Increasing Use Of Computers Research Articles

Entertainment activities and the risk of Alzheimer's disease: a Mendelian randomization analysis.

Effective prevention is key to addressing the increasing prevalence and mortality of Alzheimer's disease. Assessing the causal relationship between modifiable entertainment activity factors and the risk of Alzheimer's disease is important for developing public health measures, but establishing causal relationships in epidemiological data may be challenging. This study using the two-sample Mendelian randomization analysis aimed to investigate the causal effect of entertainment activity factors on the risk of Alzheimer's disease. Summary statistics from publicly available genome-wide association studies were used to analyze 14 modifiable entertainment activity. The inverse variance weighted random effects method as the primary analytical method to estimate causal effects was used. Additionally performed MR-Egger, weighted median and weighted model methods to assess the robustness of the results. The reliability of our findings was validated through systematic sensitivity analyses and tests for heterogeneity. We found significant correlation between time spent using computer (odds ratio 0.998; 95% confidence interval 0.996-0.999; p = 0.013) and Alzheimer's disease, compared to other studied entertainment activities that had no significant causal relationship with Alzheimer's disease. Our findings support the hypothesis that increased computer use may reduce the risk of Alzheimer's disease, providing potential strategic directions for the prevention of neurodegenerative diseases.

Extended Working Lives in Denmark and Finland: Influences of Computerization

Extended working lives become important in aging populations. Yet, for a long time, increasing computer use pushed older individuals out of the workforce. Recently, older workers’ computer skills have improved. This article investigates how computer use, experience, and training affect workforce participation in old age in countries with widespread computer use. It conducts regression analyses of Danish and Finnish survey data. Findings show that individuals who used computers had a higher chance of remaining in the workforce. Computer experience made older Finns marginally more likely to retire. However, computer training had no influence. Findings suggest that the relevance of computer use for extended working lives depends on a country’s computerization level: the higher the level, the less of an obstacle to extended working lives computerization presents. Policymakers should facilitate older workers’ computer use especially when computers are first introduced, and explore alternative means for extending working lives afterwards.

Deep-Learning Based Automatic Ergonomic Assessment Using Webcam Data

Primarily due to increasing computer use, people are spending more and more time sitting in front of a desk every day. However, prolonged sitting has been associated with tiredness, hypertension, and pain in areas like the lower back or shoulders. These symptoms arise for a variety of reasons, but musculoskeletal disorders in particular are largely associated with poor postures. The adverse results caused by poor postures can be controlled with proper training and monitoring. This study attempts to provide automatic ergonomic assessment using only webcam data. Since laptops, desktops, and phones are now widely available and equipped with built-in cameras, this solution is accessible and convenient for most people. More importantly, automatic posture assessment may help to prevent conditions associated with poor posture by giving reminders whenever improper posture occurs. To create our model, we make use of Mediapipe, which provides a solution to identifying keypoint locations from an image. By training our MLP classifier on this key-point data, we achieved a 96.96% test F1 score, indicating that our system serves as a convenient way to assess posture while maintaining high performance. To illustrate our results, we perform a final video classification by overlaying the model’s pre-dictions on each frame.

Development of Nystagmus Test and Measurement for Benign Paroxysmal Positional Vertigo

Vertigo is the illusion of rotation occuring due to a problem or a set of problems in the balance system of the body, and it is the situation that objects or places around the patients are in a revolving position around themselves. In vertigo, which is examined under two main headings as central and peripheral, central vertigo can be caused by aneurysms, tumors, and brain vascular distruption caused by brain lesions, while peripheral vertigo can occur due to thyroid types and metabolic disorders. Benign paroxysmal positional vertigo, colloquially called ‘crystal floating’, is the most common type of peripheral vertigo and many diagnostic, exercise and treatment methods are used in case of BPPV. However, today, as a result of the increase in computer use, treatment interactions have increased significantly. In line with the software created in this study, a computer-based diagnosis system and measurement system of nystagmus movements due to BPPV were developed. The system consists of three parts: mechanical, software and hardware. Visual Studio c# software interface and connection control software were formed in accordance with the diagnostic methods obtained from the literature. Software panels prepared on the interface for bithermal caloric and other tests are opened and the electronystagmography data prepared accordingly are graphed on Digilent Waveforms Analog Discovery. The performance of the BPPV test and measurement system were applied to the control group consisting of 10 healthy individuals. Dix-Hallpike, gaze, head rotation, optokinetic, pursuit tracking, bithermal caloric, Head Shaking and Saccadic tests were applied. As a result, the time for the preparation of the bithermal caloric test to 30-degree temperature value of the 3900 ml and 2600 ml was calculated as 4.00 ∓ 1.8 s and 3.67 ∓ 2.8 s. For 44-degree temperature value, they were -1,70 ∓ 2,75 s and -0,70 ∓ 3,09 s. Thus, it is seen that the developed system will enable the diagnosis of patients with BPPV to be determined in accordance with integrated visual stimuli in an accurate and ergonomic environment.

