High Levels Of Use Research Articles

Intravenous Drug Use-Associated Infective Endocarditis in Pregnant Patients at a Hospital in West Virginia.

IntroductionDue to high levels of intravenous drug use (IVDU) in West Virginia (WV), there are increasing numbers of hospitalizations for infective endocarditis (IE). More specifically, pregnant patients with IE are a uniquely challenging population, with complex management and a clinical course that further affects the health of the fetus, with high morbidity and mortality. Timely recognition and awareness of the most common bacterial causes will provide hospitals and clinicians with valuable information to manage future patients.MethodsThis retrospective study analyzed the clinical course of pregnant patients admitted with IE and IVDU history presenting at Cabell Huntington Hospital from 2013 to 2018. Inclusion criteria were women between 16 and 45 years of age confirmed to be pregnant by urine pregnancy test and ultrasonography with at least eight weeks gestation, with a first-time diagnosis of endocarditis and an identified history of IVDU. We excluded charts with pre-existing risk factors including a history of valvular disease, rheumatic heart disease, surgical valve repair or mechanical valve replacement, or a diagnosis of coagulopathies. The resulting charts were evaluated for isolated organisms, reported clinical course, and complications of the pregnancy.ResultsA total of 10 patients were identified, with methicillin-susceptible and methicillin-resistant Staphylococcus aureus, Serratia marcescens, Haemophilus parainfluenza, and Enterococcus faecalis species. Complications included loss of fetus (30%), septic embolization (40%), hemorrhagic stroke (10%), and transfer to outside facilities for cardiothoracic surgical intervention (40%).DiscussionIE in pregnancy, while rare, has serious complications. In the context of the IVDU epidemic, it has an increasing impact on WV hospitals. A better understanding of the clinical course may allow for early diagnosis and guide the development of rational empiric therapies. More effective management of IE in pregnant patients can reduce complications and potentially improve maternal and fetal morbidity or mortality.

Cumulative Social Risk and Child Screen Use: The Role of Child Temperament

It is critical to understand what children, and in which context, are at risk for high levels of screen use. This study examines whether child temperament interacts with cumulative social risk to predict young children's screen use and if the results are consistent with differential susceptibility or diathesis-stress models. Data from 1,992 families in Calgary, Alberta (81% White; 47% female; 94% >$40,000 income) from the All Our Families cohort were included. Mothers reported on cumulative social risk (e.g., low income and education, maternal depression) at <25 weeks of gestation, child's temperament at 36 months of age (surgency/extraversion, negative affectivity, effortful control), and child's screen use (hours/day) at 60 months of age. Along with socio-demographic factors, baseline levels of screen use were included as covariates. Children high in surgency (i.e., high-intensity pleasure, impulsivity) had greater screen use than children low in surgency as social risk exposure increased. In line with differential susceptibility, children high in surgency also had less screen use than children low in surgency in contexts of low social risk. Children with heightened negative affectivity (i.e., frequent expressions of fear/frustration) had greater screen use as social risk increased, supporting a diathesis-stress model. Young children predisposed to high-intensity pleasure seeking and negative affectivity in environments characterized as high in social risk may be prone to greater durations of screen use. Findings suggest that an understanding of social risks and individual characteristics of the child should be considered when promoting healthy digital health habits.

Dinâmica do uso do solo e alterações na vazão na bacia do Rio São Francisco no início do Séc. XXI

The aim of this study is to evaluate the changes occurred in the land use of Sao Francisco river basin (BHRSF), and the their influence in the observed streamflows, for the period from 2001 to 2013. In order to identify changes in land use and land cover, images from MODIS satellite - Moderate Resolution Imaging Spectroradiometer plataform were used through a code developed in the DINAMICA EGO software. The generated product presents informations about the quantification of changes in terms of area and the identification of the type and the location of the occured transitions. To analyze the trend in streamflow behavior, 18 fluviometric stations belonging to the national hydrometeorological network, operated by ANA, were used. The Mann-Kendall statistical test was applied and the results demonstrate some significant land cover transitions such as: Forest to Savanna, Woody to Savanna and Cropland to Savanna. It was also observed in 11 of the 18 fluviometric stations studied, a trend of decreasing streamflow over the years. This result may be explained by the extend irrigation activity performed in the basin. The transitions “Savanna to Cropland” and “Woody to Cropland” are assossiated to high levels of water use, which are responsible for the decrease of water supply in the Sao Francisco river basin, and therefore in the streamflows.

