High-Quality eHealth Websites for Information on Endometriosis: Systematic Search.

BACKGROUND: eHealth websites are increasingly being used by community members to obtain information about endometriosis. Additionally, clinicians can use these websites to enhance their understanding of the condition and refer patients to these websites. However, poor-quality information can adversely impact users. Therefore, a critical evaluation is needed to assess and recommend high-quality endometriosis websites. OBJECTIVE: This study aimed to evaluate the quality and provide recommendations for high-quality endometriosis eHealth websites for the community and clinicians. METHODS: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines informed 2 Google searches of international and Australian eHealth websites. The first search string used the terms "endometriosis," "adenomyosis," or "pelvic pain," whereas "Australia" was added to the second search string. Only free eHealth websites in English were included. ENLIGHT, a validated tool, was used to assess the quality across 7 domains such as usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. Websites with a total score of 3.5 or more were classified as "good" according to the ENLIGHT scoring system and are recommended as high-quality eHealth websites for information on endometriosis. RESULTS: In total, 117 eHealth websites were screened, and 80 were included in the quality assessment. Four high-quality eHealth websites (ie, those that scored 3.5 or more) were identified (Endometriosis Australia Facebook Page, Endometriosis UK, National Action Plan for Endometriosis on EndoActive, and Adenomyosis by the Medical Republic). These websites provided easily understood, engaging, and accurate information. Adenomyosis by the Medical Republic can be used as a resource in clinical practice. Most eHealth websites scored well, 3.5 or more in the domains of usability (n=76, 95%), visual design (n=64, 80%), and content (n=63, 79%). However, of the 63 websites, only 25 provided references and 26 provided authorship details. Few eHealth websites scored well on user engagement (n=18, 23%), therapeutic persuasiveness (n=2, 3%), and therapeutic alliance (n=22, 28%). In total, 30 (38%) eHealth websites scored well on general subjective evaluation. CONCLUSIONS: Although geographical location can influence the search results, we identified 4 high-quality endometriosis eHealth websites that can be recommended to the endometriosis community and clinicians. To improve quality, eHealth websites must provide evidence-based information with appropriate referencing and authorship. Factors that enhance usability, visual design, user engagement, therapeutic persuasiveness, and therapeutic alliance can lead to the successful and long-term uptake of eHealth websites. User engagement, therapeutic persuasiveness, and therapeutic alliance can be strengthened by sharing lived experiences and personal stories and by cocreating meaningful content for both the community and clinicians. Reach and discoverability can be improved by leveraging search engine optimization tools. TRIAL REGISTRATION: PROSPERO CRD42020185475; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=185475&VersionID=2124365.

Tertiary prevention and treatment of rheumatic heart disease: a National Heart, Lung, and Blood Institute working group summary.

Although entirely preventable, rheumatic heart disease (RHD), a disease of poverty and social disadvantage resulting in high morbidity and mortality, remains an ever-present burden in low-income and middle-income countries (LMICs) and rural, remote, marginalised and disenfranchised populations within high-income countries. In late 2021, the National Heart, Lung, and Blood Institute convened a workshop to explore the current state of science, to identify basic science and clinical research priorities to support RHD eradication efforts worldwide. This was done through the inclusion of multidisciplinary global experts, including cardiovascular and non-cardiovascular specialists as well as health policy and health economics experts, many of whom also represented or closely worked with patient-family organisations and local governments. This report summarises findings from one of the four working groups, the Tertiary Prevention Working Group, that was charged with assessing the management of late complications of RHD, including surgical interventions for patients with RHD. Due to the high prevalence of RHD in LMICs, particular emphasis was made on gaining a better understanding of needs in the field from the perspectives of the patient, community, provider, health system and policy-maker. We outline priorities to support the development, and implementation of accessible, affordable and sustainable interventions in low-resource settings to manage RHD and related complications. These priorities and other interventions need to be adapted to and driven by local contexts and integrated into health systems to best meet the needs of local communities.

Development and Validation of the Life Expectancy Estimator for Older Adults with Diabetes (LEAD): the Diabetes and Aging Study.