Postural strategies among office workers during a prolonged sitting bout

Sedentary behavior has increased steadily over prior decades, primarily due to increased computer use at work and at home. The total sedentary time per day has been associated with increased risk of cardiometabolic diseases; increased sitting time at work has been associated with musculoskeletal discomfort particularly in the low back. Office workers spend many hours sitting, thus efforts to increase movement through changes of posture (sit to stand) or moving while sitting have been proposed as ways to mitigate the negative effects of prolonged sitting. Yet, few studies have investigated differences in the movement patterns of office workers while sitting performing their actual work. Therefore, the aim of this study was to characterize movement patterns during a prolonged sitting bout and to determine their association with musculoskeletal pain. Twenty-eight office workers participated in this field study that used a pressure sensitive mat to quantify seat pan pressure (4 regions) and trunk sway parameters over a 2-hour bout of computer work. Data were stratified by breakers who stood up at least once within the 2-hour test and prolongers who remained sitting throughout the test. Overall, there was a decreasing trend in trunk sway parameters (mean COP position, sway path, sway area, sway velocity, maximum displacement, and in-chair movements) over time (p < 0.05), with significant changes in sitting strategies. There were significant differences in trunk sway parameters and perceived musculoskeletal discomfort between breakers and prolongers with breakers having more consistent movement while sitting over the prolonged sitting bout (p < 0.05) and lower discomfort ratings. This may indicate that interrupting prolonged bouts of sitting with short periods of standing can maintain sitting movement patterns and reduce the development of musculoskeletal discomfort. Trunk sway monitoring and promoting periodic standing may be useful tools for maintaining in chair movements that may reduce or prevent the onset of musculoskeletal discomfort during prolonged sitting.

Factors influencing use and perceptions of teledermatology: A mixed-methods study of 942 participants

BackgroundThe protracted COVID-19 pandemic highlights the need for a sustainable telemedicine practice.ObjectiveTo understand patient perceptions toward teledermatology.MethodsConvergent parallel mixed-methods study of 942 dermatology patients or their caregivers between June 2020 and April 2021.ResultsMultivariate regression found that youth, increased computer use, willingness to show body areas over photo/video, perceived quality of teledermatology, demand for social distancing and to reduce commute were associated with willingness to use teledermatology. The willingness to use teledermatology declined with the easing of COVID-19 movement restrictions, and 48.5% reported a poorer experience with teledermatology than with in-person consultations. Qualitative data from 26 interviews showed that willingness to use is influenced by pragmatic considerations, emotional factors, and data privacy concerns. These were moderated by the patient's perception of disease severity and need for an accurate diagnosis.LimitationsLack of data prior to the pandemic and during the initial lockdown period.ConclusionThe willingness to use teledermatology is influenced by circumstantial factors, technology literacy, views toward teledermatology, and factors driving the purpose of consultation. The declining willingness to use teledermatology with the easing pandemic, lower willingness to pay full in-clinic prices, and poorer experience compared with in-person consultations highlights the need to optimize this mode of delivery.

Increased Computer Use is Associated with Trunk Asymmetry That Negatively Impacts Health-Related Quality of Life in Early Adolescents.

