High-risk Users Research Articles

Association of HbA1C with mortality and cardiovascular outcome in patients with type 2 diabetes using drugs with different hypoglycemic risk

Abstract Background Previous clinical trials showed that intensive glucose control did not reduce macrovascular events and mortality. It was speculated that severe hypoglycaemia contributed to these adverse outcomes. More contemporary clinical trials using newer anti-diabetic agents with less hypoglycaemic potential showed a linear relationship between major adverse cardiovascular events (MACE) and HbA1c reduction according to a meta-regression analysis. Purpose The aim of this study was to examine the association between clinical outcomes and HbA1c under different treatment backgrounds in the real-world setting. We hypothesised that when using drugs with minimal hypoglycaemic risk, lower HbA1c would be associated with better outcomes. Methods This was a retrospective population-based cohort study using a multi-centre electronic medical record database. Eligible patients were those diagnosed with type 2 diabetes between 2009 and 2020 who received non-insulin antidiabetic drugs. Patients were stratified into two groups based on the drugs received: drugs with high hypoglycaemic risk (sulphonylurea, meglitinide) and drugs with low hypoglycaemic risk (thiazolidinediones, acarbose, DPP4 inhibitors, GLP1 agonists, SGLT-2 inhibitors). Patients were excluded if they had received these drugs for less than 180 days or had received both high and low hypoglycaemic risk oral drugs simultaneously. HbA1c levels were assessed from the index date to the date of the interested outcome or the end of the study period (31 December 2021), whichever came first. The relationship between HbA1c and clinical outcomes was examined using a Cox proportional hazards model. The outcomes of interest included all-cause mortality and MACE. Results The study population consisted of 6,923 patients, including 3,639 high hypoglycaemic risk drug users and 3,284 low hypoglycaemic risk drug users. Patients with lower HbA1c levels during the follow-up period were older and frailer. After adjusting for baseline covariates, the association between the risk of death and HbA1c presented a U-shaped pattern, and this U-shaped association was similar in the two treatment cohorts (Table 1). On the other hand, the association between the risk of MACE and HbA1c presented a J-shaped pattern. In the high hypoglycaemic risk drug cohort, patients with the highest HbA1c levels (mean HbA1c 9.6%) were associated with a higher risk of MACE compared to the group with a mean HbA1c of 7.2% (hazard ratio [HR] 4.16, 95% confidence interval [CI] 2.07-8.37); lower HbA1c levels were not associated with a lower risk of MACE (Table 2). In contrast, in the low hypoglycaemic risk drug cohort, lower HbA1c levels were associated with a higher risk of MACE (HR 3.82, 95% CI 1.29-11.28). Conclusion Lower HbA1c levels were not associated with a lower risk of all-cause mortality and MACE. Furthermore, this phenomenon was independent of the hypoglycaemic risk of anti-diabetic drugs.

Factors Affecting Application of Modern Agrochemicals and Observance of Pre-Harvest Interval in Khat, Catha edulis (Miraa) Crops in Igembe South Sub County

In Kenya, agriculture plays a crucial role in the economic development as well as alleviating poverty in the households. Strengthening the agricultural sector will call for provision of requisite extension services and ensuring necessary agricultural inputs readily available to the farmers. Evidently, agrochemicals have boosted agricultural productivity over time. Categorized broadly as fertilizers and pesticides, agrochemicals were introduced to enhance crop yields and minimize crop losses due to soil infertility, pests, and diseases. However, use of agrochemicals has been associated with various issues including effects on the environment and specifically, problems related to human health, biodiversity, and the entire ecosystem. Thus, this study investigated factors affecting application of modern agrochemicals and the observance of Pre-Harvest Interval (PHI) in Khat (Miraa) crops protection in Igembe south sub county. The specific objectives that guided the study were to investigate the effect of environmental factors on application of agrochemicals in Khat (Miraa) crops protection and whether farmers observed recommended Pre-Harvest Interval in application of agrochemicals in Khat (Miraa) crops protection in Igembe south sub county. A descriptive research design was utilized with a target population comprising Khat (Miraa) farmers in Igembe south sub county. Purposive sampling technique was adopted in selecting the sample. Stratified sampling was adopted in selecting individual respondents from the various wards to with the strata being the ward. Yamane (1967) formula was utilized to estimate the sample size of 399 respondents. Primary data was collected using a structured questionnaire with a response rate of 79.4%. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 20 and presented in figures and tables. From the analysis, the correlation between environmental factors in the application of modern agrochemicals and the protection of Khat (Miraa) crops was positive and statistically significant (?=0.546, P=0.000). The regression coefficient of environmental factors in the model was positive (r=.221) and statistically significant (P=0.000). Based on the calculated averages and PHI risk factors, majority of the farmers are categorized as high risk or very high-risk users of agrochemicals. Further statistical analysis indicated that the coefficient of the risk factor is positive (r=0.572) and statistically significant (P=0.000). Therefore, the risk factor in observance of the PHI has a significant effect on the number of farmers using specific agrochemicals. The study concluded that environmental factors and non-observance of recommended PHI, positively and significantly affects the protection of Khat (Miraa) crops. The study recommends targeted extension to sensitize Khat (Miraa) growers on importance of observing recommended PHI. Finally, the study recommends that the national and county governments ought to formulate policy guidelines that identify agrochemicals suitable in Miraa crops protection, the recommended application rates, and Pre-Harvest Intervals.

