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To evaluate a Produce Prescription Programme's utilisation, and its effects on healthy food purchasing and diabetes control among participants with type 2 diabetes. Prospective cohort study using participants' electronic health records (EHR) and food transaction data. Participants were categorized as \"Frequent Spenders\" and \"Sometimes Spenders\" based on utilisation frequency. Multivariate regressions assessed utilisation predictors; and programme effects on fruit/vegetable purchasing (spending, expenditure share, variety) and on diabetes-related outcomes (HbA1c, BMI, blood pressure). Patients enrolled by clinics in Durham, North Carolina, USA. Participants received $40 monthly for fruits and vegetables at a grocery store chain. 699 food-insecure participants (353 with diabetes). Being female and older was associated with higher programme utilisation; hospitalisations were negatively associated with programme utilisation. Frequent Spender status was associated with $8.77 more in fruit/vegetable spending (p < 0.001), 3.3% increase in expenditure share (p = 0.007), and variety increase of 2.52 fruits and vegetables (p < 0.001). For $10 of Produce Prescription Dollars spent, there was an $8.00 increase in fruit/vegetable spending (p < 0.001), 4.1% increase in expenditure share, and variety increase of 2.3 fruits/vegetables (p < 0.001). For the 353 participants with diabetes, there were no statistically significant relationships between programme utilisation and diabetes control. Programme utilisation was associated with healthier food purchasing, but the relatively short study period and modest intervention prevent making conclusions about health outcomes. Produce Prescription Programmes can increase healthy food purchasing among food-insecure people, which may improve chronic disease care.

ObjectiveTo summarize the available conceptual models for factors contributing to medication adherence based on the World Health Organization (WHO)’s five dimensions of medication adherence via a systematic review, identify the patient groups described in available conceptual models, and present an adaptable conceptual model that describes the factors contributing to medication adherence in the identified patient groups.MethodsWe searched PubMed®, Embase®, CINAHL®, and PsycINFO® for English language articles published from inception until 31 March 2020. Full-text original publications in English that presented theoretical or conceptual models for factors contributing to medication adherence were included. Studies that presented statistical models were excluded. Two authors independently extracted the data.ResultsWe identified 102 conceptual models, and classified the factors contributing to medication adherence using the WHO’s five dimensions of medication adherence, namely patient-related, medication-related, condition-related, healthcare system/healthcare provider-related, and socioeconomic factors. Eight patient groups were identified based on age and disease condition. The most universally addressed factors were patient-related factors. Medication-related, condition-related, healthcare system-related, and socioeconomic factors were represented to various extents depending on the patient group. By systematically examining how the WHO’s five dimensions of medication adherence were applied differently across the eight different patient groups, we present a conceptual model that can be adapted to summarize the common factors contributing to medication adherence in different patient groups.ConclusionOur conceptual models can be utilized as a guide for clinicians and researchers in identifying the facilitators and barriers to medication adherence and developing future interventions to improve medication adherence.Protocol RegistrationPROSPERO Identifier: CRD42020181316

Background Early introduction of complementary foods has been associated with various immune disorders, oxidative stress, and obesity in childhood. The gut microbiota and the short chain fatty acids (SCFAs) they produce are postulated to be on the causal pathway. The objective of this study was to determine if early complementary feeding (i.e. consumption of solids or non-water/formula liquids at or before 3 months) is prospectively associated with infant gut microbiota composition, diversity and SCFAs at 3 and 12 months of age in the Nurture birth cohort. Results Mother-infant dyads in the early complementary feeding group ( n  = 18) had similar baseline characteristics to those in the later feeding group ( n  = 49). We assessed differential abundance of microbial taxa (measured by 16S rRNA gene sequencing of the V4 region) by timing of complementary feeding using beta-binomial regression models (considering a two-sided FDR corrected p -value of < 0.05 as significant), and we fittted linear regression models to assess the association between early complementary feeding and SCFA concentrations (quantified using gas chromatography). After multivariable adjustment for breastfeeding, delivery method, birth weight, and gestational age, there were 13 differentially abundant microbial amplicon sequence variants (ASVs) by timing of introduction to complementary foods at 3 months and 20 ASVs at 12 months. Infants introduced to complementary foods early (vs. later) had higher concentrations of the SCFA butyric acid (mean difference = 0.65, 95% CI: 0.27, 1.04, p  < 0.01) and total SCFAs (mean difference = 38.8, 95% CI: 7.83, 69.7) at 12 months. Bilophila wadsworthia and Lachnospiraceae Roseburia were associated with early (vs. later) complementary feeding and with higher butyric acid concentrations at 3 and 12 months, respectively. Conclusions Our findings are consistent with the hypothesis that early (vs. later) introduction to complementary foods is associated with altered gut microbiota composition and butyric acid concentrations measured in stool until at least 1 year of age. Further research is needed to determine if these changes mediate future development of metabolic and immune conditions.