BACKGROUND: Estimated life expectancy for older patients with diabetes informs decisions about treatment goals, cancer screening, long-term and advanced care, and inclusion in clinical trials. Easily implementable, evidence-based, diabetes-specific approaches for identifying patients with limited life expectancy are needed. OBJECTIVE: Develop and validate an electronic health record (EHR)-based tool to identify older adults with diabetes who have limited life expectancy. DESIGN: Predictive modeling based on survival analysis using Cox-Gompertz models in a retrospective cohort. PARTICIPANTS: Adults with diabetes aged ≥ 65 years from Kaiser Permanente Northern California: a 2015 cohort (N = 121,396) with follow-up through 12/31/2019, randomly split into training (N = 97,085) and test (N = 24,311) sets. Validation was conducted in the test set and two temporally distinct cohorts: a 2010 cohort (n = 89,563; 10-year follow-up through 2019) and a 2019 cohort (n = 152,357; 2-year follow-up through 2020). MAIN MEASURES: Demographics, diagnoses, utilization and procedures, medications, behaviors and vital signs; mortality. KEY RESULTS: In the training set (mean age 75 years; 49% women; 48% racial and ethnic minorities), 23% died during 5 years follow-up. A mortality prediction model was developed using 94 candidate variables, distilled into a life expectancy model with 11 input variables, and transformed into a risk-scoring tool, the Life Expectancy Estimator for Older Adults with Diabetes (LEAD). LEAD discriminated well in the test set (C-statistic = 0.78), 2010 cohort (C-statistic = 0.74), and 2019 cohort (C-statistic = 0.81); comparisons of observed and predicted survival curves indicated good calibration. CONCLUSIONS: LEAD estimates life expectancy in older adults with diabetes based on only 11 patient characteristics widely available in most EHRs and claims data. LEAD is simple and has potential application for shared decision-making, clinical trial inclusion, and resource allocation.

Differential expression of C5aR1 and C5aR2 in innate and adaptive immune cells located in early skin lesions of bullous pemphigoid patients.

Bullous pemphigoid (BP), the by far most frequent autoimmune subepidermal blistering disorder (AIBD), is characterized by the deposition of autoantibodies against BP180 (type XVII collagen; Col17) and BP230 as well as complement components at the dermal-epidermal junction (DEJ). The mechanisms of complement activation in BP patients, including the generation of C5a and regulation of its two cognate C5aRs, i.e., C5aR1 and C5aR2, are incompletely understood. In this study, transcriptome analysis of perilesional and non-lesional skin biopsies of BP patients compared to site-, age-, and sex-matched controls showed an upregulated expression of C5AR1, C5AR2, CR1, and C3AR1 and other complement-associated genes in perilesional BP skin. Of note, increased expressions of C5AR2 and C3AR1 were also observed in non-lesional BP skin. Subsequently, double immunofluorescence (IF) staining revealed T cells and macrophages as the dominant cellular sources of C5aR1 in early lesions of BP patients, while C5aR2 mainly expressed on mast cells and eosinophils. In addition, systemic levels of various complement factors and associated molecules were measured in BP patients and controls. Significantly higher plasma levels of C3a, CD55, and mannose-binding lectin-pathway activity were found in BP patients compared to controls. Finally, the functional relevance of C5aR1 and C5aR2 in BP was explored by two in vitro assays. Specific inhibition of C5aR1, resulted in significantly reduced migration of human neutrophils toward the chemoattractant C5a, whereas stimulation of C5aR2 showed no effect. In contrast, the selective targeting of C5aR1 and/or C5aR2 had no effect on the release of reactive oxygen species (ROS) from Col17-anti-Col17 IgG immune complex-stimulated human leukocytes. Collectively, this study delineates a complex landscape of activated complement receptors, complement factors, and related molecules in early BP skin lesions. Our results corroborate findings in mouse models of pemphigoid diseases that the C5a/C5aR1 axis is pivotal for attracting inflammatory cells to the skin and substantiate our understanding of the C5a/C5aR1 axis in human BP. The broad expression of C5aRs on multiple cell types critical for BP pathogenesis call for clinical studies targeting this axis in BP and other complement-mediated AIBDs.

Lessons from implementing the Australian National Action Plan for Endometriosis.