Screening practices and risk assessment for maculopathy in pentosan polysulfate users across different exposure levels.

In this population-based cohort study, we investigated screening practices for maculopathy and incidences of specific macular/retinal conditions in pentosan polysulfate (PPS) users and assessed the relationship between these outcomes and drug exposure levels. Using a health claims database that covers approximately 50 million Koreans, we identified 138,593 individuals who were prescribed PPS between 2010 and 2021. For the 133,762 PPS users who initiated therapy between 2012 and 2021, the cumulative PPS dose for each participant was evaluated, and based on their cumulative PPS dose, patients were categorized into the high-risk (≥ 500g), low-risk (50-500g), and minimal exposure (< 50g) groups. We analyzed the performance and methods of these examination methods used between 2018 and 2021 and compared them among cumulative dose groups to determine whether high-risk users underwent maculopathy screening more frequently or appropriately. We assessed the cumulative incidence of overall macular degeneration and maculopathy excluding common macular diseases following PPS therapy initiation. Most PPS users (99.7%) received a cumulative PPS dose < 500g and the high- and low-risk groups comprised 445 (0.3%) and 22,185 (16.6%) patients, respectively. During the study period, monitoring examinations were conducted in 52.6% and 49.4% of high- and low-risk patients, respectively, revealing no significant difference between the two groups (P = 0.156). No significant differences were observed in the annual percentages of patients receiving ophthalmic examinations between the high- and low-risk groups (all P > 0.05). The cumulative incidences of overall macular degeneration and maculopathy excluding common macular diseases in high-risk users were 19.3% and 9.0%, respectively, which were significantly different from those of low-risk users (both P < 0.001). Multivariate Cox regression analysis revealed significantly higher risks of maculopathy excluding common macular diseases in the low- (Hazard ratio [HR] of 1.55 [95% CI 1.13-2.12]) and high-risk groups (HR of 1.66 [95% CI 1.22-2.27]) compared to the minimal exposure group. Our findings suggest a need for increased emphasis on PPS maculopathy screening in high-risk patients, highlighting raising awareness regarding exposure-dependent risks and the establishment of screening guidelines.

Weight Change at 12 Months among Hormonal Contraceptive Users at Nur Sejahtera Clinics of National Population and Family Development Board (LPPKN): A Retrospective Study

Introduction: Weight gain was among the most common side effects that caused women to discontinue using hormonal contraception. However, previous literature had reported inconsistent findings of the association between hormonal contraception and weight change. This study aimed to determine the impact of hormonal contraceptive use on weight gain and factors associated with weight gain among the hormonal contraceptive users. Methods: A retrospective cohort study was conducted in four Nur Sejahtera Clinics using universal sampling method between September to November 2021. This study recruited women that had been using the hormonal contraception continuously for at least 12 months and had their weight measure at baseline and 12 months. Sociodemographic and clinical characteristic of the participant, weight measurement at baseline and 12 months and the type of hormonal contraception used were retrieved from the records. Multiple logistic regression was used to examine the factors associated with &gt;5% weight gain. Results: A total of 366 samples were recruited. About one-third (33.6%) of hormonal contraceptive users had their weight gain more than 5% from their baseline weight. The risk factor for weight gain more than 5% were women with aged less than 40 years (AOR=2.09; 95% CI:1.26,3.45) and Etonogestrel (ENG) implant user (AOR = 7.91; 95% CI:2.69,23.24). Conclusion: One third of the hormonal contraception users had their weight gain greater than 5%. Lifestyle intervention to prevent weight gain could be targeted at high-risk users who are less than 40 years old and those on ENG implant.

Effects of User-Reported Risk Factors and Follow-Up Care Activities on Satisfaction With a COVID-19 Chatbot: Cross-Sectional Study.

