the primary DTP series, indicating the need for a booster dose. Seroprotection against measles and rubella viruses was lower than levels needed to prevent transmission, particularly in the West region; re-introduction of either virus could lead to an epidemic. Haiti should reach ≥95% DTP3 and two-dose MR coverage and add tetanus and diphtheria vaccine booster doses per global recommendations. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background The ACIP recommends influenza and Tdap vaccination during pregnancy to reduce the risk of influenza and pertussis in the mother and her infant. We assessed influenza and Tdap vaccination coverage and associated factors among pregnant women enrolled in PREVAIL, a prospective birth cohort study in Cincinnati, OH. We assessed sensitivity and specificity of self report for both vaccines against state registry, maternal healthcare provider, and work-place records. Methods We enrolled and interviewed 265 pregnant women regarding self-reported receipt of influenza and Tdap vaccines, and obtained vaccine records from registry, electronic medical record, provider, employer, or pharmacy. We grouped subjects by documented vaccination status and analyzed demographic variables and vaccine attitudes regarding efficacy, safety, and hesitancy using unadjusted Fisher exact tests. We analyzed sensitivity and specificity of maternal recall. Results We identified documentation of influenza and Tdap vaccine receipt during pregnancy in 172/265 (64.9%) and 238/265 (89.8%) of women, respectively (Figure 1); by self report, 177/265 (66.8%) reported receiving influenza and 221/265 (83.4%) Tdap vaccine. The two most common primary reasons cited for receiving influenza vaccine were "to protect my baby" (36.7%) and "to protect myself" (26%; Figure 2). Pregnant women were more likely to get Tdap vaccine if a healthcare worker recommended it (OR 5.4). Subjects were more likely to get influenza vaccine if they believed it was effective in preventing influenza in themselves (OR 9.0) or their babies (OR 8.1). While positive recall had a high concordance (95.2% and 93.4% for influenza and Tdap, respectively), 12.5% and 32.1% of mothers incorrectly recalled not receiving an influenza or Tdap vaccine, respectively, that was documented as received in the records (Figure 3). Conclusion We found high concordance between maternal recall and verification for both influenza and Tdap vaccines. In this single-site cohort of 265 women, self report was a reliable measure of vaccination status among pregnant women. Provider communication to pregnant women regarding effectiveness of influenza and Tdap vaccinations for themselves and their infants may lead to higher maternal vaccination rates. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Annually in the US alone , Clostridioides difficile infection (CDI) afflicts nearly 500,000 patients causing 29,000 deaths. Since early and aggressive interventions could save lives but are not optimally deployed in all patients, numerous studies have published predictive models for adverse outcomes. These models are usually developed at a single institution, and largely are not externally validated. This aim of this study was to validate the predictability for severe CDI with previously published risk scores in a multicenter cohort of patients with CDI. Methods We conducted a retrospective study on four separate inpatient cohorts with CDI from three distinct sites: the Universities of Michigan (2010–2012 and 2016), Chicago (2012), and Wisconsin (2012). The primary composite outcome was admission to an intensive care unit, colectomy, and/or death attributed to CDI within 30 days of positive test. Structured query and manual chart review abstracted data from the medical record at each site. Published CDI severity scores were assessed and compared with each other and the IDSA guideline definition of severe CDI. Sensitivity, specificity, area under the receiver operator characteristic curve (AuROC), precision-recall curves, and net reclassification index (NRI) were calculated to compare models. Results We included 3,775 patients from the four cohorts (Table 1) and evaluated eight severity scores (Table 2). The IDSA (baseline comparator) model showed poor performance across cohorts(Table 3). Of the binary classification models, including those that were most predictive of the primary composite outcome, Jardin, performed poorly with minimal to no NRI improvement compared with IDSA. The continuous score models, Toro and ATLAS, performed better, but the AuROC varied by site by up to 17% (Table 3). The Gujja model varied the most: from most predictive in the University of Michigan 2010–2012 cohort to having no predictive value in the 2016 cohort (Table 3). Conclusion No published CDI severity score showed stable, acceptable predictive ability across multiple cohorts/institutions. To maximize performance and clinical utility, future efforts should focus on a multicenter-derived and validated scoring system, and/or incorporate novel biomarkers. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Use of self-reported confidence ratings may be an efficient method for assessing recall bias. In this exploratory application of the method, the authors examined the relation between case-control status and self-reported confidence ratings. In 2002 and 2003, melanoma cases (n = 141) and controls (n = 143) aged 20–44 years residing in Ontario, Canada, estimated the amounts of time they had spent outdoors in summer activities when they were 6–18 years of age and indicated their confidence in the accuracy of each estimate. The generalized estimating equations extension of logistic regression was used to examine dichotomized confidence ratings (more confident vs. less confident) for activities reported for ages 6–11 years and 12–18 years. Types of activity were associated with more confident reporting for both age strata; as the number of stable outdoor activity periods (total number of similar outdoor periods within each activity) reported by respondents increased, confidence decreased. Cumulative time spent outdoors was also associated with more confidence but reached statistical significance only for the age stratum 12–18 years. There was no statistically significant association between case-control status and self-reported confidence for either age stratum (6–11 years: odds ratio = 0.91; 12–18 years: odds ratio = 1.32), which suggests an absence of recall bias for reported time spent outdoors. [ABSTRACT FROM AUTHOR]