Alcohol consumption and the risk of mortality and myocardial infarction in patients with rheumatoid arthritis.

Many studies have found that moderate alcohol consumption is associated with lower risks of mortality and myocardial infarction (MI). Our aim was to examine the potential effects of alcohol on all-cause mortality and MI in rheumatoid arthritis (RA), a risk factor condition. A cohort study (1995-2017) was conducted using medical records of RA patients from The Health Improvement Network in the United Kingdom (UK). Alcohol exposure was divided into non-drinkers, mild (1-7 UK units/week), moderate (8-14 UK units/week), moderate-high (15-21 UK units/week), and high (>21 UK units/week) consumption levels. We calculated hazard ratios (HRs) for the relation of alcohol consumption to all-cause mortality and MI, adjusting for covariates. Of 30,320 RA patients, 5,994 deaths and 1,098 MI cases occurred over 236,188 person-years. Mild-to-moderate alcohol use was associated with lower all-cause mortality in RA patients, including those taking methotrexate. The multivariable HRs (95% CI) for mortality by alcohol use category were non-drinkers 1.0, mild 0.80 (0.75-0.85), moderate 0.74 (0.67-0.82), moderate-high 0.84 (0.72-0.98), and high 0.99 (0.86-1.15). Mild, moderate-high, and high levels of alcohol use were associated with lower risk of MI among RA patients. The HRs MI risk by alcohol use category were non-drinkers 1.0, mild 0.81 (0.70-0.94), moderate 0.84 (0.68-1.04), moderate-high 0.51 (0.35-0.74), and high 0.59 (0.42-0.84). These findings suggest that mild-to-moderate alcohol use is associated with a lower mortality risk and overall alcohol use is associated with a lower MI risk in RA patients, similar to the general population.

Contraceptive Use Among Adolescents With and Without Disabilities

PurposeThe aim of this study is to assess contraceptive use at last intercourse among adolescent girls with and without disabilities. MethodsData were from the 2015 and 2017 Oregon Healthy Teens survey, a state-wide representative sample of 11th grade students. Among respondents at risk for unplanned pregnancy (n = 3,702), we estimated the prevalence of contraceptive method used at last intercourse—including intrauterine device, implant, Depo-Provera, oral contraceptive pills, patch, ring, condoms, withdrawal, and emergency contraception—by disability status. We used multivariable Poisson regression to measure the association between disability status and use of any contraceptive. ResultsGirls with disabilities were more likely to report having had intercourse compared to girls without disabilities (49.2% vs. 37.4%). Girls with disabilities were less likely to use oral contraceptive pills (32.8% vs. 36.6%) or condoms (51.9% vs. 59.7%) compared to their non-disabled peers. After adjusting for demographic factors, 92.3% of girls with disabilities reported using any contraceptive method compared to 94.7% of girls without a disability (adjusted prevalence difference −2.6%, 95% CI −.26%, −4.9%; adjusted prevalence ratio .97, 95% CI .95–1.00, p = .03). ConclusionsWe observed high levels of contraceptive use among Oregon high school girls. Still, girls with disabilities were slightly less likely to report contraceptive use compared to their non-disabled peers. Given the high proportion of teens with disabilities who are sexually active, the magnitude of the difference in contraceptive use could be of concern on a national scale and further research is warranted.

Prevalence and antimicrobial susceptibility pattern of coagulase-negative staphylococci obtained from nares of adult patients admitted to Ahmadu Bello University Teaching Hospital (ABUTH), Zaria