PurposeThis study aimed to investigate the effects of trunk asymmetry on the health-related quality of life of early adolescents and to identify daily activities that were associated with trunk asymmetry in this cohort.MethodsThis study included 200 early adolescents (52 male and 148 female) aged 10 to 14 years in Hong Kong. Among them, 100 adolescents were considered to have trunk asymmetry with angle of trunk rotation ≥5° and one or more physical signs on visual inspection. The 36-Item Short Form Health Survey was used to measure the eight scales under the physical and mental domains of the health-related quality of life. The adolescents reported their average daily durations spent (1) using a computer; (2) using a smartphone; (3) watching television, videos or DVDs; (4) doing homework; and (5) doing physical exercise. Independent samples t-tests, chi-square (χ2) tests or Mann–Whitney U-tests were performed to compare the health-related quality of life and the average daily duration of daily activities between early adolescents with and without trunk asymmetry. Logistic regression was performed to investigate the odds ratios of daily activities for trunk asymmetry.ResultsCompared with early adolescents without trunk asymmetry, those with trunk asymmetry had a lower health-related quality of life in some of the physical domains, namely, bodily pain and general health, and all mental domains, namely, vitality (energy/fatigue), social functioning, role limitation due to emotional problems and mental health (p < 0.05). Use of computer was found to be significantly associated with trunk asymmetry in early adolescents (OR = 1.63, 95% CI [1.23, 2.14]).ConclusionOur results indicate that increased computer use is associated with trunk asymmetry, which negatively impacts the health-related quality of life in early adolescents.

Increased Screen Time Is Associated With Alcohol Desire and Sweetened Foods Consumption During the COVID-19 Pandemic.

Background: Elevated screen time has been associated with addictive behaviors, such as alcohol and sugar intake and smoking. Considering the substantial increase in screen time caused by social isolation policies, this study aimed to analyze the association of increased screen time in different devices during the COVID-19 pandemic with consumption and increased desire of alcohol, smoking, and sweetened foods in adults.Methods: A sample of 1,897 adults with a mean age of 37.9 (13.3) years was assessed by an online survey, being composed by 58% of women. Participants were asked whether screen time in television, cell phone, and computer increased during the pandemic, as well as how much time is spent in each device. Closed questions assessed the frequency of alcohol and sweetened food consumption, smoking, and an increased desire to drink and smoke during the pandemic. Educational level, age, sex, feeling of stress, anxiety, depression, and use of a screen device for physical activity were covariates. Binary logistic regression models considered adjustment for covariates and for mutual habits.Results: Increased television time was associated with increased desire to drink (OR = 1.46, 95% CI: 1.12; 1.89) and increased sweetened food consumption (OR = 1.53, 95% CI: 1.18; 1.99), while an increase in computer use was negatively associated with consumption of alcohol (OR = 0.68, 95% CI: 0.53; 0.86) and sweetened foods (OR = 0.78, 95% CI: 0.62; 0.98). Increased cell phone time was associated with increased sweetened food consumption during the pandemic (OR = 1.78, 95% CI: 1.18; 2.67). Participants with increased time in the three devices were less likely to consume sweetened foods for ≥5 days per week (OR = 0.63, 95% CI: 0.39; 0.99) but were twice as likely to have sweetened food consumption increased during pandemic (OR = 2.04, 95% CI: 1.07; 3.88).Conclusion: Increased screen time was differently associated with consumption and desire for alcohol and sweets according to screen devices. Increased time in television and cell phones need to be considered for further investigations of behavioral impairments caused by the pandemic.

Influence of sitting behaviors on sleep disturbance and memory impairment in breast cancer survivors.

BackgroundThe purpose was to prospectively examine the effects of sedentary behaviors on subjective memory impairment in breast cancer survivors (BCS) and the extent to which sleep disturbances mediated this pathway.MethodsBCS (N = 380; M age = 57.38 ± 9.25 years) completed questionnaires assessing demographics, health history, sitting behaviors, sleep disturbance, subjective memory impairment, and moderate‐to‐vigorous physical activity (MVPA) at baseline and 6‐month follow‐up. A subsample (N = 300) wore an accelerometer to objectively estimate sedentary time and MVPA. Structural equation modeling was used to test direct and indirect effects of self‐reported and objectively estimated sedentary behaviors on memory impairment (through sleep disturbance) across time. Models were adjusted for demographic, clinical, and MVPA covariates.ResultsAt baseline, more total daily sitting (γ = 0.23), occupational sitting (γ = 0.11), television viewing (γ = 0.15), and computer use (γ = 0.22) were associated with greater sleep disturbance, which was associated with greater memory impairment (γ = −0.22). Indirect effects of self‐reported sitting on memory were significant. At follow‐up, increased total daily sitting (γ = 0.08) and computer use (γ = 0.14) predicted increased sleep disturbance, which predicted increased memory impairment (γ = −0.09). The indirect path from increased computer use to memory impairment was significant (β = −0.01). In the accelerometer subsample, greater daily sedentary time at baseline was associated with less sleep disturbance (γ = −0.14) and memory impairment (indirect effect: β = 0.03).ConclusionsFindings provide early evidence that sedentary contexts may differentially influence sleep disturbance and memory impairment in BCS. Computer use and television viewing may pose the strongest risks to cognitive health. Disparate findings between objective and subjective sedentary measures warrant further research.

