Cross-sectional Survey Research Articles

Student nurses' views on an E-Learning module on comfort, safety, and mobility with older adults: a cross-sectional study.

Nursing students often receive insufficient training in older adults' care. Examine nursing students' perceptions of an e-learning module developed to enhance their knowledge about the comfort, safety, and mobility of older adults. A cross-sectional survey was administered to third-year baccalaureate nursing students at a Canadian university after they had completed the comfort, safety, and mobility module. The survey assessed students' perceptions of the e-learning module using four 5-pointLikert-type items. The survey also contained demographic questions and one open-ended question that invited participants to make any comments they wished. Descriptive statistics were used to summarize participants'demographic characteristics. Responses to the open-ended quesiton were summative content analyzed. The survey was completed by 119 participants, who reported that the module increased their confidence, perceptions and knowledge in working with older adults. Participants also found the method of instruction to be convenient, interactive, and enjoyable. Results suggest that the learning module has the potential to facilitate student nurses' learning about comfort, safety, and mobility.

Continuous glucose monitoring among nurse practitioners in primary care: Characteristics associated with prescribing and resources needed to support use.

Continuous glucose monitoring (CGM) can improve health for people with diabetes but is limited in primary care (PC). Nurse Practitioners (NPs) in PC can improve diabetes management through CGM, but NPs' interest in CGM and support needed are unclear. We describe behaviors and attitudes related to CGM for diabetes management among NPs in PC. This cross-sectional web-based survey of NPs practicing in PC settings used descriptive statistics to describe CGM experience and identify resources to support prescribing. We used multivariable regression to explore characteristics predicting prescribing and confidence using CGM for diabetes. Nurse practitioners in hospital-owned settings were twice as likely to have prescribed CGM (odds ratio [OR] = 2.320, 95% CI [1.097, 4.903]; p = .002) than private practice; those in academic medical centers were less likely (OR = 0.098, 95% CI [0.012, 0.799]; p = .002). Past prescribing was associated with favorability toward future prescribing (coef. = 0.7284, SE = 0.1255, p < .001) and confidence using CGM to manage diabetes (type 1: coef. = 3.57, SE = 0.51, p < .001; type 2: coef. = 3.49, SE = 0.51, p < .001). Resources to prescribe CGM included consultation with an endocrinologist (62%), educational website (61%), and endocrinological e-consultations (59%). Nurse practitioners are open to prescribing CGM and can improve diabetes management and health outcomes for PC patients. Research should explore mechanisms behind associations with CGM experience and attitudes. Efforts to advance CGM should include educational websites and endocrinology consultations for NPs in PC.

Sociodemographic Factors, Health-Risk Behaviors, and Chronic Conditions Are Associated with a High Prevalence of Depressive Symptoms: Findings from the Indonesian Family Life Survey-5.

Depression is a significant public health challenge. However, limited research exists regarding the risk of sociodemographic factors, health-risk behavior, and chronic conditions in relation to the development of depression in Indonesia. This study assesses the prevalence of depressive symptoms in adolescents and adults, and identifies its potential associations with sociodemographic factors, health-risk behaviors, and chronic conditions. A national cross-sectional population-based survey was performed, using the Indonesian Family Life Survey (IFLS-5), to assess depressive symptoms in respondents aged 15 years and older. Depression was evaluated using the Center for Epidemiologic Studies-Depression (CES-D) scale, and potential associations with sociodemographic factors, health-risk behaviors, and chronic conditions were examined using logistic regression analysis. The study revealed a high prevalence of depressive symptoms, with the highest incidence observed in the age group of 25-34 years. Factors such as unmarried status, younger age, good physical activity, and having chronic conditions showed associations with depression. These findings have implications for developing public mental health strategies to reduce the prevalence of depression in Indonesia.