Coagulase-negative staphylococci (CoNS) are part of the normal microbial flora of the skin and mucous membranes. Nasal colonization with antibiotic-resistant CoNS represents both a risk factor for the colonized individual and their immediate contacts. This study determines the antibiotics susceptibility pattern and resistance phenotypes to a specific group of antimicrobial agents in CoNS isolate from the nares of adult patients from Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Kaduna State, Nigeria. One hundred and twenty-three presumptive staphylococci isolate from nasal colonization surveillance cultures of adult patients were collected from the diagnostic medical microbiology laboratory of ABUTH, Zaria and were characterized using standard microbiological procedures and their susceptibility to commonly used antimicrobial agents determined using the guideline of European committee on antimicrobial susceptibility testing (EUCAST). A total of 60 of the 123 (49%) staphylococcal isolate were CoNS. Characterization of the sixty CoNS isolate showed that the most predominant species were S. chromogenes (30.0%), S xylosus (15.0%) and S. schleiferi subsp. coagulans (13.3%). The highest level of resistance was observed to Cefoxitin (95.0%) and the lowest to Tigecycline (1.7%). S. epidermidis isolates were observed to show ≥60% resistance to all tested antibiotics with the exception of Tigecycline (0%) and Gentamicin (20%). Analysis of the multiple antibiotic resistance index (MARI) showed that majority (96.7%) of the isolates were resistant to 3 or more of the antimicrobial agents. No isolate was resistant to all the tested antimicrobial agents. A very high proportion of the CoNS isolates were resistant to cefoxitin, penicillin, tetracycline, amoxicillin-clavulanate, and vancomycin. In conclusion, the high proportion of isolates with MARI of 0.3 and above indicates a high level of antibiotic use or exposure in the study area. These findings revealed the need for continued surveillance for resistant phenotype to inform clinical therapy decisions

Sharing Healthcare Records in the Cloud Using Attribute-Based Encryption and De-Duplication

Cloud based healthcare computing have changed the face of healthcare in many ways. The main advantages of cloud computing in healthcare are scalability of the required service and the provision to upscale or downsize the data storge, collaborating Artificial Intelligence (AI) and machine learning. The current paper examined various research studies to explore the utilization of intelligent techniques in health systems and mainly focused into the security and privacy issues in the current technologies. E-Healthcare is an emerging field of medical informatics, referring to the delivery of health services and information using the Internet and related technologies. Rendering efficient storage and security for all data is very important for cloud computing. Securing and privacy preserving of data is of high priority when it comes to cloud storage. E-Healthcare is the most important source in the healthcare society. E-healthcare system is now being popularized globally. Implementing the E-healthcare system will have more advantages such as online services for teleconsultation (second medical opinion), e-prescription, e-referral, telemonitoring, telecare etc. E-healthcare system provides high level of security and cost-effective use of patients records, information and communication in support of healthcare and health related issues.

Grave Goods in Early Medieval Europe: regional variability and decline

This article analyses the use of grave goods in burials across early medieval Europe and how that use changed over the course of the 6th to 8th centuries CE with the widespread transition to unfurnished burial. It uses data gathered from published cemetery excavation reports from England, France, Germany, Belgium, Switzerland, and the Netherlands. The grave good use in these cemeteries was analysed using GIS methods to visualise regional differences, as well as statistical methods to analyse how grave good use evolved over time in those regions. This analysis revealed clear regional distinctions in grave good use, with England and Alamannia appearing similar, with relatively high levels of grave good use. Meanwhile, parts of Frankia and of Burgundy had considerably lower levels of grave good use. Distributions of individual artefact types tended to match those of overall numbers, but there were a few key exceptions, such as vessels, which followed a quite different pattern, being found in high numbers along the Frankish coast, but in much lower numbers elsewhere. Despite these overall trends, there was still considerable intra-regional and intra-cemetery variation that suggests communities and individuals had the ability to make highly individual choices about the way to bury their dead, along with the ability to subvert local norms. It also revealed that while there was a general decline in the use of grave goods across this period, and everywhere eventually reached the point of almost completely unfurnished burial, this decline occurred at different rates. In particular, there was a zone around the North Sea, including Kent, western Frankia, and the Low Countries, where there was little change in grave good use until it was suddenly abandoned in the early 8th century. Different types of objects declined at different rates across different regions, with few clear trends, suggesting that only personal accessories held a common significance across Europe; the meanings of all other object types were negotiated on a local basis.

Pilot Randomized Controlled Trial of Motivational Interviewing with Sexual Minority Male Couples to Reduce Drug Use and Sexual Risk: The Couples Health Project.