Unsw-Nb15 Dataset and Machine Learning Based Intrusion Detection Systems

The network attacks become the most important security problems in the today’s world. There is a high increase in use of computers, mobiles, sensors,IoTs in networks, Big Data, Web Application/Server,Clouds and other computing resources. With the high increase in network traffic, hackers and malicious users are planning new ways of network intrusions. Many techniques have been developed to detect these intrusions which are based on data mining and machine learning methods. Machine learning algorithms intend to detect anomalies using supervised and unsupervised approaches.Both the detection techniques have been implemented using IDS datasets like DARPA98, KDDCUP99, NSL-KDD, ISCX, ISOT.UNSW-NB15 is the latest dataset. This data set contains nine different modern attack types and wide varieties of real normal activities. In this paper, a detailed survey of various machine learning based techniques applied on UNSW-NB15 data set have been carried out and suggested thatUNSW-NB15 is more complex than other datasets and is assumed as a new benchmark data set for evaluating NIDSs.

The impact of computer use on myopia development in childhood: The Generation R study

Environmental factors are important in the development of myopia. There is still limited evidence as to whether computer use is a risk factor. The aim of this study is to investigate the association between computer use and myopia in the context of other near work activities.Within the birth cohort study Generation R, we studied 5074 children born in Rotterdam between 2002 and 2006. Refractive error and axial length was measured at ages 6 and 9. Information on computer use and outdoor exposure was obtained at age 3, 6 and 9 years using a questionnaire, and reading time and reading distance were assessed at age 9 years. Myopia prevalence (spherical equivalent ≤–0.5 dioptre) was 11.5% at 9 years. Mean computer use was associated with myopia at age 9 (OR = 1.005, 95% CI = 1.001–1.009), as was reading time and reading distance (OR = 1.031; 95% CI = 1.007–1.055 (5–10 h/wk); OR = 1.113; 95% CI = 1.073–1.155 (>10 h/wk) and OR = 1.072; 95% CI = 1.048–1.097 respectively). The combined effect of near work (computer use, reading time and reading distance) showed an increased odds ratio for myopia at age 9 (OR = 1.072; 95% CI = 1.047–1.098), while outdoor exposure showed a decreased odds ratio (OR = 0.996; 95% CI = 0.994–0.999) and the interaction term was significant (P = 0.036). From our results, we can conclude that within our sample of children, increased computer use is associated with myopia development. The effect of combined near work was decreased by outdoor exposure. The risks of digital devices on myopia and the protection by outdoor exposure should become widely known. Public campaigns are warranted.

A trend of cumulative trauma disorders in indian computer users: A comparison of surveys of the year 2009 versus 2019

Background: Digitalization has resulted in increased computer use. Computer use involves repetitive movements and relatively static posture of neck, limbs, and trunk, contributing in cumulative trauma disorders (CTDs). Over a decade, ergonomic awareness has increased, but CTDs have prevailed. Objective: A comparison of 2009 versus 2019 surveys was done to understand CTD trends and to find the significance of the number of people affected due to hours per day computer use. Study Design: A comparison of two surveys was conducted to research trend in occurrences of CTDs. Methods: The sampling was done using the snowball method. Both surveys had identical research methodology and collected data of (n) 100 computer users of India with an age range of 20–50 years, i.e., total of N = 200 in combined surveys. Participants filled in the self-explanatory questionnaire on Google Forms that assessed areas of CTD pain, severity of pain, and functional performance during pain. Results: Data analysis showed a higher percentage of pain in the neck, eye strain, and back pain in computer users in both 2009 and 2019 surveys. There was an overall decrease in the percentage of computer users affected with CTDs from 86% to 70%, but anatomically, an increase in percentages of pain in the upper limb, headaches, and lower-back pain was reported in 2019. The relation between duration of computer use and number of computer users affected was found to be nonsignificant for both 2009 and 2019 surveys (χ[2] = 3.5408; P = 1.7027 and χ[2] = 1.3739; P = 0.5031, respectively, 95% confidence interval [CI] [4.605, 7.378]). Spearman's correlation showed no significant correlation between duration of computer use and severity of pain in both 2009 (r = 0.078; P = 0.443, 95% CI [−0.120, 0.270]) and 2019 (r = −0.085; P = 0.398, 95% CI [−0.277, 0.114]). Conclusion: The comparison of 2009 and 2019 surveys showed an overall decrease in the percentage of computer users affected with CTDs in the 2019 survey. An increase in upper-limb pain, headache, and lower-back ache percentages was noted, while upper-back pain, neck pain, and eye strain percentage showed a decreasing trend in the 2019 survey. The percentage of computer users affected with pain in the neck, pain in the back, and eye strain was higher than other CTD areas in both the surveys. The duration of computer use did not show a significant correlation to the presence of CTDs among computer users in both surveys.

