Use of diagnostic self-tests on body materials among Internet users in the Netherlands: prevalence and correlates of use.
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ABSTRACT: Background
A range of self-tests on body materials has become available to the general public, but the extent of their use has hardly been studied. This study examined how many people use diagnostic self-tests on body materials such as blood or urine, as well as the type of tests that are used, and factors associated with their use.Methods
Cross-sectional survey. Participants were recruited from an existing Dutch Internet panel of 12,529 persons, and information was collected by means of a structured Internet-based questionnaire. Multiple logistic regression analyses were used to assess correlates of self-test use.Results
Response to the survey was 63%. Sixteen percent of the respondents said they had ever used at least one self-test, with a mean of 2.1 tests per self-tester. The most frequently reported self-tests were those for diabetes and cholesterol. Self-testers generally reported lower health status and had a higher BMI than non-testers. On the other hand, they were more likely to engage in health-related behaviour such as the use of dietary supplements and homeopathic medicine.Conclusion
Self-testing proved to be relatively prevalent among Dutch Internet users. We therefore think that it is essential to develop appropriate information for consumers, health care providers and policymakers, about the pros and cons of self-testing and specific self-tests. More test-specific research is needed.
SUBMITTER: Ronda G
PROVIDER: S-EPMC2675528 | biostudies-literature | 2009 Apr
REPOSITORIES: biostudies-literature
Publications
Use of diagnostic self-tests on body materials among Internet users in the Netherlands: prevalence and correlates of use.
Ronda Gaby G Portegijs Piet P Dinant Geert-Jan GJ Buntinx Frank F Norg Roelf R van der Weijden Trudy T
BMC public health 20090409
<h4>Background</h4>A range of self-tests on body materials has become available to the general public, but the extent of their use has hardly been studied. This study examined how many people use diagnostic self-tests on body materials such as blood or urine, as well as the type of tests that are used, and factors associated with their use.<h4>Methods</h4>Cross-sectional survey. Participants were recruited from an existing Dutch Internet panel of 12,529 persons, and information was collected by ...[more]
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Project description:Importance:Laboratory testing is an important target for high-value care initiatives, constituting the highest volume of medical procedures. Prior studies have found that up to half of all inpatient laboratory tests may be medically unnecessary, but a systematic method to identify these unnecessary tests in individual cases is lacking. Objective:To systematically identify low-yield inpatient laboratory testing through personalized predictions. Design, Setting, and Participants:In this retrospective diagnostic study with multivariable prediction models, 116?637 inpatients treated at Stanford University Hospital from January 1, 2008, to December 31, 2017, a total of 60?929 inpatients treated at University of Michigan from January 1, 2015, to December 31, 2018, and 13?940 inpatients treated at the University of California, San Francisco from January 1 to December 31, 2018, were assessed. Main Outcomes and Measures:Diagnostic accuracy measures, including sensitivity, specificity, negative predictive values (NPVs), positive predictive values (PPVs), and area under the receiver operating characteristic curve (AUROC), of machine learning models when predicting whether inpatient laboratory tests yield a normal result as defined by local laboratory reference ranges. Results:In the recent data sets (July 1, 2014, to June 30, 2017) from Stanford University Hospital (including 22?664 female inpatients with a mean [SD] age of 58.8 [19.0] years and 22?016 male inpatients with a mean [SD] age of 59.0 [18.1] years), among the top 20 highest-volume tests, 792?397 were repeats of orders within 24 hours, including tests that are physiologically unlikely to yield new information that quickly (eg, white blood cell differential, glycated hemoglobin, and serum albumin level). The best-performing machine learning models predicted normal results with an AUROC of 0.90 or greater for 12 stand-alone laboratory tests (eg, sodium AUROC, 0.92 [95% CI, 0.91-0.93]; sensitivity, 98%; specificity, 35%; PPV, 66%; NPV, 93%; lactate dehydrogenase AUROC, 0.93 [95% CI, 0.93-0.94]; sensitivity, 96%; specificity, 65%; PPV, 71%; NPV, 95%; and troponin I AUROC, 0.92 [95% CI, 0.91-0.93]; sensitivity, 88%; specificity, 79%; PPV, 67%; NPV, 93%) and 10 common laboratory test components (eg, hemoglobin AUROC, 0.94 [95% CI, 0.92-0.95]; sensitivity, 99%; specificity, 17%; PPV, 90%; NPV, 81%; creatinine AUROC, 0.96 [95% CI, 0.96-0.97]; sensitivity, 93%; specificity, 83%; PPV, 79%; NPV, 94%; and urea nitrogen AUROC, 0.95 [95% CI, 0.94, 0.96]; sensitivity, 87%; specificity, 89%; PPV, 77%; NPV 94%). Conclusions and Relevance:The findings suggest that low-yield diagnostic testing is common and can be systematically identified through data-driven methods and patient context-aware predictions. Implementing machine learning models appear to be able to quantify the level of uncertainty and expected information gained from diagnostic tests explicitly, with the potential to encourage useful testing and discourage low-value testing that incurs direct costs and indirect harms.