Antibody Levels and Infection Status of Pertussis in the Population under Pertussis Resurgence in Guangxi in 2018: A Cross-Sectional Survey

ObjectivePertussis cases have increased markedly since 2018 in Guangxi. The aim of this study was to evaluate antibody levels and the infection status of pertussis in the resident population. MethodA total of 10,215 serum samples from residents were collected from August–November 2018 and tested for anti-pertussis IgG and toxin IgG using the enzyme-linked immunosorbent assay (ELISA). ResultsOf the collected samples, 1,833 (17.94%) tested positive for anti-pertussis IgG, with the median concentration of 16.06 IU/mL. Antibody level < 10 IU/mL accounted for more than 60% in children under 4 years of age, but declined with age, whereas the percentages of the other three levels (10–40, 40–50, and ≥ 50 IU/mL) increased almost with age (P < 0.001). Moreover, 7,924 samples were selected for anti-pertussis toxin IgG, of which 653 (8.24%) tested positive (≥ 40 IU/mL) with the median concentration of 5.89 IU/mL, and 204 participants (2.56%) had recent pertussis infection (≥ 100 IU/mL). Among the different age groups, the highest rates of positivity and recent infection were observed at 11–20 years of age, the lowest positivity rate at 5 years of age, and the lowest recent infection rate at 4 years of age (P < 0.001, P = 0.005, respectively). ConclusionThe survey results showed that all age groups in Guangxi lacked immunity against pertussis, which was one of the main factors contributing to the resurgence of pertussis in 2018. In addition, the prevalence of pertussis is relatively high in Guangxi, and its incidence is seriously underestimated, especially in adolescents and adults.

Predictors of confidence in research: a cross-sectional survey of pharmacists in the north of England.

Pharmacist-led research is key to optimizing medicines use and improving pharmacy services, yet it is not yet widely embedded into careers. This study aims to identify predictors of confidence in meeting the research learning outcomes in the Royal Pharmaceutical Society (RPS) Post-Registration Foundation and Core Advanced curricula, to provide targeted recommendations for building research capability and capacity within the profession. The study was a cross-sectional electronic survey, distributed to eligible pharmacists in March 2023 (n = 253). The survey gathered demographic information, research experience, and self-reported confidence in meeting the research learning outcomes in the RPS Post-Registration Foundation and Core Advanced curricula. Pre-determined independent variables were analysed using two binomial logistic regression models (one per curriculum) to identify predictors of the dichotomous variable: confidence with meeting all research learning outcomes in that curriculum. Participants were more likely to self-report as confident (versus not confident) with meeting all research learning outcomes in a curriculum if they had recent experience (within the previous 12 months) of research or research-related activities, held a postgraduate research qualification, had undertaken research training outside of a postgraduate qualification, discussed research in their appraisal, or worked in the hospital sector. Conversely, male gender, years practicing, and protected time for research did not predict confidence. A targeted approach, including improving access to research methods training, experience-based learning, mentorship, and linking research projects to key organizational objectives, could be the key to developing research capability and capacity across all sectors and career stages.

Diet quality among mothers and children in India: Roles of social and behavior change communication and nutrition-sensitive social protection programs

BackgroundLimited evidence exists on determinants of maternal and child diet quality. ObjectivesThis study examined the role of Social and Behavior Change Communication (SBCC) and nutrition-sensitive social protection (NSSP) programs on maternal and child diet quality. MethodsData were from cross-sectional phone survey on 6,627 Indian mothers that took place in late 2021. The Diet Quality Questionnaire (DQQ) was used to measure maternal and child diet quality, including minimum dietary diversity (MDD), dietary diversity scores (DDS), non-communicable disease (NCD)-Protect and NCD-Risk, adherence to dietary guidelines (All-5 and India-All-6), and unhealthy child feeding. Multivariate regression models were used to explore the association between diet indicators and coverage of SBCC and NSSP programs. ResultsMaternal and child diet quality was suboptimal, with more mothers (57%) achieving MDD than children (23%). SBCC was positively associated with healthy food consumption in children (Odds Ratio, OR=2.14 for MDD, β=0.60 for DDS and 0.54 for NCD-Protect), and mothers (β=0.38 for DDS and 0.43 for NCD-Protect). Cash transfers were associated with healthier diets in mothers (OR=1.45 for MDD, 1.86 for All-5, and 2.14 for India-All-6, β=0.43 for DDS and 0.26 for NCD-Protect), but less associations for children (β=0.14 for NCD-Protect). Receiving food was associated with healthier diets in mothers (OR 1.47 for MDD, β= 0.27 for DDS and 0.33 for NCD-Protect) and children (β=0.19 for DDS and 0.15 for NCD-Protect), but also with unhealthy food in children (OR=1.34). Exposure to multiple programs showed stronger associations with diet quality. ConclusionSBCC had greater positive impact on child feeding than food and cash transfers, while cash had a stronger association with improved maternal diets. Food and cash are also associated with unhealthy food consumption. Our study underscores the importance of interventions that combine education, resource provision, and targeted support to promote maternal and child diet quality.