The COVID-19 pandemic influenced many to consider methods to reduce human contact and ease the burden placed on health care workers. Conversational agents or chatbots are a set of technologies that may aid with these challenges. They may provide useful interactions for users, potentially reducing the health care worker burden while increasing user satisfaction. Research aims to understand these potential impacts of chatbots and conversational recommender systems and their associated design features. The objective of this study was to evaluate user perceptions of the helpfulness of an artificial intelligence chatbot that was offered free to the public in response to COVID-19. The chatbot engaged patients and provided educational information and the opportunity to report symptoms, understand personal risks, and receive referrals for care. A cross-sectional study design was used to analyze 82,222 chats collected from patients in South Carolina seeking services from the Prisma Health system. Chi-square tests and multinomial logistic regression analyses were conducted to assess the relationship between reported risk factors and perceived chat helpfulness using chats started between April 24, 2020, and April 21, 2022. A total of 82,222 chat series were started with at least one question or response on record; 53,805 symptom checker questions with at least one COVID-19-related activity series were completed, with 5191 individuals clicking further to receive a virtual video visit and 2215 clicking further to make an appointment with a local physician. Patients who were aged >65 years (P<.001), reported comorbidities (P<.001), had been in contact with a person with COVID-19 in the last 14 days (P<.001), and responded to symptom checker questions that placed them at a higher risk of COVID-19 (P<.001) were 1.8 times more likely to report the chat as helpful than those who reported lower risk factors. Users who engaged with the chatbot to conduct a series of activities were more likely to find the chat helpful (P<.001), including seeking COVID-19 information (3.97-4.07 times), in-person appointments (2.46-1.99 times), telehealth appointments with a nearby provider (2.48-1.9 times), or vaccination (2.9-3.85 times) compared with those who did not perform any of these activities. Chatbots that are designed to target high-risk user groups and provide relevant actionable items may be perceived as a helpful approach to early contact with the health system for assessing communicable disease symptoms and follow-up care options at home before virtual or in-person contact with health care providers. The results identified and validated significant design factors for conversational recommender systems, including triangulating a high-risk target user population and providing relevant actionable items for users to choose from as part of user engagement.

No decline in drug overdose deaths in Norway: An ecological approach to understanding at-risk groups and the impact of interventions.

Aim: This Norwegian case study examines groups at risk of drug overdose deaths, evidence-based harm reduction interventions, low-threshold services and treatment implemented, as well as trends in drug overdose deaths between 2010 and 2021. We aimed to explore the relevance of interventions for at-risk groups and discuss their potential impact on drug overdose trends. Method/data: Using an ecological approach, we analysed the following: (1) groups identified through latent profile analysis (LPA) among a sample of 413 high-risk drug users collected in 2010-2012, supplemented with other relevant studies up to 2021; (2) published information on harm-reduction interventions, low-threshold services and treatment in Norway; and (3) nationwide drug overdose mortality figures supplemented with published articles on the topic. Results: High-risk drug users in 2010-2012 commonly engaged in frequent illegal drug use, injecting and poly-drug use (including pharmaceutical opioids), which continued into following decade. The interventions implemented between 2010 and 2021 were relevant for at-risk groups identified in the surveys. However, there was no decrease in the trend of drug overdose deaths up to 2021. While relevant interventions may have mitigated a theoretical increase in mortality, new at-risk groups may have contributed to fatal outcomes associated with pharmaceutical opioids. Conclusion: The interventions were relevant to the risk groups identified among high-risk drug users and potentially effective in preventing an increase in drug overdose trends. However, tailored interventions are needed for individuals at risk of death from prescribed opioids. Comprehensive studies encompassing all at-risk populations, including both legal and non-medical users of prescription opioids, are needed.

Developing Suicide Prevention Tools in the Context of Digital Peer Support: Qualitative Analysis of a Workshop With Multidisciplinary Stakeholders.