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Project description:ObjectiveThe purpose of this 4-year study was to assess the prevalence over time and predictors of PIU using the Problematic and Risky Internet Use Screening Scale (PRIUSS). We also identified an Intermediate risk PRIUSS score.Study designIn this longitudinal cohort study we recruited participants using random selection from 2 colleges, participants completed a yearly PRIUSS. We used multivariate logistic regression analysis to evaluate predictors of PIU. We pursued receiver operating curve (ROC) analysis to identify an Intermediate risk PRIUSS score. Finally, we applied Markov modeling to test the dynamics of moving through PIU risk states over time.ResultsOur 319 participants included 56% females, 58% from the Midwest and 75% Caucasian. PIU prevalence estimates varied between 9% and 11% over the four years. PIU risk status from the previous time period was identified as the main predictor for PIU (OR=24.1, 95% CI: 12.8-45.4, p<0.0001). ROC analysis identified the optimal threshold for defining Intermediate risk was a PRIUSS score of 15.ConclusionThis longitudinal study of PIU among college students found that risks were present across groups and over time. The most salient predictor of PIU was being at risk at the previous time point. Based on results, we propose a PRIUSS score of 15 as an Intermediate risk cut-off to better identify those at risk of developing PIU.
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Project description:BACKGROUND: Malaria rapid diagnostic tests (RDTs) are protected from humidity-caused degradation by a desiccant added to the device packaging. The present study assessed malaria RDT products for the availability, type and design of desiccants and their information supplied in the instructions for use (IFU). METHODS: Criteria were based on recommendations of the World Health Organization (WHO), the European Community (CE) and own observations. Silica gel sachets were defined as self-indicating (all beads coated with a humidity indicator that changes colour upon saturation), partial-indicating (part of beads coated) and non-indicating (none of the beads coated). Indicating silica gel sachets were individually assessed for humidity saturation and (in case of partial-indicating silica gels) for the presence of indicating beads. RESULTS: Fifty malaria RDT products from 25 manufacturers were assessed, 14 (28%) products were listed by the "Global Fund Quality Assurance Policy" and 31 (62%) were CE-marked. All but one product contained a desiccant, mostly (47/50, 94%) silica gel. Twenty (40%) RDT products (one with no desiccant and 19 with non-indicating desiccant) did not meet the WHO guidelines recommending indicating desiccant. All RDT products with self- or partial-indicating silica gel (n?=?22 and 8 respectively) contained the toxic cobalt dichloride as humidity indicator. Colour change indicating humidity saturation was observed for 8/16 RDT products, at a median incidence of 0.8% (range 0.05%-4.6%) of sachets inspected. In all RDTs with partial-indicating silica gel, sachets with no colour indicating beads were found (median proportion 13.5% (0.6%-17.8%) per product) and additional light was needed to assess the humidity colour. Less than half (14/30, 47%) IFUs of RDT products with indicating desiccants mentioned to check the humidity saturation before using the test. Information on properties, safety hazards and disposal of the desiccant was not included in any of the IFUs. There were no differences between Global Fund-listed and CE marked RDT products compared to those which were not. Similar findings were noted for a panel of 11 HIV RDTs that was assessed with the same checklist as the malaria RDTs. CONCLUSION: RDTs showed shortcomings in desiccant type and information supplied in the IFU.
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Project description:BackgroundsInternet addiction (IA) has become a major public health issue worldwide and is closely linked to psychiatric disorders and suicide. The present study aimed to investigate the prevalence of IA and its associated psychosocial and psychopathological determinants among internet users across different age groups.MethodsThe study was a cross-sectional survey initiated by the Taiwan Suicide Prevention Center. The participants were recruited from the general public who responded to the online questionnaire. They completed a series of self-reported measures, including Chen Internet Addiction Scale-revised (CIAS-R), Five-item Brief Symptom Rating Scale (BSRS-5), Maudsley Personality Inventory (MPI), and questions about suicide and internet use habits.ResultsWe enrolled 1100 respondents with a preponderance of female subjects (85.8%). Based on an optimal cutoff for CIAS-R (67/68), the prevalence rate of IA was 10.6%. People with higher scores of CIAS-R were characterized as: male, single, students, high neuroticism, life impairment due to internet use, time for internet use, online gaming, presence of psychiatric morbidity, recent suicide ideation and past suicide attempts. Multiple regression on IA showed that age, gender, neuroticism, life impairment, internet use time, and BSRS-5 score accounted for 31% of variance for CIAS-R score. Further, logistic regression showed that neuroticism, life impairment and internet use time were three main predictors for IA. Compared to those without IA, the internet addicts had higher rates of psychiatric morbidity (65.0%), suicide ideation in a week (47.0%), lifetime suicide attempts (23.1%), and suicide attempt in a year (5.1%).ConclusionNeurotic personality traits, psychopathology, time for internet use and its subsequent life impairment were important predictors for IA. Individuals with IA may have higher rates of psychiatric morbidity and suicide risks. The findings provide important information for further investigation and prevention of IA.