Patient preferences for teleradiology services and remote image interpretation: An empirical study.

This study aims to examine patient preferences for teleradiology services and remote image interpretation. In this context, this study aims to address the following research questions: (i) How do patients perceive teleradiology services, focusing specifically on comfort, quality of care and satisfaction, communication and information, and accessibility and ease of use; (ii) How do patient demographics (age, gender, urban vs. rural residence) influence the perceptions on teleradiology services? A cross-sectional survey design is adopted in this study. The survey comprises five sections targeting demographic information, comfort, and preferences regarding remote image interpretation, perceived quality of care and satisfaction, communication and information clarity, and accessibility and technology aspects using five-point Likert scale ratings. A total of 406 patients (209 males and 197 females; 170 urban residents; 174 semi-urban residents, and 62 rural residents) using teleradiology services participated in the study. Participants reported high satisfaction with remote image interpretation (3.78 ± 1.19), quality of care (3.31 ± 1.19), understanding (3.84 ± 1.43), and user-friendliness (3.67 ± 1.29). Key issues were technical problems (3.81 ± 1.35), feedback difficulties (3.19 ± 1.58), privacy concerns (2.43 ± 1.46), and low awareness (2.37 ± 1.12). Urban participants scored significantly better in comfort, preferences, and communication than those from semi-urban and rural areas. Teleradiology design and implementation should be optimized to align with patient preferences and enhance overall satisfaction.

Correlates of stocking naloxone: a cross-sectional survey of community pharmacists.

Provision of take-home naloxone (THN) and overdose education reduces opioid-related mortality. In Australia, from July 2022, all Australian community pharmacies were eligible to supply naloxone for free through the nationalTHN Program. This study aimed to identify naloxone stocking rates and correlates of stocking naloxone across Australian pharmacies. Data were collected from a representative sample of Australian pharmacists in Victoria, New South Wales, Queensland and Western Australia via an online survey. Data collected included pharmacy and pharmacist characteristics and services offered within the pharmacy, including needle and syringe programs, opioid agonist treatment (OAT) and stocking naloxone. Binary probit regression analysis was used to identify correlates of stocking naloxone after controlling for key covariates. Data from 530 pharmacists were analysed. In total, 321 pharmacies (60.6%) reported stocking naloxone. Chain pharmacies and pharmacies that provided OAT had a greater probability of stocking naloxone (B = 0.307, 95%CI: [0.057, 0.556], and B = 0.543, 95%CI: [0.308, 0.777] respectively). Most (61.7%) pharmacists felt comfortable discussing overdose prevention with patients who use prescription opioids, and this comfort was associated with a higher probability of stocking naloxone (B = 0.392, 95%CI: 0.128, 0.655). Comfort discussing overdose prevention with people who use illicit opioids was lower (49.4%) and was not associated with stocking naloxone. There is scope to increase stocking of naloxone and comfort with overdose prevention, particularly through addressing comfort working with higher risk groups such as people who use illicit opioids.

Barriers and risk factors associated with non-treatment-seeking for suicidality onset during the COVID-19 pandemic among young adults