Studies of long-term effects of breastfeeding on the health of both infants and mothers often rely on maternal recall of breastfeeding duration after several decades. The authors evaluated this recall by 140 college-educated, US women 69–79 years of age who breastfed a child in 1940–1956 and recorded the duration both prospectively in a diary for the Menstruation and Reproductive History Study and retrospectively in a questionnaire in 1990–1991. Mean prospective breastfeeding duration was 5.6 months (range, 1–12 months). Mean reporting difference, questionnaire minus diary duration, was 0.0 months, with a standard deviation of 2.7 months; women who recorded short durations tended to overreport, while women who noted long durations underreported. The weighted kappa statistic for reporting agreement was 0.55 (95% confidence interval: 0.42, 0.67), with better recall observed for women in the youngest quintile at recall, firstborns, and infants with more siblings. Ever having breastfed was recalled by 94% of women. For categories of 1–3, 4–6, 7–9, and 10–12 months, recalled breastfeeding duration was correctly classified by 54% of women and was classified within ±1 category by 89%. The observed misclassification, if nondifferential with respect to outcome, would appreciably attenuate estimates of dose-response associations between breastfeeding duration and later health. [ABSTRACT FROM PUBLISHER]

Many cancers have long latency periods, and dietary factors in adolescence may plausibly affect cancer occurrence in adulthood. Because of a lack of prospective data, retrospective collection of data on adolescent diet is essential. The authors evaluated a 124-item high school food frequency questionnaire (HS-FFQ) assessing diet during high school (15–35 years in the past) that was completed in 1998 by 45,947 US women in the Nurses’ Health Study II (NHSII) cohort. To assess reproducibility, the authors readministered the HS-FFQ approximately 4 years later to 333 of these women. The mean Pearson correlation for 38 nutrient intakes was 0.65 (range, 0.50–0.77), and the mean Spearman rank correlation for food intakes was 0.60 (range, 0.37–0.77). Current adult diet was only weakly correlated with recalled adolescent diet (for nutrient intakes, mean r = 0.20). For assessment of validity, 272 mothers of the NHSII participants were asked to report information on their daughters’ adolescent diets using the HS-FFQ. In this comparison, the mean Pearson correlation was 0.40 (range, 0.13–0.59) for nutrients, and the mean Spearman rank correlation for foods was 0.30 (range, 0.10–0.61). While further studies are warranted, these findings imply that this food frequency questionnaire provides a reasonable record of adolescent diet. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the construct-related validity of self-reported historical walking, running, and jogging (WRJ) activity on the basis of data from the Aerobics Center Longitudinal Study (Dallas, Texas). A total of 4,100 men and 963 women underwent at least one medical examination between 1976 and 1985 and completed a follow-up questionnaire in 1986. Levels of glucose, cholesterol, and triglycerides, resting systolic blood pressure, body mass index (weight (kg)/height (m)2), and cardiorespiratory fitness were measured at the time of the medical examination. The follow-up questionnaire assessed WRJ and other strenuous activities for each year from 1976 through 1985. Data analysis included Spearman and partial correlations, analysis of variance, analysis of covariance, and t tests. Results indicated significant correlations between recalled WRJ and treadmill times for each year throughout the 10-year period (r = 0.40–0.61). Participants were classified as historically either sufficiently physically active to receive a health benefit or insufficiently active for a health benefit. Engaging in sufficient levels of historical WRJ was associated with higher treadmill times and lower body mass indices for men and women and lower triglyceride levels for men. Self-reported historical WRJ can be assessed with reasonable validity in comparison with measured treadmill performance, with no decay in accuracy of reporting for up to 10 years in the past. [ABSTRACT FROM AUTHOR]