Informal caregiving for older adults, often long-term, can be concurrently burdensome and beneficial. This longitudinal study aims to delineate distinct joint trajectories of burden and benefits of caregiving among informal caregivers of older adults with functional limitations. We conducted group-based multi-trajectory modelling on longitudinal data – collected at four time-points – on burden (modified-Caregiver Reaction Assessment) and benefits (short Positive Aspects of Caregiving scale) from 274 informal caregivers of older adults in Singapore to delineate joint trajectories of burden and benefits. We used multinomial logistic regression to identify factors associated with the joint trajectories and linear regression to examine the overall well-being across caregivers with distinct joint trajectories. Four distinct joint trajectories were identified: persistently low burden and high benefits (44.5% of caregivers); persistently moderate burden and very high benefits (23.0%); persistently moderate burden and high benefits (19.0%); and persistently high burden and high benefits (13.5%). Having care-related support from an experienced/trained live-in home help worker at baseline (versus those without) was associated with persistently lower burden. Being more prepared in caregiving at baseline was associated with persistently higher benefits. The findings highlight the meaningful heterogeneity in joint trajectories of burden and benefits of caregiving. Training live-in home help workers and informal caregivers to prepare for caregiving roles may reduce burden and enhance benefits of caregiving.

Inappropriate, misleading, missing, and inaccurate citations pervade the biomedical literature. Nicholas Peoples and colleagues argue that new strategies can better enable scientific references to function as an accurate web of knowledge

Progesterone is a steroid hormone that is critical for implantation and maintenance of pregnancy, and low levels are associated with higher miscarriage risk. However, little is known about its trajectory during early pregnancy. We sought to determine the gestational age-specific normative values of serum progesterone on a week-by-week basis, and its associated maternal and fetal factors, during the first trimester of a viable low-risk pregnancy. A cross-sectional study was conducted at KK Women’s and Children’s Hospital from 2013 to 2018. 590 women with a single viable intrauterine low-risk pregnancy, between gestational weeks 5 and 12, were recruited. Serum progesterone showed an increasing trend during the first trimester, with a transient decline between gestational weeks 6–8, corresponding to the luteal–placental shift. Lowest levels were seen at week 7. Maternal age, BMI, parity, gestational age and outcome of pregnancy at 16 weeks’ gestation were found to be associated with progesterone levels. Normative values of serum progesterone for low-risk pregnancies would form the basis for future work on pathological levels of serum progesterone that may increase risk of miscarriage. Larger studies are required to validate these normative values, and personalize them to account for maternal age, BMI, parity and gestational age.

To investigate whether A) duration of ulcer before start of treatment in specialist health care, and B) severity of ulcer according to University of Texas classification system (UT) at start of treatment (baseline), are independent predictors of healing time. This retrospective cohort study, based on electronic medical record data, included 105 patients from two outpatient clinics in Western Norway with a new diabetic foot ulcer during 2009-2011. The associations of duration of ulcer and ulcer severity with healing time were assessed using cumulative incidence curves and subdistribution hazard ratio estimated using competing risk regression with adjustment for potential confounders. Of the 105 participants, 45.7% achieved ulcer healing, 36.2% underwent amputations, 9.5% died before ulcer healing and 8.5% were lost to follow-up. Patients who were referred to specialist health care by a general practitioner ≥ 52 days after ulcer onset had a 58% (SHR 0.42, CI 0.18-0.98) decreased healing rate compared to patients who were referred earlier, in the adjusted model. High severity (grade 2/3, stage C/D) according to the UT classification system was associated with a decreased healing rate compared to low severity (grade1, stage A/B or grade 2, stage A) with SHR (95% CI) equal to 0.14 (0.05-0.43) after adjustment for referral time and other potential confounders. Early detection and referral by both the patient and general practitioner are crucial for optimal foot ulcer healing. Ulcer grade and severity are also important predictors for healing time, and early screening to assess the severity and initiation of prompt treatment is important.