IntroductionResearchers predict long-term increases in suicide deaths following the COVID-19 pandemic. Little is known about risk factors for suicidal ideation (SI) and suicidal attempts (SA) or treatment barriers and promoters during the pandemic. We examine these factors in a young adult sample. MethodsAnalyses used a 2022 cross-sectional survey dataset (N = 1,956). Logistic regression identified factors associated with pandemic suicidality (i.e., SI, SA). Non-treatment seekers reported barriers to seeking treatment. Logistic regression identified promotive factors associated with treatment-seeking. Results28.6% of our sample developed suicidality during the pandemic, of whom 49.6% did not seek treatment. Asian race and sexual minority status were strongly associated with increased odds of pandemic suicidality. Among SI non-treatment-seekers, barriers were primarily attitudinal (e.g., “symptoms are not serious enough for treatment”); among non-treatment-seekers with SA, barriers were mostly structural (e.g., insufficient funds). Previous depression treatment was strongly associated with increased odds of treatment-seeking. ConclusionAsian American individuals were at increased risk for pandemic suicidality, which may reflect interpersonal risks related to COVID-19-related anti-Asian racism. Our findings point to a “foot-in-the-door” effect: past treatment-seeking was positively associated with future treatment-seeking. To promote this effect and decrease barriers, we suggest integrated mental health screening and referrals in primary care.

Perception on hematology/oncology pharmacy practice and education needs in Nigeria: A national survey.

Nigeria is a low-middle income country located in sub-Saharan Africa. Although cancer burden has continued to increase over time, there is a lack of pharmacists who specialize in oncology providing pharmaceutical care. The objectives of this study were to understand the perception of hematology/oncology pharmacy practice in Nigeria as well as the unmet education needs. This is a cross-sectional survey conducted in December 2023. Pharmacists who were active members of various pharmacy organizations in Nigeria were invited to complete the survey. The survey focused on the perceptions of training needs in oncology pharmacy, current challenges and opportunities, as well as resources and support needed. Descriptive statistics were utilized for the data analysis. Of the 263 responders, the largest group fell between 25 and 34 years old (35%), over half received a Bachelor of Pharmacy as their highest degree (53%), and majority did not receive any oncology pharmacy training as part of their education (73%). Many respondents strongly agreed that pharmacists in Nigeria need specialized training to better serve cancer patients (79%). Cancer therapeutics and chemotherapy pharmacology were more prioritized compared to other training needs (mean (SD): 2.63(1.95) and 2.69(1.64), respectively). The main challenge that respondents faced was a lack of relevant skills and knowledge in oncology pharmacy (mean (SD): 2.23(1.53)). More than a fourth of the respondents were aware about the board certification process (28.8%), citing overcoming the cost barrier as the main obstacle for taking the board examination (mean (SD): 1.92 (1.38)). Respondents preferred online courses and onsite specialty training (75%) as the mode of training to address unmet needs. Despite the challenges and unmet education needs in hematology/oncology clinical practice, Nigerian pharmacists are very willing to expand their knowledge and improve their skills in patient care. The findings of this study can inform policy makers, healthcare administrators, and pharmacy educators in developing global partnerships among pharmacy organizations which employ targeted strategies like sponsorships to address such unmet needs.

Knowledge status of skin tear prevention and its demographic and occupational influencing factors: A National cross-sectional survey among nurses.

A skin tear (ST) is a common skin injury that is often misdiagnosed or overlooked. This study examined the current state of nurses' ST knowledge and its influencing factors. A national cross-sectional survey combined with a quantitative analysis was used to provide evidence of poor ST knowledge among nurses and its influencing factors. An electronic questionnaire survey was conducted among 1293 nurses from 32 hospitals in 18 provinces across China, including a General Information Questionnaire, ST Knowledge Assessment Instrument (OASES) and a Self-directed Learning Competence Scale for Nurses (SLCS-N). The mean OASES score was 9.51 ± 3.15, with a score rate of 47.55%. Pearson's correlation analysis showed positive correlations, ranging from none to strong, between every dimension in the OASES and from strong to extremely strong between every dimension in the SLCS-N. Multivariate analysis revealed multiple independent factors influencing ST knowledge, such as hospital tier, specialized nurses in wound/ostomy/incontinence care, participation in training for wound/ostomy/incontinence management, willingness to undergo ST training, self-assessed grade in ST care and the degree of emphasis of managers. ST knowledge status was generally poor among nurses nationwide. Managers should establish a comprehensive and specialized curriculum-based system, develop evidence-based standardized nursing processes, and provide tailored training programs to address nurses' unique characteristics and individualized needs, thereby enhancing their proficiency in ST-related knowledge and skills. This study is the first to identify a poor level of ST knowledge among nurses nationwide, particularly in the four dimensions of risk assessment: prevention, treatment, classification, and observation. Based on the findings regarding demographic factors and ST experiences, an integrated management system and educational program should be implemented to improve nurses' awareness and knowledge in this field. No patient or public contributions.