Abstract: Endometriosis is a common yet under-recognised chronic disease with one in nine (more than 830,000) women and those assigned female at birth diagnosed with endometriosis by the age of 44 years in Australia. In 2018, Australia was the first country to develop a roadmap and blueprint to tackle endometriosis in a nationwide, coordinated manner. This blueprint is outlined in the National Action Plan for Endometriosis (NAPE), created from a partnership between government, endometriosis experts and advocacy groups. The NAPE aims to improve patient outcomes in the areas of awareness and education, clinical management and care and research. As researchers and clinicians are working to improve the lives of those with endometriosis, we discuss our experiences since the launch of the plan to highlight areas of consideration by other countries when developing research priorities and clinical plans. Historically, major barriers for those with endometriosis have been twofold; first, obtaining a diagnosis and secondly, effective symptom management post-diagnosis. In recent years, there have been calls to move away from the historically accepted 'gold-standard' surgical diagnosis and single-provider specialist care. As there are currently no reliable biomarkers for endometriosis diagnosis, specialist endometriosis scans and MRI incorporating artificial intelligence offer a novel method of visualisation and promising affordable non-invasive diagnostic tool incorporating well-established technologies. The recognised challenges of ongoing pain and symptom management, a holistic interdisciplinary care approach and access to a chronic disease management plan, could lead to improved patient outcomes while reducing healthcare costs. Lay summary: Endometriosis is a chronic disease where tissue like the lining of the uterus is found in other locations around the body. For the 830,000 people living with endometriosis in Australia, this often results in an immense burden on all aspects of daily life. In 2018, Australia was the first country to introduce a roadmap and blueprint to tackle endometriosis in a nationwide coordinated manner with the National Action Plan for Endometriosis. This plan was created as a partnership between government, endometriosis experts and advocacy groups. There are several other countries who are now considering similar plans to address the burden of endometriosis. As researchers and clinicians are working to improve the lives of those with endometriosis, we share our experiences and discuss areas that should be considered when developing these national plans, including diagnostic pathways without the need for surgery, and building new centres of expertise in Endometriosis and Pelvic Pain.

Do isolamento à colaboração: desenvolvimento de uma comunidade de professores de educação física em tempos de pandemia / Del aislamiento a la colaboración: desarrollo de una comunidad de profesores de educación física en tiempos de pandemia / From isolation to collaboration: development of a community of physical education teachers in pandemic times

O objetivo deste estudo foi explorar o desenvolvimento de um grupo de professores de Educação Física (EF), que enfrentaram dificuldades com o ensino remoto, em uma comunidade de prática (CdP) durante a pandemia da COVID-19. O estudo teve como enfoque os fatores que apoiaram o processo de cultivo da CdP em formato on-line. Empregando a metodologia de pesquisa-ação, o estudo envolveu 15 professores de EF (uma professora atuou como professora-facilitadora) e uma amiga crítica. Os dados foram gerados por meio de encontros da CdP, entrevistas, conversas com amiga crítica e diário reflexivo. A análise temática resultou em quatro temas abrangentes: a) a pandemia como catalisadora da colaboração; b) auto-organização dos professores para viabilizar a comunidade; c) desenvolvimento de pesquisa colaborativa; e d) diálogo para um novo ciclo de colaboração. Notavelmente, a auto-organização dos professores foi fundamental para guiar a CdP ao longo de estágios de desenvolvimento. São discutidos outros aspectos que contribuíram para o desenvolvimento da CdP em um cenário de pandemia.(AU)

El objetivo de este estudio ha sido explorar el desarrollo de un grupo de profesores de Educación Física (EF) que enfrentaron dificultades con la enseñanza remota, en una comunidad de práctica (CdP) durante la pandemia de COVID-19. El estudio se centró en los factores que apoyaron el proceso de cultivo de la CdP en un formato online. Utilizando la metodología de investigación-acción, el estudio involucró a 15 profesores brasileños de EF, una profesora que actuó como profesora-facilitadora y una amiga crítica. Los datos se generaron a través de encuentros de la CdP, entrevistas, conversaciones con la amiga crítica y diario reflexivo. El análisis temático resultó en cuatro temas generales: a) la pandemia como catalizadora de la colaboración; b) autoorganización de los profesores para hacer posible la comunidad; c) desarrollo de investigación colaborativa; y d) diálogo para un nuevo ciclo de colaboración. De manera notable, la autoorganización de los profesores fue fundamental para guiar a la CdP a lo largo de las etapas de desarrollo. Se discuten otros aspectos que contribuyeron al desarrollo de la CdP en un escenario de pandemia.(AU)

The purpose of this study was to explore the development of a group of Brazilian Physical Education (PE) teachers, who struggled with remote teaching, into a community of practice (CoP) during the COVID-19 pandemic. The study focused on factors that supported the CoP cultivation process in an online format. Employing action research methodology, the study involved 15 PE teachers, with one of them acting as a teacher-facilitator, and one critical friend. Data were generated through CoP's meetings, interviews, critical friend conversations, and reflexive journaling. Thematic analysis resulted in four overarching themes: a) the pandemic as a catalyst for collaboration; b) teachers' self-organization to enact the community; c) development of collaborative research; and d) dialogue towards a new cycle of collaboration. Noteworthy was that teachers' self-organization was critical for guiding the CoP throughout stages of development. Further aspects that contributed to CoP's development in a pandemic scenario are discussed.(AU)