Suicide is the fourth leading cause of death among young people aged 15-29 years worldwide and suicide rates are increasing. Suicide prevention strategies can be effective but young people face barriers to accessing them. Providing support digitally can facilitate access, but this can also pose risks if there is inappropriate or harmful content. Collaborative approaches are key for developing digital suicide prevention tools to ensure support is appropriate and helpful for young people. Tellmi (previously MeeToo) is a premoderated UK-based peer-support app where people aged 11-25 years can anonymously discuss issues ranging from worries to life challenges. It has procedures to support high-risk users, nevertheless, Tellmi is interested in improving the support they provide to users with more acute mental health needs, such as young people struggling with suicide and self-harm ideation. Further research into the best ways of providing such support for this population is necessary. The aim of this study is to explore the key considerations for developing and delivering digital suicide prevention tools for young people aged 18-25 years from a multidisciplinary perspective, including the views of young people, practitioners, and academics. A full-day, in-person workshop was conducted with mental health academics (n=3) and mental health practitioners (n=2) with expertise in suicide prevention, young people with lived experience of suicidal ideation (n=4), and a computer scientist (n=1) and technical staff from the Tellmi app (n=6). Tellmi technical staff presented 14 possible evidence-based adaptations for the app as a basis for the discussions. A range of methods were used to evaluate them, including questionnaires to rate the ideas, annotating printouts of the ideas with post-it notes, and group discussions. A reflexive thematic analysis was performed on the qualitative data to explore key considerations for designing digital suicide prevention tools in the context of peer support. Participants discussed the needs of both those receiving and providing support, noting several key considerations for developing and delivering digital support for high-risk young people. In total, four themes were developed: (1) the aims of the app must be clear and consistent, (2) there are unique considerations for supporting high-risk users: (subtheme) customization helps tailor support to high-risk users, (3) "progress" is a broad and multifaceted concept, and (4) considering the roles of those providing support: (subtheme) expertise required to support app users and (subtheme) mitigating the impact of the role on supporters. This study outlined suggestions that may be beneficial for developing digital suicide prevention tools for young people. Suggestions included apps being customizable, transparent, accessible, visually appealing, and working with users to develop content and language. Future research should further explore this with a diverse group of young people and clinicians.

Determination of the cutoff point for Smartphone Application-Based Addiction Scale for adolescents: a latent profile analysis

BackgroundsThe Smartphone Application-Based Addiction Scale (SABAS) is a validated 6-item measurement tool for assessing problematic smartphone use (PSU). However, the absence of established cutoff points for SABAS hinders its utilities. This study aimed to determine the optimal cutoff point for SABAS through latent profile analysis (LPA) and receiver operating characteristic curve (ROC) analyses among 63, 205. Chinese adolescents. Additionally, the study explored whether PSU screening with SABAS could effectively capture problematic social media use (PSMU) and internet gaming disorder (IGD).MethodWe recruited 63,205. adolescents using cluster sampling. Validated questionnaires were used to assess PSMU, IGD, and mental health (depression, anxiety, sleep disturbances, well-being, resilience, and externalizing and internalizing problems).ResultsLPA identified a 3-class model for PSU, including low-risk users (38.6%, n = 24,388.), middle-risk users (42.5%, n = 26,885.), and high-risk users (18.9%, n = 11,932.). High-risk users were regarded as “PSU cases” in ROC analysis, which demonstrated an optimal cut-off point of 23 (sensitivity: 98.1%, specificity: 96.8%). According to the cutoff point, 21.1% (n = 13,317.) were identified as PSU. PSU adolescents displayed higher PSMU, IGD, and worse mental health. PSU screening effectively captured IGD (sensitivity: 86.8%, specificity: 84.5%) and PSMU (sensitivity: 84.5%, specificity: 80.2%).ConclusionA potential ideal threshold for utilizing SABAS to identify PSU could be 23 (out of 36). Employing SABAS as a screening tool for PSU holds the potential to reliably pinpoint both IGD and PSMU.

The distribution of alcohol-attributable healthcare encounters across the population of alcohol users in Ontario, Canada

Recent evidence suggests there may be no safe level of alcohol use as even low levels are associated with increased risk for harm. However, the magnitude of the population-level health burden from lower levels of alcohol use is poorly understood. The objective was to estimate the distribution of alcohol-attributable healthcare encounters (emergency department (ED) visits and hospitalizations) across the population of alcohol users aged 15+ in Ontario, Canada. Using the International Model of Alcohol Harms and Policies (InterMAHP) tool, wholly and partially alcohol-attributable healthcare encounters were estimated across alcohol users: (1) former (no past-year use); (2) low volume (≤67.3 g ethanol/week); (3) medium volume (>67.3–134.5 g ethanol/week for women and >67.3–201.8 g ethanol/week for men); and (4) high volume (>134.5 g ethanol/week for women and >201.8 g ethanol/week for men). The alcohol-attributable healthcare burden was distributed across the population of alcohol users. A small population of high volume users (23% of men, 13% of women) were estimated to have contributed to the greatest proportion of alcohol-attributable healthcare encounters, particularly among men (men: 65% of ED visits and 71% of hospitalizations, women: 49% of ED visits and 50% of hospitalizations). The 71% of women low and medium volumes users were estimated to have contributed to a substantial proportion of alcohol-attributable healthcare encounters (47% of ED visits and 34% of hospitalizations). Findings provide support for universal alcohol policies (i.e., delivered to the entire population) for reducing population-level alcohol-attributable harm in addition to targeted policies for high-risk users.