A randomized controlled trial evaluated the preliminary efficacy of a dyadically-delivered motivational interviewing (MI) intervention to reduce drug use and sexual risk in a sample of 50 sexual minority (cis)male (SMM) couples. In each couple, at least one partner was aged 18–29; reported drug use and sexual HIV transmission risk; and was HIV-negative. Couples were randomized to either the three-session MI intervention or an attention-matched control, with follow-up surveys completed at 3- and 6-months post-baseline. Between-group differences for all outcomes were non-significant in the overall sample. Subsequent moderation analyses indicated the intervention significantly reduced illicit drug use (excluding marijuana) at 3-month follow-up when either respondents (B = − 1.96; interval rate ratio—IRR 0.02–1.22; p = .001), their partners (B = − 2.60; IRR 0.01–0.64; p = .004), or both (B = − 2.38; IRR 0.01–0.80; p = .001) reported high levels of baseline use. The intervention also reduced condomless anal sex (CAS) with casual partners when both partners reported high frequency baseline CAS (B = − 2.54; IRR 0.01–0.83; p = .047). Findings provide initial evidence of the potential for MI to address drug use and sexual risk-taking among SMM couples at highest risk.Trial Registration ClinicalTrials.gov (NIH U.S. National Library of Medicine) Identifier: #NCT03386110.

Effects of a remotely supervised motor rehabilitation program for individuals with Rett syndrome at home

Purpose In this study, the effect of a remotely supervised, home-based, family-centered individualized rehabilitation program of motor activities for individuals with Rett syndrome (RTT) was evaluated. Materials and methods Thirteen participants with classic genetically confirmed RTT followed by a three-month program of motor activities at home. A total of 47 rehabilitative goals were set. Goals achievement, motor function, and parental satisfaction were evaluated. Each program was carried out by the participant's parents and remotely supervised via Skype calls, twice by a therapist experienced in RTT rehabilitation. Results Thirty-seven (78.7%) rehabilitative goals were achieved or overachieved. Ten participants (76.9%) significantly increased their gross motor functional level with a medium size effect (0.604). Parental reports of the involved families suggest, on average, a high level of usefulness of the program (4.4/5), adherence to the program (4.4/5), and general satisfaction (4.5/5). Conclusions Our findings strongly support the implementation of such programs for this population. As these programs were remotely supervised, they can be implemented when the children are away from referenced facilities for long durations, such as during long holidays or a Covid-19 type lockdown. Implications for rehabilitation A remote supervised motor activity program carried out by the primary caregiver supports motor functioning in RTT. Therapists should consider family members' motivation to carry out the activities and integrate them into the family's daily routine. The program should be flexible to adapt to any sudden change in medical and environmental conditions, functional ability, and family members' motivational levels.

Perioperative gabapentinoid use lowers short-term opioid consumption following lower limb arthroplasty: Systematic review and meta-analysis.

The management of post-operative pain and high levels of acute and chronic opioid use following total knee arthroplasty (TKA) and total hip arthroplasty (THA) remain challenges to the perioperative team. We performed a system-atic review and meta-analysis to determine the opioid sparing effects, analgesic effects, and safety profile of perioperative gabapentinoid usage in lower limb arthroplasty. We searched multiple databases from inception until May 2019 and included randomized controlled trials (RCT) on perioperative gabapentinoids in lower limb arthroplasty. The primary outcome was cumulative opioid con-sumption (oral morphine equivalents) at 24 and 48 hours, and the secondary outcomes were pain scores, time to hospi-tal discharge, and adverse events including nausea, vomiting, pruritus, and sedation. Methodological quality was as-sessed using the Cochrane tool. The grading of recommendations assessment, development, and evaluation method-ology for the certainty of evidence was also used. We included 19 RCT involving 2,455 patients undergoing lower limb arthroplasty. The overall methodological quality of included studies was good. Gabapentinoid use was associated with a significant reduction in opioid consump-tion at 24 hour (mean difference (MD) 22.81 mg [95 percent Confidence Interval (CI) 13.64-31.98]) and 48 hour (MD 44.03 mg [95 percent CI 16.92-71.14]). We found no meaningful difference in pain scores at rest between gabapenti-noid and placebo groups at 24 or 48 hours. Gabapentinoid use reduced the risk of post-operative nausea (risk ratio (RR) 0.69 [95 percent CI 0.57-0.82]), vomiting (RR 0.65 [95 percent CI 0.47-0.91]), and pruritus (RR 0.60 [0.37-0.98]), but not sedation (RR 1.25 [0.76-2.06]). There was no effect on time to discharge from hospital (MD-0.05 days [95 per-cent CI -0.31 to 0.20]. The addition of gabapentinoids to perioperative multimodal analgesia decreases opioid consumption fol-lowing lower limb arthroplasty, while also lowering rates of nausea, vomiting, and pruritus. Further study is required to evaluate the effect of gabapentinoid use on long-term opioid use and dependence.