Comunidade de prática e o desenvolvimento profissional docente de professores de educação física em uma escola brasileira / Community of practice and continuing professional development of physical education teachers in a brazilian school / Comunidad de práctica y el desarrollo profesional docente de profesores de educación física en una escuela brasileña

Resumo Esta pesquisa teve o objetivo de explorar o desenvolvimento profissional de professores de Educação Física (EF) em uma escola municipal brasileira. Este estudo se constituiu como uma pesquisa-ação da qual participaram seis professores de EF, uma facilitadora e uma critical friend. Reuniões com os professores e entre as pesquisadoras; entrevistas; caderno de campo foram as fontes de dados. Os resultados apontam que a comunidade de prática (CP) pôde dar suporte aos professores durante seu desenvolvimento. As necessidades essenciais dos professores foram atendidas; a CP teve decisões autônomas; e a sua voz ouvida. O suporte oferecido aos professores pela CP foi originado pelo processo de construção da própria prática dos professores, sob o apoio de seus próprios pares e da facilitadora enquanto eles se uniam em uma comunidade recém-desenvolvida.

Abstract This research aimed to explore the continuing professional development (CPD) of Physical Education (PE) teachers in a municipal Brazilian school. The investigation was an action research study and the participants included six PE teachers, one facilitator and one critical friend. Data sources included meetings with teachers and between researchers; interviews; and field notes. Results revealed that the community of practice (CoP) could support teachers' CPD. Teachers essential needs were addressed; the CoP made autonomous decisions and their voice was heard. The support that the CoP provided to teachers was generated by teachers' own process of building their own practice, with support from their peers and the facilitator while teachers joined in a recently formed community.

Resumen Esta investigación tuvo como objetivo explorar el desarrollo profesional de profesores de Educación Física (EF) en una escuela municipal brasileña. Este estudio se constituyó como una investigación-acción en la que participaron seis profesores de Educación Física, una facilitadora y una critical friend. Las fuentes de datos fueron encuentros con profesores y entre las investigadoras, entrevistas y cuaderno de campo. Los resultados muestran que la comunidad de práctica (CP) puede proporcionar apoyo a los profesores durante su desarrollo. Las necesidades esenciales de los profesores fueron atendidas, la CP tomó decisiones autónomas y su voz fue escuchada. El apoyo que la CP brindó a los docentes se genera mediante el propio proceso de construcción de la práctica de los profesores, con el apoyo de sus colegas y de la facilitadora, cuando estos se unían en una comunidad recién desarrollada.

Adipocytes contribute to the growth and progression of multiple myeloma: Unraveling obesity related differences in adipocyte signaling.

The prevalence of obesity over the last several decades in the United States has tripled among children and doubled among adults. Obesity increases the incidence and progression of multiple myeloma (MM), yet the molecular mechanisms by which adipocytes contribute to cancer development and patient prognosis have yet to be fully elucidated. Here, we obtained human adipose-derived stem cells (ASCs) from twenty-nine normal (BMI = 20-25 kg/m(2)), overweight (25-30 kg/m(2)), obese (30-35 kg/m(2)), or super obese (35-40 kg/m(2)) patients undergoing elective liposuction. Upon differentiation, adipocytes were co-cultured with RPMI-8226 and NCI-H929 MM cell lines. Adipocytes from overweight, obese and super obese patients displayed increased PPAR-gamma, cytochrome C, interleukin-6, and leptin protein levels, and decreased fatty acid synthase protein. 8226 MM cells proliferated faster and displayed increased pSTAT-3/STAT-3 signaling when cultured in adipocyte conditioned media. Further, adipocyte conditioned media from obese and super obese patients significantly increased MM cell adhesion, and conditioned media from overweight, obese and super obese patients enhanced tube formation and expression of matrix metalloproteinase-2. In summary, our data suggest that adipocytes in the MM microenvironment contribute to MM growth and progression and should be further evaluated as a possible therapeutic target.