Prescription opioids, consumption cultures and “informal governing images” among “young street guys” in Nigeria

PurposeThis paper aims to explore the misuse of prescription opioids, associated consumption cultures and the emergence of “informal governing images” among young men in Nigeria.Design/methodology/approachUsing a qualitative research approach involving purposive sampling: six in-depth interviews, one focus group discussion and key informant interviews with two health-care professionals using the transgressive theory approach, this paper explores consumption cultures, motivations and the resultant “informal governing images” associated with the misuse of prescription opioids among young local street high-risk users in Nigeria.FindingsFindings show complex expressions of diverse consumption practices, such as grinding, sniffing and concoction of tramadol (TM)with other opioids. The “puff-puff pass” practice serves as induction for new users of opioids commonly accessed through street drug dealers and pharmacists sold via backdoors. Codeine mixtures with different brands of soft drinks for dilution are used to achieve a “lower high” while a concoction of different opioids, with alcohol, and spirits obtains a “higher high”. Manufacturers’ indelible colouring and bottling discourage the non-medical use of opioids. Desiring to be awake for nocturnal activities, mostly “yahoo-yahoo” (internet fraud), sexual enhancement and dosage competitions, are motivations for the non-medical use of prescription opioids. These consumption cultures create “misuse circuits”, leading to the emergence of “informal governing images” triggered by threats from formal controls.Practical implicationsThis paper, therefore, concludes that pharmaceutical industries should also add colourings to TM and codeine just like they did in rophinol to discourage the non-medical use of prescription opioids among young people in Nigeria.Social implicationsThis paper concludes that rather than branding and packaging in such a way that concealability is difficult for high-risk users as the best way to discourage the non-medical consumption of prescription opioids in Nigeria, the focus should be on addressing youth poverty and unemployment and improving access to treatment for drug use disorders, instead of calling for more enforcement-based measures.Originality/valueThis is an original research.

Association between Problematic Smartphone Use and Physical Activity among Adolescents: A Path Analysis Based on the 2020 Korea Youth Risk Behavior Web-Based Survey.

Physical activity is known to prevent several diseases and positively affect mental health. Previous studies have shown that smartphone addiction negatively affects the physical activity of children and adolescents. This study aimed to investigate the relationship between problematic smartphone use and physical activity among adolescents and the related factors using path analysis. Using data from the 16th Youth Risk Behavior Web-based Survey from 2020, scores on the Smartphone Addiction Scale-Short Version for Adolescents, physical activity, sex, socioeconomic status (SES), academic performance, depression, smoking, drinking, and sitting time were assessed. Complex sampling and path analyses were performed. Of the total 54,948 students, 25.5% were smartphone risk users, including potential and high-risk users. The direct path coefficients of each factor indicated that female sex (-0.14 for male), low SES (-0.062), high academic performance (0.056), low sitting time for studying purposes (-0.033), high sitting time for non-studying purposes (0.071), and depressive mood (0.130) were related to problematic smartphone use (all P<0.001). Each factor affected problematic smartphone use, and subsequently had a negative effect on the amount of physical activity, with a direct path coefficient of -0.115 (P<0.001). In this study, we confirmed that problematic smartphone use among adolescents was negatively associated with performing an adequate amount of physical activity and that various factors, such as sex, SES, academic performance, and sitting time, directly and indirectly affected this relationship.

1069-P: Digital Platform Users Managing Three Chronic Conditions—Diabetes, Hypertension, and Overweight—Experience Better Outcomes than Those Who Manage One Condition, after Six Months