Preventing Hospital Readmission for Patients With Comorbid Substance Use Disorder : A Randomized Trial.

Hospitalized patients with comorbid substance use disorders (SUDs) are at high risk for poor outcomes, including readmission and emergency department (ED) use. To determine whether patient navigation services reduce hospital readmissions. Randomized controlled trial comparing Navigation Services to Avoid Rehospitalization (NavSTAR) versus treatment as usual (TAU). (ClinicalTrials.gov: NCT02599818). Urban academic hospital in Baltimore, Maryland, with an SUD consultation service. 400 hospitalized adults with comorbid SUD (opioid, cocaine, or alcohol). NavSTAR used proactive case management, advocacy, service linkage, and motivational support to resolve internal and external barriers to care and address SUD, medical, and basic needs for 3 months after discharge. Data on inpatient readmissions (primary outcome) and ED visits for 12 months were obtained for all participants via the regional health information exchange. Entry into SUD treatment, substance use, and related outcomes were assessed at 3-, 6-, and 12-month follow-up. Participants had high levels of acute care use: 69% had an inpatient readmission and 79% visited the ED over the 12-month observation period. Event rates per 1000 person-days were 6.05 (NavSTAR) versus 8.13 (TAU) for inpatient admissions (hazard ratio, 0.74 [95% CI, 0.58 to 0.96]; P = 0.020) and 17.66 (NavSTAR) versus 27.85 (TAU) for ED visits (hazard ratio, 0.66 [CI, 0.49 to 0.89]; P = 0.006). Participants in the NavSTAR group were less likely to have an inpatient readmission within 30 days than those receiving TAU (15.5% vs. 30.0%; P < 0.001) and were more likely to enter community SUD treatment after discharge (P = 0.014; treatment entry within 3 months, 50.3% NavSTAR vs. 35.3% TAU). Single-site trial, which limits generalizability. Patient navigation reduced inpatient readmissions and ED visits in this clinically challenging sample of hospitalized patients with comorbid SUDs. National Institute on Drug Abuse.

Effect of Smartphone on Hand Performance and Strength in the Healthy Population.

The study aimed to determine the interactive effects of smartphone use on hand grip strength as well as functional hand performance in young people. The evolution of technology smartphone has become our necessity. It has made our lifestyle more comfortable in the form of browsing the internet, important conversation, and source of entertainment. However, it has negatively impacted our lifestyle too. Smartphone consumption among the young population has become broadly popular for different purposes aside from communication including playing games as well as internet browsing. The main complications associated with the increase in the use of smartphones results in weakness of the hand as well as wrist. High levels of smartphone use diminished hand grip strengths as well as and hand function leading to decreased hand grip strength in their dominant hand.

A Real-World Single-Centre Study of Patients with Diabetic Macular Oedema Who Wore a Home-Use Sleep Mask (Noctura 400) for One Year.

A “Real-World” single-centre observational study was carried out to analyse the effects of enhanced patient interaction with the use of the Noctura 400 sleep mask on a group of 26 diabetics displaying diabetic retinopathy (DR) and diabetic macular oedema (DMO), of which 24 completed the study. We hoped to find if patient compliance could be maintained and to determine the anatomical and functional consequences of consistent mask wear. While this study was ongoing, COVID-19 impacted on normal eye clinic practice, allowing an unexpected analysis of the effects of this disruption to the clinical system on mask wear and disease progress. Throughout the whole study, outcomes were positive, with a high level of consistent patient use of the mask, above 74% up to and beyond 1 year. Even during the COVID-19 1st lockdown in England, the patients maintained a 65% nightly light mask compliance. Statistically significant improvements in maculopathy, including cyst reduction (56.4% of eyes with cysts exhibited cyst shrinkage), and visual acuity (VA) improvement (42/48 eyes gained 5 letters or more) were observed and maintained to the end of the study. Anatomical improvement or stability was recorded in all but one study eye. This investigation shows that given that there is appropriate interaction with patients who are self-treating in home environment, a high level of patient compliance can be maintained, even while there are disruptions to the normal hospital clinic setup.