Resiliência, suporte social e prática esportiva: relações e possibilidades de intervenção social / Resilience, social support and sports practice: relations and social intervention possibilities

Embora nos últimos anos tenha vindo a aumentar o número de pesquisas que examinam a resiliência e o suporte social no contexto do esporte de competição, são ainda necessários estudos que examinem estas variáveis em contexto não competitivo, junto de crianças e jovens. Esta pesquisa teve por objetivo estudar a prática esportiva, a resiliência e o suporte social junto de 1052 com idades entre os 12 e os 20 anos (15,53 ± 1,68), estudantes de escolas públicas brasileiras. Inicialmente, examinaram-se as relações entre o sexo e a idade com a prática esportiva, resiliência e suporte social. Em seguida, averiguou-se a existência de diferenças nos níveis de resiliência e suporte social em função de diferentes níveis de prática esportiva. Os participantes preencheram uma bateria de questionários. Os resultados revelaram que os alunos mais novos praticavam esporte com mais frequência que as moças e os mais velhos. Não foram encontradas diferenças entre sexos nos níveis de resiliência, mas as moças estavam mais satisfeitas com o suporte social do que os rapazes. Os alunos no início da adolescência eram menos resilientes e estavam menos satisfeitos com o seu suporte social do que os jovens adultos e os alunos a meio da adolescência, respetivamente. Os resultados apontam ainda para uma relação significativa entre a prática esportiva e a resiliência, bem como entre a prática esportiva e o grau de satisfação dos sujeitos com suas redes de suporte social, independentemente do número de sujeitos que compunham esta rede. (AU)

Although in recent years the number of research examining resilience and social support in competitive sports context has increased, further studies are needed to examine these variables in non-competitive contexts, with children and young people. This research aimed to study sports practice, resilience and social support in 1052 Brazilian students from public schools, aged 12 and 20 years old (15.53 ± 1.68). Initially, we examined the relationship between sex and age with sports practice, resilience and social support. Afterwards, we examined differences in resilience and social support across different levels of sports practice. Participants completed a pack of questionnaires. The results revealed that the boys and younger students practiced sport more often than girls and older students. No differences were found between sexes in resilience levels, but girls were more satisfied with their perceived social support than boys. Students in their early teens were less resilient and were less satisfied with the social support they perceived than young adults and students in their mid-teens, respectively. The results also indicated a significant relationship between sports practice and resilience, as well as between sports and the level of satisfaction with the social support network, regardless of the number of subjects that made up that network. (AU)

Ethnic Differences in Geriatric Conditions and Diabetes Complications Among Older, Insured Adults With Diabetes: The Diabetes and Aging Study.

OBJECTIVE: The aim of this study was to evaluate ethnic differences in burden of prevalent geriatric conditions and diabetic complications among older, insured adults with diabetes. METHOD: An observational study was conducted among 115,538 diabetes patients, aged ≥60, in an integrated health care system with uniform access to care. RESULTS: Compared with Whites, Asians and Filipinos were more likely to be underweight but had substantively lower prevalence of falls, urinary incontinence, polypharmacy, depression, and chronic pain, and were least likely of all groups to have at least one geriatric condition. African Americans had significantly lower prevalence of incontinence and falls, but higher prevalence of dementia; Latinos had a lower prevalence of falls. Except for end-stage renal disease (ESRD), Whites tended to have the highest rates of prevalent diabetic complications. DISCUSSION: Among these insured older adults, ethnic health patterns varied substantially; differences were frequently small and rates were often better among select minority groups, suggesting progress toward the Healthy People 2020 objective to reduce health disparities.

Incidence of remission in adults with type 2 diabetes: the diabetes & aging study.

OBJECTIVE: To estimate the incidence of remission in adults with type 2 diabetes not treated with bariatric surgery and to identify variables associated with remission. RESEARCH DESIGN AND METHODS: We quantified the incidence of diabetes remission and examined its correlates among 122,781 adults with type 2 diabetes in an integrated healthcare delivery system. Remission required the absence of ongoing drug therapy and was defined as follows: 1) partial: at least 1 year of subdiabetic hyperglycemia (hemoglobin A1c [HbA1c] level 5.7-6.4% [39-46 mmol/mol]); 2) complete: at least 1 year of normoglycemia (HbA1c level <5.7% [<39 mmol/mol]); and 3) prolonged: complete remission for at least 5 years. RESULTS: The incidence density (remissions per 1,000 person-years; 95% CI) of partial, complete, or prolonged remission was 2.8 (2.6-2.9), 0.24 (0.20-0.28), and 0.04 (0.01-0.06), respectively. The 7-year cumulative incidence of partial, complete, or prolonged remission was 1.47% (1.40-1.54%), 0.14% (0.12-0.16%), and 0.007% (0.003-0.020%), respectively. The 7-year cumulative incidence of achieving any remission was 1.60% in the whole cohort (1.53-1.68%) and 4.6% in the subgroup with new-onset diabetes (<2 years since diagnosis) (4.3-4.9%). After adjusting for demographic and clinical characteristics, correlates of remission included age >65 years, African American race, <2 years since diagnosis, baseline HbA1c level <5.7% (<39 mmol/mol), and no diabetes medication at baseline. CONCLUSIONS: In community settings, remission of type 2 diabetes does occur without bariatric surgery, but it is very rare.