Determinants of the utilization of recognized traditional and complementary medicine service in Malaysia: a secondary analysis of a cross-sectional population-based survey.

The utilization of traditional and complementary medicine (T&amp;CM) services has witnessed a global increase over the past decades. Currently, seven practice areas are recognized in Malaysia: traditional Malay medicine, traditional Chinese medicine, traditional Indian medicine, homeopathy, Islamic medical practice, chiropractic, and osteopathy. Many global studies have investigated the general determinants of T&amp;CM service utilization. However, there has been no comprehensive study reporting specific determinants of recognized T&amp;CM service utilization. This study aimed to examine the prevalence and specific determinants of recognized T&amp;CM service utilization in Malaysia at a national level. This study is a secondary analysis of data from the National Health and Morbidity Survey (NHMS), a cross-sectional population-based survey conducted in Malaysia in 2015. A total of 6,207 respondents aged ≥18 years were included in this study. The associations of sociodemographic, health, and lifestyle factors with the utilization of the three T&amp;CM service categories (traditional Malay medicine, traditional Chinese medicine, and other T&amp;CM) were examined using three separate logistic regression analyses. The prevalence of recognized T&amp;CM service utilization in the last 12 months was 19.3%, with 15.0% for traditional Malay medicine, 3.9% for traditional Chinese medicine, and 1.5% for other T&amp;CM. The determinants of traditional Malay medicine service utilization were female sex; age range of 18-29 years; married or widowed/divorced status; Malay, Indigenous or other ethnicities; high household income; and being overweight/obese. The determinants of traditional Chinese medicine service utilization were the age range of 30-49 years, urban residential location, Chinese ethnicity, and adequate fruit and vegetable intake. No specific determinants were identified for other T&amp;CM. This study provided novel evidence of a strong ethnocultural ownership towards traditional medicine. User profiles were distinctively different between varied T&amp;CM services. Customized approaches to regulate, develop, and institutionalize specific T&amp;CM services are crucial for fulfilling the unique needs of diverse communities.

Interest and its associations with university entrance grades, lecturers’ perceived support, and student dropout

AbstractMotivation decreases in higher education programs and is associated with dropout. Consequently, analyzing the development of motivation and subsequent student behavior is needed. We focused on factors that influence subject interest through the cognitive–rational aspect (university entrance grades) as well as the emotional aspect (perceived support from lecturers) and associated these variables with student dropout. We used data from 2301 co-op students in their first academic year collected by cross-sectional survey and university administration. We identified direct effects of interest, support, and university entrance grade on dropout rates and found that interest mediates lecturers’ perceived support and student dropout.

The relationship between loneliness and blood glucose: a cross-sectional survey among Japanese

Recently, researchers have uncovered a correlation between loneliness and both the development and management of diabetes. Nevertheless, previous studies employing an unvalidated loneliness questionnaire impair result accuracy. Furthermore, this aspect has not been researched in the Japanese population. Therefore, this cross-sectional study analyzed data from the Kanagawa prospective “ME-BYO” Cohort Study (ME-BYO cohort) to investigate the correlation between loneliness, as measured by 20 items on the UCLA Loneliness Scale, and blood glucose levels. A total of 666 participants were included in the analysis, with a mean age of 54.1 years and a mean BMI of 23 kg/m2. Half of the participants had obtained an education level beyond high school. The mean household income and physical activity level were reported as 6.83 million Japanese yen and 12.3 METs-h/day, respectively. Model 1 of the linear regression analysis determined that there was no significant association between the loneliness scale and HbA1c (p = 0.512). After adjusting for age, gender, BMI (model 2), sitting time, physical activity level (model 3), housemates, household income, and final education (model 4), and controlling for social support, quality of life, and depression (model 5), the results showed no significant association, with a p-value of 0.823, 0.791, 0.792, and 0.816, respectively. Thus, the study found no link between loneliness and HbA1c in the high SES population. This finding contradicts previous results and may be attributed to the impact of population characteristics, SES status, or genetic backgrounds.