Screening by whole-body clinical skin examination may improve early diagnosis of melanoma and reduce mortality, but objective scientific evidence of this is lacking. As part of a randomized controlled trial of population screening for melanoma in Queensland, Australia, the authors assessed the validity of self-reported history of whole-body skin examination and factors associated with accuracy of recall among 2,704 participants in 2001. Approximately half of the participants were known to have undergone whole-body skin examination within the past 3 years at skin screening clinics conducted as part of the randomized trial. All positive and negative self-reports were compared with screening clinic records. Where possible, reports of skin examinations conducted outside the clinics were compared with private medical records. The validity of self-reports of whole-body skin examination in the past 3 years was high: Concordance between self-reports and medical records was 93.7%, sensitivity was 92.0%, and specificity was 96.3%. Concordance was lower (74.3%) for self-reports of examinations conducted in the past 12 months, and there was evidence of “telescoping” in recall for this more recent time frame. In multivariate analysis, women and younger participants more accurately recalled their history of skin examinations. Participants with a history of melanoma did not differ from other participants in their accuracy of recall. [ABSTRACT FROM AUTHOR]

It has been of interest to researchers in chronic disease epidemiology to determine whether elderly subjects can accurately recall their physical activity patterns in the distant past. As part of a 32-year follow-up of the Prospective Population Study of Women in Göteborg, Sweden, 433 participants currently aged 70–92 years recalled their leisure-time physical activity at the original examination in 1968, when they had been 38–60 years of age. Using a four-point scale, subjects were originally asked to describe leisure-time activity during the previous 12 months. Identical questions were asked in 2000 describing levels in 1968 and current levels. Subjects were more likely to overestimate their previous activity level than to underestimate it: 43.9% of women classified themselves consistently at both examinations; 48.7% overestimated and 7.4% underestimated their previous activity levels. Using current activity as a proxy for recalled levels did not improve the moderate agreement with activity as originally reported in 1968. The average magnitude of the recall bias (recalled minus original values) amounted to one half of a unit on the four-point scale and was not significantly associated with age or body mass index. In summary, systematic errors were observed in remote physical activity recalls by elderly women, who generally remembered being more active 32 years earlier than they had originally reported. Physical activity recall questionnaires for the distant past should be used with caution, particularly in older populations. [ABSTRACT FROM AUTHOR]

Bowel perforation due to inadvertent ingestion of foreign objects is, fortunately, a rare event. However, it can lead to deadly complications when it occurs. Thin, sharp and pointed objects like toothpicks are more likely to pierce the bowel wall. Diagnosing toothpick ingestion and perforation is difficult since most patients do not recall swallowing the toothpick, symptoms and physical examinations are nonspecific, the symptoms can resemble many abdominal pathologies, and since a toothpick has a radiolucent nature that makes it difficult to detect through X-ray imaging. Due to this, most of the cases are identified during the transoperative period. We present the case of a 27-year-old male who presented with symptoms clinically indistinguishable from acute appendicitis. During surgery, two toothpicks were discovered that compromised the cecum and the appendix. After successful removal of the foreign objects, the patient underwent a full recovery. [ABSTRACT FROM AUTHOR]

Inadvertent ingestion of foreign bodies is a common condition within clinical practice. It rarely produces any symptoms. The diagnosis is difficult since most patients do not recall having swallowed any object. Needles, pins, keys, nails and bones are among the most commonly ingested foreign bodies. Severe complications are uncommon, but if present they can put patients' lives at risk. Although extremely rare, the ingested foreign body may end lodging in the appendix, posing a challenge for the clinical team. Once the exact location of the object is confirmed, the extraction of the foreign object must be performed to avoid complications. The present report describes a case of a young adult patient, who presented to the emergency room after a routine medical examination. A 30 mm metallic nail was discovered in the tip of the appendix. After a failed endoscopic approach an appendectomy was performed, and the patient underwent a complete recovery. [ABSTRACT FROM AUTHOR]