The "other diseases" of the Millennium Development Goals: rhetoric and reality of free drug distribution to cure the poor's parasites.

The sixth MDG aims 'to combat HIV/AIDS, TB, malaria and other diseases'. The residual category of 'other diseases' has become the focus of intense interest, partly because it has provided an opportunity to increase resources for the control of the mostly parasitic 'neglected tropical diseases' (NTDs). Intense lobbying has secured large amounts of funding from donors, as well as generous donations of medicines from the major drug companies. A massive programme is now underway to treat the parasites of the poor in Africa via integrated vertical interventions of mass drug administration in endemic areas. The approach has been hailed as remarkably effective, with claims that there is now a real prospect of complete control and, for some NTDs, even elimination. However, a closer look at evaluation and research data reveals that much less is known about what is being achieved than is suggested. Competition between implementing organisations is leading to potentially counterproductive exaggerations about treatment coverage. Detailed local-level research in Uganda and Tanzania shows that actual rates of drug take-up among target populations are often lower than is necessary to effectively control the diseases, and that methods of drug distribution may even lead to active resistance to treatment. If current trends are not corrected, declining rates of NTD infection will not be sustained. Much more rigorous and effective monitoring is essential.

Resisting control of neglected tropical diseases: dilemmas in the mass treatment of schistosomiasis and soil-transmitted helminths in north-west Uganda.

A strong case has recently been made by academics and policymakers to develop national programmes for the integrated control of Africa's 'neglected tropical diseases'. Uganda was the first country to develop a programme for the integrated control of two of these diseases: schistosomiasis and soil-transmitted helminths. This paper discusses social responses to the programme in Panyimur, north-west Uganda. It shows that adults are increasingly rejecting free treatment. Resistance is attributed to a subjective fear of side-effects; divergence between biomedical and local understandings of schistosomiasis/bilharzia; as well as inappropriate and inadequate health education. In addition, the current procedures for distributing drugs at a district level are problematic. Additional research was carried out in neighbouring areas to explore the generalizability of findings. Comparable problems have arisen. It is concluded that the national programme will not fulfil its stated objectives of establishing a local demand for mass treatment unless it can establish more effective delivery strategies and promote behavioural change in socially appropriate ways. To do so will require new approaches to social, economic and political aspects of distribution. There are reasons why populations infected with the 'neglected tropical diseases' are themselves neglected. Those reasons cannot just be wished away.

Longitudinal study of new and prevalent use of self-monitoring of blood glucose.

OBJECTIVE: We sought to assess longitudinal association between self-monitoring of blood glucose (SMBG) and glycemic control in diabetic patients from an integrated health plan (Kaiser Permanente Northern California). RESEARCH DESIGN AND METHODS: Longitudinal analyses of glycemic control among 1) 16,091 patients initiating SMBG (new-user cohort) and 2) 15,347 ongoing users of SMBG (prevalent-user cohort). SMBG frequency was based on pharmacy use (number of blood glucose test strips dispensed), and glycemic control was based on HbA(1c) (A1C). In the new-user cohort, ANCOVA models (pre- and posttest design) were used to assess the effect of initiating SMBG. In the prevalent-user cohort, repeated-measure, mixed-effects models with random-intercept and time-dependent covariates were used to assess changes in SMBG and A1C. All models were stratified by therapy (no medications, oral agents only, or insulin) and adjusted for baseline A1C, sociodemographics, insulin injection frequency, comorbidity index, medication adherence, smoking status, health care use, and provider specialty. RESULTS: Greater SMBG practice frequency among new users was associated with a graded decrease in A1C (relative to nonusers) regardless of diabetes therapy (P < 0.0001). Changes in SMBG frequency among prevalent users were associated with an inverse graded change in A1C only among pharmacologically treated patients (P < 0.0001). CONCLUSIONS: These observational findings are consistent with short-term benefits of initiating SMBG practice for all patients but continuing benefits only for pharmacologically treated patients. Differences in effectiveness between new versus prevalent users of SMBG have implications for guideline development and interpretation of observational outcomes data.