AbstractObjectiveTo explore conditions and outcomes of a first delivery at term that might predict later preterm birth.DesignPopulation based, prospective register based study.SettingMedical Birth Registry of Norway, 1999-2015.Participants302 192 women giving birth (live or stillbirth) to a second singleton child between 1999 and 2015.Main outcome measuresMain outcome was the relative risk of preterm delivery (<37 gestational weeks) in the birth after a term first birth with pregnancy complications: pre-eclampsia, placental abruption, stillbirth, neonatal death, and small for gestational age.ResultsWomen with any of the five complications at term showed a substantially increased risk of preterm delivery in the next pregnancy. The absolute risks for preterm delivery in a second pregnancy were 3.1% with none of the five term complications (8202/265 043), 6.1% after term pre-eclampsia (688/11 225), 7.3% after term placental abruption (41/562), 13.1% after term stillbirth (72/551), 10.0% after term neonatal death (22/219), and 6.7% after term small for gestational age (463/6939). The unadjusted relative risk for preterm birth after term pre-eclampsia was 2.0 (95% confidence interval 1.8 to 2.1), after term placental abruption was 2.3 (1.7 to 3.1), after term stillbirth was 4.2 (3.4 to 5.2), after term neonatal death was 3.2 (2.2 to 4.8), and after term small for gestational age was 2.2 (2.0 to 2.4). On average, the risk of preterm birth was increased 2.0-fold (1.9-fold to 2.1-fold) with one term complication in the first pregnancy, and 3.5-fold (2.9-fold to 4.2-fold) with two or more complications. The associations persisted after excluding recurrence of the specific complication in the second pregnancy. These links between term complications and preterm delivery were also seen in the reverse direction: preterm birth in the first pregnancy predicted complications in second pregnancies delivered at term.ConclusionsPre-eclampsia, placental abruption, stillbirth, neonatal death, or small for gestational age experienced in a first term pregnancy are associated with a substantially increased risk of subsequent preterm delivery. Term complications seem to share important underlying causes with preterm delivery that persist from pregnancy to pregnancy, perhaps related to a mother’s predisposition to disorders of placental function.

Hypertension is prevalent among older adults (60 years and above), but control of blood pressure (BP) remains suboptimal. While there is increasing interest in using digital technology for managing hypertension, information about the extent and potential correlates of such use among older adults remains scant. We assessed the prevalence and correlates of the use of digital technology for managing hypertension among older adults with hypertension. We also investigated if the use of digital technology was associated with BP or hypertension control. The use of digital technology (internet or digital apps) for information about or managing BP or hypertension was assessed among 1729 older adults diagnosed with hypertension participating in a national survey in Singapore. Regression analysis was used to assess the correlates (based on the Unified Theory of Use and Acceptance of Technology), and whether such use was associated with hypertension control or BP values. Digital technology for managing hypertension was used by 7.1% of older adults with hypertension. Those of higher age and with limitations in one or more activities or instrumental activities of daily living were less likely, while those with secondary education and above, and with stronger social network were more likely to use digital technology. There was no association between the use of digital technology and hypertension control. While users of digital technology had lower systolic (by 2.1 mmHg, adjusted p value = 0.12) and diastolic (by 1.6 mmHg, adjusted p value = 0.13) BP than non-users, the differences were not statistically significant. Given its low prevalence, there is potential for increased use of digital technology for managing hypertension among older adults with hypertension in Singapore. Initiatives to increase digital health use should target specific older adult subgroups.

Medication adherence is essential for improving the health outcomes of patients. Various patient-reported outcome measures (PROMs) have been developed to measure medication adherence in patients. However, no study has summarized the psychometric properties of these PROMs to guide selection for use in clinical practice or research. This study aims to evaluate the quality of the PROMs used to measure medication adherence. This study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the EMBASE, PubMed, Cochrane Library, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. The PROMs were then evaluated based on the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. A total of 121 unique medication adherence PROMs from 214 studies were identified. Hypotheses testing for construct validity and internal consistency were the most frequently assessed measurement properties. PROMs with at least a moderate level of evidence for ≥5 measurement properties include the Adherence Starts with Knowledge 20, Compliance Questionnaire-Rheumatology, General Medication Adherence Scale, Hill-Bone Scale, Immunosuppressant Therapy Barrier Scale, Medication Adherence Reasons Scale (MAR-Scale) revised, 5-item Medication Adherence Rating Scale (MARS-5), 9-item MARS (MARS-9), 4-item Morisky Medication Adherence Scale (MMAS-4), 8-item MMAS (MMAS-8), Self-efficacy for Appropriate Medication Adherence Scale, Satisfaction with Iron Chelation Therapy, Test of Adherence to Inhalers, and questionnaire by Voils. The MAR-Scale revised, MMAS-4, and MMAS-8 have been administered electronically. This study identified 121 PROMs for medication adherence and provided synthesized evidence for the measurement properties of these PROMs. The findings from this study may assist clinicians and researchers in selecting suitable PROMs to assess medication adherence.