The coexistence of diabetes, hypertension, and overweight increases the risk for macrovascular and microvascular complications. This study followed users who managed multiple chronic conditions measures, blood glucose (BG), blood pressure (BP) and weight with a single integrated digital platform. The objective was to investigate BG levels and engagement to blood glucose monitoring system (BGMS) in users managing BG, BP and weight on a single platform compared to users managing only BG on the same platform. A retrospective data analysis was performed on users who were active during 2019-2022 and measured BG using Dario platform at least six months. The test group included users who measured BP and weight within 6 months from their first BG measurement; a matched control group was generated of users who measured BG only. BG levels were assessed by average BG (BG avg) and BGMS engagement was assessed by counting BG measurements per month. High-risk users were defined as those who started BG avg&amp;gt;180mg/dL in Month 1. The test group of 2,154 users showed significantly greater (1.7-fold) BGMS engagement than the control group of 14,954 users in Month 1 and Month 6 (p&amp;lt;0.01) (N=17,108). A test subgroup of 343 high-risk users who measured 3 conditions demonstrated significantly greater reduction versus matched control subgroup of 1,579 high-risk users measured BG only, after 6 months (17% vs.11%) (p&amp;lt;0.01). Moreover, the ratio of population that reduced their BG avg to lower than 180 mg/dL after 6 months (equivalent to A1C 8.0; HEDIS measure) was significantly higher in the test subgroup versus control subgroup in high-risk (by 30%; p&amp;lt;0.01). Monitoring several conditions may have the potential to offer a greater means for person with diabetes effectively manage glycemia. This study can illuminate the relative contribution of multi chronic conditions management driving behavioral change to successful diabetes outcomes. Disclosure Y.Hershcovitz: Employee; DarioHealth Corp. S.Budman: Employee; DarioHealth Corp. N.Yaniv: Employee; DarioHealth Corp. O.Manejwala: Employee; DarioHealth Corp., Stock/Shareholder; DarioHealth Corp.

146-LB: Impact of a Digital Health Educational Feature on Engagement and Glycemic Outcomes

Introduction: Digital health educational features have the potential to improve engagement and glycemic outcomes in individuals with diabetes by providing improved knowledge, increased motivation, and personalized learning. Engagement actions are well evaluated by digital monitoring or by logging iterations, and clinical outcomes by target range measurements. A new learning feature in the Dario application included educational videos and learning materials including healthy eating habits, activity, and stress relief. This study evaluated the effect of implementing such a feature on users’ engagement and clinical outcomes. Method: A retrospective data evaluation study was performed on Dario TM members who experienced the educational feature. Engagement (blood glucose measurements and logging food to Dario app) and glycemic outcomes were assessed three months pre-post experiencing the feature. Results: A group of 994 people with type 2 and prediabetes who were active in the app and measured their blood glucose 3 months before using the new feature and in the following 3 months after, was evaluated. The average number of measurements was increased by 34% (P&amp;lt;0.05) following the introduction of the new learning feature. A subgroup of 303 users that reported depression as a co-existing condition increased food logging events by 39%. In a subgroup of 234 high-risk users (baseline &amp;gt;180 mg/dL) the average blood glucose and glucose variability were significantly reduced by 13% and 11% on average, respectively (p&amp;lt;0.05). Conclusion: The present study demonstrates that by providing improved knowledge, increased motivation, and personalized learning digital health educational features can help users feel more empowered to manage their diabetes effectively. Disclosure Y. Hershcovitz: Employee; DarioHealth Corp. A. Gurewitz: None. O. Manejwala: Employee; DarioHealth Corp. Stock/Shareholder; DarioHealth Corp.

Synthetic cannabinoids awareness among patients with opioid use disorder in Serbia - A survey based cross-sectional pilot study.

There is limited data on the awareness and use of synthetic cannabinoids (SCs) in high-risk population in Serbia, despite SCs becoming more and more common at illicit drug market. This pilot study aimed to examine the awareness and prevalence of use of SCs in patients with an opioid-use disorder and to identify patient characteristics and other factors associated with SCs use. This cross-sectional study was conducted at the Clinic for Psychiatry, Clinical Center Vojvodina, Serbia, the largest tertiary health care institution in this region of the country. All patients hospitalized due to the treatment of opioid dependence during November and December 2017 were included (response rate 100%), and filled-out an anonymous questionnaire specifically developed for the purpose of this study. Differences between patients reporting SCs use and those who did not were compared using chi-square test with values of p < 0.05 were considered significant. Out of 64 patients (median age 36.37 years), one third (32.81%) reported using SCs. Socio-demographic characteristics of the subjects were not associated with SCs use. There were differences in the most common sources of information reported between the SCs users and non-users. Majority of SCs users (76.0%) were informed about SCs through friends, compared with just 26.0% of non-users (<0.001). Nearly all study participants (93.8%) were daily tobacco users. The share of respondents reporting alcohol and marihuana use was significantly higher among the SCs users (52.0% vs. 20.9%, p = 0.011 and 15.6% vs. 12.5%, p = 0.015), respectively. Higher share of SCs users used multiple psychoactive substances (38.1% vs. 16.3%), and this difference was statistically significant (p = 0.047). The most commonly reported adverse effect of SCs among users included dry mouth (81.0%), trouble thinking clearly (52.4%) and panic attacks (52.4%). Understanding the awareness and use of SCs among high-risk drug users, as well as associated factors can help improve substance-use disorder treatment in our setting. Educational activities targeting public are urgently needed to raise awareness on SCs, considering that social contacts are the main sources of information on SC for this vulnerable population. Users of SCs have also reported using other psychoactive substances more often, and this calls for a holistic approach addressing multiple factors to improve substance-use treatment in our setting.