Chronic homelessness - what women’s experiences can tell us

This article reassesses the policy concept of chronic homelessness in the light of women’s experiences of long-term homelessness. Chronic homelessness, associated with long-term homelessness and high levels of emergency and homelessness service use among men, has received increased focus in research, policy and services in recent years, and despite women’s comparative housing disadvantages, the overwhelming majority of people identified as experiencing chronic homelessness are male. This article draws on Carole Bacchi’s work on how policy problems are represented, and on the results of a small qualitative study with women experiencing long-term or chronic homelessness, to show how current representations of chronic homelessness obscure rather than reflect women’s experiences of long-term homelessness, marginalising their claims to housing and other assistance. The article concludes by suggesting opportunities to change this representation of the problem through research, evaluation, policy and program development that are informed by women’s experiences.

Food insecurity, food-related characteristics and behaviors, and fruit and vegetable intake in mobile market customers

Mobile markets (MM) bring affordable, quality, healthy foods to high-need, low-food access communities. However, little is known about food insecurity of MM customers. This manuscript evaluates food insecurity prevalence in MM customers and assesses associations between food insecurity and MM use, food-related characteristics and behaviors, and fruit and vegetable (FV) intake. Customers (N = 302) completed cross-sectional surveys in summer 2019 that assessed: food security, food availability, cooking attitude, self-efficacy for healthy cooking, self-efficacy for cooking and eating FV, social connectedness, and FV intake. Descriptive and multivariate analyses were used to describe and assess associations with food insecurity and FV intake. Results show most MM customers were food insecure (85%). In logistic regression models adjusted for sociodemographic characteristics, long-term MM use (OR = 0.77, CI = 0.60–0.997), access to affordable, quality foods (OR = 0.81, CI = 0.71–0.93), and self-efficacy for both cooking healthy foods (OR = 0.88, CI = 0.80–0.97) and cooking and eating FV (OR = 0.90, CI = 0.82–0.98) were associated with lower odds of food insecurity; negative cooking attitudes (OR = 1.12, CI = 1.02–1.24) were associated with higher odds of food insecurity. Being food insecure (β = −1.37, SE=0.43, p < 0.01) was associated with poorer FV intake; this association attenuated slightly (β = −1.22, SE=0.43, p < 0.01) when length of MM use was added to the general linear model, which was also associated with higher fruit and vegetable intake (β = 0.26, SE=0.10, p = 0.01). Results suggest the MM reaches customers experiencing high levels of food insecurity and long-term MM use is associated with lower food insecurity and higher FV intake. Relationships between food insecurity and several food characteristics/behaviors provide insight for potential targets for wrap-around interventions to address food insecurity among customers. Findings suggest longitudinal evaluation of the MM's impact on food security and other food-related characteristics/behaviors is warranted.

Prevalence and socio-demographic correlates of tobacco and alcohol use in four sub-Saharan African countries: a cross-sectional study of middle-aged adults