Psychometric properties of the Swedish version of the Parenting Concerns Questionnaire in parents with cancer.

Parenting concerns can be a major source of distress for patients with cancer who are parents of dependent children; however, these are often not addressed in health care. The Parenting Concerns Questionnaire (PCQ) is an instrument designed to assess parents' worries about the impact of cancer on their children and their ability to parent during this time. The Swedish version of thePCQ has, however, not been evaluated. This study therefore aimed to examine the psychometric properties of the PCQ in a sample of Swedish parents with cancer. A sample of 336 patients with cancer having dependent children (≤18 years) were included in a cross-sectional web-based survey. Participants completed questionnaires assessing parenting concerns, depression, anxiety, and stress symptoms (DASS); self-efficacy, family functioning (FAD-GF); and sociodemographic and clinical characteristics. Descriptive analyses, as well as reliability and validity analyses, were conducted followed by a confirmatory factor analysis of the factor structure proposed by the authors of the original version of the PCQ. The majority were mothers (94.9%) with breast cancer (66.4%) aged 40-50 years (59.5%). The results showed evidence for convergent, criterion, and known group's validity, but the original three-factor structure of the PCQ was not fully supported by confirmatory factor analysis. Evaluating parenting concerns may be an important step towards identifying patients who could benefit from targeted psychosocial interventions. However, the PCQ may require some further refinement to fully capture the breadth of parenting concerns in parents with cancer in different settings.

Service Robots Acceptance among Customers of Insurance Companies: An Application of Service Robot Acceptance Model

Drawing from the Service Robot Acceptance Model (sRAM), this paper investigates the acceptance of service robots among customers of Nepalese insurance companies. Using a cross-sectional survey design, data were collected from 243 customers of insurance companies through purposive sampling. Hypotheses were tested using Partial Least Squares Structural Equation Modelling (PLS-SEM). This paper found that Perceived Ease of Use (PEOU), Perceived Usefulness (PU), Subjective Social Norms (SSN), and Perceived Social Interactivity (PSI) significantly influence Customer Acceptance of Service Robots (CASR). Additionally, PEOU significantly influences PU, and SSN significantly influences PU. However, Perceived Humanness (PH), Perceived Social Presence (PSN), Rapport (RAP), and Trust (TR) do not significantly influence CASR. This paper provides a significant evidencebased framework for developers and managers to prioritise the functional aspects, social presence, and social interactivity of service robots in the Nepalese insurance companies. This paper is one of the pioneering studies to explain service robot acceptance among customers of insurance companies by applying the sRAM in the Nepalese context.

Associations of hypertension and antenatal care-seeking with perinatal mortality: A nested case-control study in rural Bangladesh.

Maternal hypertension may be an underrecognized but important risk factor for perinatal death in low resource settings. We investigated the association of maternal hypertension and perinatal mortality in rural Bangladesh. This nested, matched case-control study used data from a 2019 cross-sectional survey and demographic surveillance database in Baliakandi, Bangladesh. We randomly matched each pregnancy ending in perinatal death with five pregnancies in which the neonate survived beyond seven days based on maternal age, education, and wealth quintile. We estimated associations of antenatal care-seeking and self-reported hypertension with perinatal mortality using conditional logistic regression and used median and interquartile ranges to assess the mediation of antenatal care by timing or frequency. Among 191 cases and 934 matched controls, hypertension prevalence was 14.1% among cases and 7.7% among controls. Compared with no diagnosis, the probability of perinatal death was significantly higher among women with a pre-gestational hypertension diagnosis (OR 2.90, 95% CI 1.29, 6.57), but not among women with diagnosis during pregnancy (OR 1.68, 95% CI 0.98, 2.98). We found no association between the number of antenatal care contacts and perinatal death (p = 0.66). Among women with pre-gestational hypertension who experienced a perinatal death, 78% had their first antenatal contact in the sixth or seventh month of gestation. Hypertension was more common among rural women who experience a perinatal death. Greater effort to prevent hypertension prior to conception and provide early maternity care to women with hypertension could improve perinatal outcomes in rural Bangladesh.