Can I see some ID? Examining validity of the marijuana purchase task among late adolescent cannabis users.

Cannabis demand (i.e., reinforcing value) can be assessed using a marijuana purchase task (MPT; assesses hypothetical purchasing of cannabis at escalating prices) and has been related to use frequency, problems, and cannabis use disorder symptoms in adults. Cannabis demand has yet to be studied in adolescents, which can inform prevention and intervention efforts to reduce cannabis-related risks. The present study sought to validate the MPT with a sample of late adolescent lifetime cannabis users. Participants aged 15-18 years old (n = 115, Mage = 16.9, SD = 0.9) residing in a state with legalized cannabis use completed online assessments at baseline and 6-month follow-up. Convergent and divergent validity was examined, while principal component analysis was conducted to determine the factor structure and assess predictive validity. Three indices, Omax (i.e., maximum expenditure on cannabis), breakpoint (i.e., price suppressing consumption to zero), and alpha (i.e., degree to which consumption decreases with increasing price) were all significantly associated with cannabis use, consequences, craving, and expenditures and significantly differentiated low-risk users and high-risk users as measured by the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). A two-factor solution reflecting amplitude (intensity, alpha, Omax) and persistence (breakpoint, Pmax) was observed. Both factors were associated with cannabis use and consequences in baseline regression models. At follow-up, persistence was associated with consequences; amplitude was not associated with either outcome. These findings provide initial evidence that the MPT is a valid measure for assessing cannabis demand among adolescents and can be used to understand mechanisms of adolescent cannabis use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

인터넷 중독 성향의 청소년 자녀를 둔 어머니 경험에 관한 현상학적 연구

Objectives The purpose of this study is to find out what experiences of mothers of adolescents with Internet addiction tendencies and to reveal the meanings of mothers' experiences. Methods In order to achieve the purpose of the study, a Korean-style Internet addiction self-diagnosis test (K-scale) was conducted on mothers and adolescents, respectively. The results showed that both mothers and adolescents were “potential risk users” and “high risk users.”. Among them, a study was conducted on mothers. The interviews were analyzed using Giorgi's phenomenological method, and the four-step procedures were applied to grasp the overall meanings, distinguish the meanings, convert the academic terms, and integrate them into general structural statements. Results As a result of the study, 72 semantic units, 36 sub-components, and 8 components were derived. The eight components were “feeling a sense of crisis,” “response to eliminate problems,” “vicious cycle of conflict,” “collapsing presence as a mother,” “getting smaller in a relationship,” “considering mother's role,” “attempting to change,” and “picturing hope.” It was revealed that mothers experienced worsening experiences when they only tried to eliminate their children's Internet addiction problems, and that it led to a virtuous cycle of recovery when they tried to reset their relationship with their children through existential concerns about the mother's role in frustrating situations. Conclusions This study is meaningful in that it examined the mother's experiences in coping with Internet problems by exploring in detail and in-depth what experiences of mothers of adolescents with Internet-addiction tendencies. Based on the results of this study, psychological and educational intervention directions were presented to solve the difficulties of mothers of adolescents with Internet addiction tendencies.

Association between Smartphone Addiction and Suicide.

Objective: This study aimed to explore the associations between smartphone overdependence (smartphone addiction) and suicidal ideation and attempts among Korean adolescents to acknowledge the risk of smartphone overuse. Methods: Data were obtained from the results of the 2020 Korea Youth Risk Behavior Web-based Survey. Smartphone addiction was categorized into three groups: adolescents who scored less than 23 were categorized as the general user group and formed the reference, those with scores of 23–30 were categorized as the potential-risk user group, and those with scores higher than 31 were categorized under the high-risk user group. Suicidal ideation and suicide attempt were identified as dependent variables in the present study. Multiple logistic regression was used to analyze the relationship between SA and suicidal ideation and suicide attempt status among Korean adolescents. Results: This study included 41,173 general users of smartphones, 12,142 potential-risk users, and 1633 high-risk users from among 54,948 adolescents who were middle- and high-school students. Adolescents with potentially risky smartphone use showed a higher likelihood of suicidal ideation (OR: 1.50, CI: 1.42–1.60). Similarly, adolescents with high-risk smartphone use showed a significant risk of suicidal ideation (OR: 2.49, CI: 2.21–2.81) and suicide attempt (OR: 1.87, CI: 1.48–2.37) compared to the adolescents who were general users. Conclusion: Our study results encourage parents and social workers to acknowledge that adolescents’ smartphone addiction leads to a higher risk to their mental health, wherein they may engage in suicidal ideation and even resort to a suicide attempt.