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Project description:This pilot study investigated the patterns of video and internet gaming habits and the prevalence and correlates of gaming addiction in Hong Kong adolescents. A total of 503 students were recruited from two secondary schools. Addictive behaviors of video and internet gaming were assessed using the Game Addiction Scale. Risk factors for gaming addiction were examined using logistical regression. An overwhelming majority of the subjects (94%) reported using video or internet games, with one in six (15.6%) identified as having a gaming addiction. The risk for gaming addiction was significantly higher among boys, those with poor academic performance, and those who preferred multiplayer online games. Gaming addiction was significantly associated with the average time spent gaming per week, frequency of spending money on gaming, period of spending money on gaming, perceived family disharmony, and having more close friends. These results suggest that effective educational and preventative programs or strategies are needed.
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Project description:Practice guidelines recommend routine use of pulmonary function tests (PFTs), computed tomography (CT), and positron emission tomography (PET) for the workup of resectable lung cancer patients. Little is known about the frequency of guideline concordance in routine practice.A cohort study (2007 to 2013) of 15,951 lung cancer patients undergoing lobectomy or pneumonectomy was conducted with MarketScan, a claims database of individuals with employer-provided health insurance. Guideline concordance was defined by claims for PFT within 180 days of resection and for CT and PET within 90 days of resection. Generalized linear models were used to evaluate temporal trends, patient characteristics, and costs associated with guideline-concordant care.Overall, 61% of patients received guideline-concordant care, increasing from 57% in 2007 to 66% in 2013 (p < 0.001). Compared with patients who received guideline-discordant care, patients with guideline-concordant care more frequently underwent repeat testing (PFT: 21% versus 12%, p < 0.001; CT: 46% versus 22%, p < 0.001; PET: 2.3% versus 1.1%, p < 0.001). Health plan-adjusted mean total test-related costs were higher among guideline-concordant patients who underwent repeat testing than patients who did not ($4,304 versus $3,454, p < 0.001).Forty percent of lung cancer patients treated with surgical procedures did not receive recommended noninvasive cancer staging and physiologic assessment before resection. Guideline concordance was associated with repeat testing, and repeat testing was associated with higher costs. These findings support the need for quality improvement interventions that can increase guideline concordance while curbing potential excess use of diagnostic tests.
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Project description:When comparing binary test results from two diagnostic systems, superiority in both "sensitivity" and "specificity" also implies differences in all conventional summary indices and locally in the underlying receiver operating characteristics (ROC) curves. However, when one of the two binary tests has higher sensitivity and lower specificity (or vice versa), comparisons of their performance levels are nontrivial and the use of different summary indices may lead to contradictory conclusions. A frequently used approach that is free of subjectivity associated with summary indices is based on the comparison of the underlying ROC curves that requires the collection of rating data using multicategory scales, whether natural or experimentally imposed. However, data for reliable estimation of ROC curves are frequently unavailable. The purpose of this article is to develop an approach of using "diagnostic likelihood ratios", namely, likelihood ratios of "positive" or "negative" responses, to make simple inferences regarding the underlying ROC curves and associated areas in the absence of reliable rating data or regarding the relative binary characteristics, when these are of primary interest.For inferences related to underlying curves, the authors exploit the assumption of concavity of the true underlying ROC curve to describe conditions under which these curves have to be different and under which the curves have different areas. For scenarios when the binary characteristics are of primary interest, the authors use characteristics of "chance performance" to demonstrate that the derived conditions provide strong evidence of superiority of one binary test as compared to another. By relating these derived conditions to hypotheses about the true likelihood ratios of two binary diagnostic tests being compared, the authors enable a straightforward statistical procedure for the corresponding inferences.The authors derived simple algebraic and graphical methods for describing the conditions for superiority of one of two diagnostic tests with respect to their binary characteristics, the underlying ROC curves, or the areas under the curves. The graphical regions are useful for identifying potential differences between two systems, which then have to be tested statistically. The simple statistical tests can be performed with well known methods for comparison of diagnostic likelihood ratios. The developed approach offers a solution for some of the more difficult to analyze scenarios, where diagnostic tests do not demonstrate concordant differences in terms of both sensitivity and specificity. In addition, the resulting inferences do not contradict the conclusions that can be obtained using conventional and reasonably defined summary indices.When binary diagnostic tests are of primary interest, the proposed approach offers an objective and powerful method for comparing two binary diagnostic tests. The significant advantage of this method is that it enables objective analyses when one test has higher sensitivity but lower specificity, while ensuring agreement with study conclusions based on other reasonable and widely acceptable summary indices. For truly multicategory diagnostic tests, the proposed method can help in concluding inferiority of one of the diagnostic tests based on binary data, thereby potentially saving the need for conducting a more expensive multicategory ROC study.
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