Socio-economic and Demographic Determinants of Household Fertility Decisions

This study investigates the socio-economic and demographic determinants of household fertility decisions in Nigeria. Using the family system model as framework, a cross-sectional survey design in a retrospective study was adopted. Quantitative data were purposively gotten from the 2018 Nigeria Demographic and Health Survey (NDHS) household recode dataset. Data were analysed using descriptive statistics and Logistic Regressions at P&lt;0.05. The mean age at first birth of respondents was 18.8±4.0 years. The mean of Children ever-born was 5.9±2.8. The Children ever-born was highest in the North West region (36.7%), while the South East had the least (12.6%) sum of Children ever-born in the six regions. The relationship between children ever-born and the age at first birth is statistically significant (χ2= 8334.4, p=&lt;0.001). Women with all living are 2.0 times (OR=2.071, CI=1.987-2.158) more likely to increase their Children ever-born than women who have experienced the loss of a child. Women who have no formal education are 5.8 times (OR=5.835, CI=5.504-6.186) more likely to increase their Children ever-born than women with tertiary education. Women who do not utilize contraception in any way and those who used the folkloric method were respectively 0.8 times and 5.5 times more likely to increase their children ever-born than women using modern contraceptives respectively. Based on the findings, it is recommended that fertility controls must be prioritized, specifically by encouraging girl child education across the nation.

Gatekeeping and referral of patients holding private health insurance: a survey among general practitioners in Norway

Objective Private health insurance is becoming more common in Norway. The aim of this study was to investigate GPs’ opinions on private health insurance, and their experiences from consultations where health insurance can affect decisions about referring. Design A web based cross-sectional survey. Setting Norwegian general practice. Subjects All GPs in Norway were in 2019 invited to participate in an online survey. Main outcome measures The GPs’ opinions and experiences regarding health insurance were reported as proportions. Multiple logistic regression was used to test associations between how frequently GPs refer patients without further considerations and variables concerning their characteristics, opinions, and experiences. Results Of 1,309 GPs (response rate 27%), 93% stated that private health insurance raises the risk of overtreatment and 90% considered such insurance to contribute to inequality in health. Frequently being pressured to refer in the absence of a medical indication was reported by 42%. Moreover, 28% often or always chose to refer patients without further consideration, and this was associated with perceptions of pressure with an adjusted odds ratio (AOR) of 3.80, 95% confidence interval (CI) 2.73–5.29, and unpleasant reactions from patients following refusals (AOR 1.63, 95% CI 1.14–2.33). Conclusion Although most participating GPs associated private health insurance with overtreatment and inequality in health, more than one in four choose to refer without further consideration. GPs’ experience of pressure to refer and negative reactions from patients when they consider referrals not to be medically indicated, raises the risk of medical overuse for patients holding private health insurance.

Changes in modes of cannabis consumption pre- and post-legalization and their correlates among adults in Ontario, Canada: 2017–2022

ABSTRACT Background: Despite an increase in the varieties of cannabis products available for consumption, limited evidence is available about the patterns of cannabis consumption methods before and after legalization. Objectives: To examine the changes in modes of cannabis use and their correlates among adults in Ontario, Canada both prior to and following cannabis legalization in 2018. Methods: Data were utilized from the 2017 to 2022 Centre for Addiction and Mental Health’s (CAMH) Monitor study, a repeated cross-sectional survey of adults 18 years of age and older (n = 2,665; 56% male). The surveys employed a regionally stratified sampling design using computer-assisted telephone interviews and web surveys. Multinomial regression was performed to examine different modes of cannabis use. Results: The exclusive use of cannabis through ingestion methods increased from 4.0% in 2017 to 16.6% in 2022 (p < .001). However, the exclusive use of inhalation-based cannabis decreased from 49.4% in 2017 to 25.5% in 2022 (p < .001). Relative to inhalation-based modes, adults were about five times more likely to use ingestion-based modes in 2020 [RRR = 4.65 (2.94–7.35)] and 2022 [RRR = 4.75 (2.99–7.55)] than in 2019, after accounting for sociodemographic factors. Conclusions: Ingestion-based cannabis use among adults increased fourfold between 2017 and 2022, a period during which recreational cannabis use was legalized in Canada. The increase was especially evident after the legalization of cannabis edibles.