Internet Addiction among Brazilian Students: Prevalence and Association with Emotional Problems

The objective of this study was to evaluate the prevalence of Internet addiction (I.A.) among students and its association with emotional problems. A total of 2,214 students (M = 21.9; SD = 1.86) from all Brazilian regions responded to an online questionnaire and were classified according to the IAT instrument score in NRU= No-risk Users, LRU= Low-risk Users, and RHU= Risk and High-risk Users. DASS-21 measured emotional problems, and the data were analyzed using descriptive and inferential statistics. It was observed that 12.5% were classified as URAR and presented higher levels of depression (p&lt; 0.001), anxiety (p&lt; 0.001), and stress (p&lt; 0.001). The main predictors for I.A. were depression (aOR = 3.2), anxiety (aOR = 2.5), and stress (aOR = 2.6). These results confirm an association between DI and emotional problems, as indicated in the literature.

Relationship between Smartphone Addiction and Sleep Satisfaction: A Cross-Sectional Study on Korean Adolescents.

The purpose of this study was to analyze the relationship between smartphone addiction and sleep satisfaction in 54,948 Korean adolescents. This study utilized the Korea Youth Risk Behavior Web-Based Survey (KYRBS). The dependent variable was sleep satisfaction. Independent variables were smartphone addiction level and usage time. Gender, school grade, stress, depression, regular physical activity (PA), asthma, allergic rhinitis, and atopic dermatitis were selected as confounding variables. A chi-squared test, logistic regression, and independent t-test were performed for data analysis. As a result of the chi-squared test, sleep satisfaction showed significant relationships with all confounding variables (all p < 0.001). As a result of adjusting all confounding variables, sleep satisfaction of smartphone normal users was significantly higher (odds ratios: 1.372, p < 0.001) than that of high-risk users with smartphone addiction. Smartphone users with a daily smartphone usage time from 2 h to 8 h a day were 1.096–1.347 times (p = 0.014 to p < 0.001) more likely to be satisfied with their sleep than smartphone users with a daily smartphone usage time over 8 h, who were unsatisfied with their sleep. The group that was not satisfied with their sleep had a significantly higher average daily smartphone usage time and total score on the smartphone addiction scale than the group that was satisfied with their sleep (both p < 0.001). In conclusion, it will be necessary to manage the use of smartphones to improve the sleep satisfaction of Korean adolescents.

Associations between Children's Health-Related Characteristics, Self-Esteem, and Fathers' Parenting Practices and Media Addiction among Younger School-Aged Korean Children.

This study aimed to investigate the relationship between media addiction levels among early school-aged children and their health status, self-esteem, and their fathers’ parenting practices. Therefore, we analyzed the data from a total of 1149 fathers and children from the 10th year (2017) survey of the Panel Study on Korean Children (PSKC), by the Korean Children’s Panel Research Institute. Specifically, a multinomial logistic analysis was conducted to identify the factors affecting children’s media addiction. The media addiction levels were 68.8%, 24.9%, and 6.3%, in general, high-risk, and potential-risk users, respectively. When media addiction levels were used as the reference group for general users, the pattern observed in the data revealed a direct positive association between media use time and the probability of becoming a potential-risk user (79.4%, OR = 1.79, 95% CI: 1.20, 2.68). Furthermore, when general users were used as the reference group, the male gender accounted for the majority of high-risk users, at 99% (OR = 1.99, 95% CI: 1.46, 2.71). Within this group, the children’s body mass index (BMI) was high (5%, OR = 1.05, 95% CI: 1.00, 1.11), their media use time increased by 1 h a day (145%, OR = 2.45, 95% CI: 1.93, 3.11), their self-esteem decreased (32%, OR = 0.68, 95% CI: 0.49, 0.95), the fathers’ authoritative parenting practices were low (37%, OR = 0.63, 95% CI: 0.43, 0.92), and the permissive parenting practices were high (92%, OR = 1.92, 95% CI: 1.09, 3.37). Therefore, the results of this study highlight children’s media use time and the risk factors related to high BMIs in order to prevent media addiction among early school-aged children. Our findings also suggest appropriate parenting practices and highlight the need to strengthen children’s self-esteem.