BackgroundSubstance misuse is a global public health problem. In addition to social and economic concerns, consumption of tobacco and alcohol is associated with susceptibility to cardiovascular, respiratory, and infectious diseases, cancers, and risk of transition to substance use disorders. African data suggest regional differences in the prevalence and patterns of substance use, but a number of key questions remain. This cross-sectional population-based study of middle-aged adults aims to examine prevalence and socio-demographic correlates of substance use in four sub-Saharan African countries, in rural and urban settings.MethodsParticipants aged between 40 and 60 years were recruited from six research centres as part of the Africa Wits-INDEPTH partnership for Genomic Research study. Data on patterns of tobacco and alcohol consumption was captured, and the latter further assessed using the CAGE (cut-annoyed-guilty-eye) questionnaire.ResultsData from 10,703 participants suggested that more men (68.4%) than women (33.3%) were current substance users. The prevalence of current smoking was significantly higher in men than in women (34.5% vs 2.1%, p < 0.001). Smokeless tobacco was used more by women than men (14.4% vs 5.3%, p < 0.001). Current smoking was associated with alcohol consumption in men, and smoking cessation in men was associated with being a former drinker, having higher socio-economic status, and if married or cohabiting. Current alcohol consumption was higher in men, compared to women (60.3% vs 29.3%), and highest in men from Soweto (70.8%) and women from Nanoro (59.8%). The overall prevalence of problematic alcohol consumption among men was 18.9%, and women 7.3%. Men were significantly more likely to develop problematic drinking patterns, and this was more common in those who were divorced or widowed, and in current smokers.ConclusionsRegional variation in the patterns and prevalence of substance use was observed across study sites, and in rural and urban settings. The high levels of substance use recorded in this study are of concern due to the increased risk of associated morbidities. Further longitudinal data will be valuable in determining trends in substance misuse in Africa.

Cross-Sectional and Longitudinal Associations between 24-Hour Movement Behaviours, Recreational Screen Use and Psychosocial Health Outcomes in Children: A Compositional Data Analysis Approach

It remains unclear whether the time-use composition of 24-h movement behaviours (sleep, sedentary time (ST), physical activity (PA)) and recreational screen use are independently associated with psychosocial health. This study examined the cross-sectional and longitudinal associations between 24-h movement behaviour composition, recreational screen use and psychosocial health outcomes in children. Measures completed at baseline (n = 127; 11.7 years) and follow-up (n = 88; 12.8 years) included accelerometer-based 24-h movement behaviours, self-reported recreational screen use and psychosocial health (Strengths and Difficulties Questionnaire, Kessler’s Psychological Distress Scale). Linear mixed models were used to examine the cross-sectional and longitudinal associations between the 24-h movement behaviour composition and recreational screen use levels with psychosocial health outcomes. Overall, the movement behaviour composition (p < 0.05) and recreational screen use levels (p < 0.01) were both cross-sectionally but not longitudinally associated with psychosocial health outcomes. Relative to other behaviours, sleep was negatively associated, while light-intensity PA was positively associated with internalising problems and total difficulties scores. ST was positively associated with internalising problems. High levels of recreational screen use (>2 h/day) were associated with greater externalising problems, total difficulties scores and psychological distress. These findings reinforce the importance of achieving a balance between different types of movement behaviours over a 24-h period for psychosocial health.

The impact of artificial intelligence on the accounting profession in the tourism sector in Egypt

The research aims to achieve identify the impact of artificial intelligence on the accounting profession. The research reached a set of results, The high level of use of artificial intelligence in companies in the tourism sector from the point of view of the study sample individuals, The high level of technology use in the accounting profession In companies in the tourism sector from the point of view of the study sample individuals, The impact Positive for the level of use of artificial intelligence on the accounting profession from the viewpoint of the study sample. The research recommends a set of recommendations, The need to work on increasing the use of artificial intelligence applications in the accounting field to benefit from the advantages it enjoys and to obtain solutions to many diverse and complex problems, which will positively affect the decision-making process, The necessity for colleges and institutes to teach how to use artificial intelligence applications in the accounting field within the curricula related to the accounting field to qualify a new generation of accountants and professors with the ability to use accounting technological methods and contribute to their development, Institutions and organizations provide programs and courses related to artificial intelligence applications for accountants to increase their capabilities, skills and capabilities in this field, The necessity for financial and management accountants to use artificial intelligence applications to develop their work because of its advantages that help them acquire many skills.

Using Oral Rehydration Therapy (ORT) in the Community.

For ORT to have a maximum impact on public health it should be used in the community, in the home. A number of programs have been developed over the years to extend ORT to home use. One of the most successful approaches was the Oral Therapy Education Program (OTEP) developed by BRAC, the world’s largest NGO. Mothers were taught in the home by an OTEP worker using seven simple messages and a demonstration. The program, which led to high levels of use and knowledge retention, is described. What the OTEP and other successful home-based programs have demonstrated is that home care of diarrhea using ORS can be effectively implemented and can have a positive impact on the reduction of diarrhea morbidity and mortality.