The Effect of Computer Use on Work Discretion and Work Intensity: Evidence from Europe

AbstractThis article studies changes in computer use and work discretion and intensity in the EU‐15 between 1995 and 2015. We document that while the proportion of workers using computers has increased from 40 per cent to more than 60 per cent, there remain significant differences between countries even within the same occupations. Several countries have seen a significant increase in computer use even in low‐skilled occupations generally assumed to be less affected by technology. Overall, the great increase in computer use between 1995 and 2015 coincided with a period of modest deterioration of job quality in the EU‐15 as a whole, as work discretion declined for most occupational and educational groups, while work intensity increased slightly for most of them. Our OLS results exploiting variation within country‐occupation cells point to a sizeable positive effect of computer use on work discretion, but to no effect on work intensity. Our instrumental variable estimates point to an even more benign effect of computer use on job quality as measured by work discretion and work intensity. Hence, the results suggest that the (moderate) deterioration in the quality of work observed in the EU‐15 between 1995 and 2015 has occurred despite the spread of computers, rather than because of them.

Your biggest refund, guaranteed? Internet access, tax filing method, and reported tax liability

The fraction of US individual income tax returns filed as hand-prepared paper returns fell from 31 to 15% between 1999 and 2004, reflecting the spread of high-speed Internet and increased use of tax preparation software. I use zip code-level Internal Revenue Service tax data from 1998 to 2007 and Federal Communications Commission Internet service provider data to examine the effect of high-speed Internet availability on tax reporting behavior. Differences-in-differences results show increased rates of itemizing, higher total value of itemized deductions, and lower tax-to-income ratios after high-speed Internet becomes available. I differentiate between access in the tax year and the filing year and show that the tax reporting effects are driven by filing year availability and that filing year Internet availability also positively predicts electronic filing. I use instrumental variables methods to explore the relationship between Internet availability-induced electronic filing on tax reporting behavior and find suggestive evidence that e-filing driven by Internet access increased itemizing rates and total value itemized and lowered tax-to-income ratios. The results suggest changes in tax filing method driven by increased computer use and Internet access helped taxpayers identify relevant deductions and credits and lowered reported tax liability.

The Effect of Computer Use on Job Quality: Evidence from Europe

This paper studies changes in computer use and job quality in the EU-15 between 1995 and 2015. We document that while the proportion of workers using computers has increased from 40% to more than 60% over twenty years, there remain significant differences between countries even within the same occupations. Several countries have seen a significant increase in computer use even in low-skilled occupations generally assumed to be less affected by technology. Overall, the great increase in computer use between 1995 and 2015 has coincided with a period of modest deterioration of job quality in the EU-15 as whole, as discretion declined for most occupational and educational groups while intensity increased slightly for most of them. Our OLS results that exploit variation within country-occupation cells point to a sizeable positive effect of computer use on discretion, but to small or no effect on intensity at work. Our instrumental variable estimates point to an even more benign effect of computer use on job quality. Hence, the results suggest that the (moderate) deterioration in the quality of work observed in the EU-15 between 1995 and 2015 has occurred despite the spread of computers, rather than because of them.

Trends in domain-specific physical activity and sedentary behaviors among Chinese school children, 2004\u20132011

BackgroundDramatic increases in child overweight have occurred in China. A comprehensive look at trends in physical activity and sedentary behaviors among Chinese youth is needed. The study aimed to examine trends in domain-specific physical activity and sedentary behaviors, explore mean and distributional changes in predicted behaviors over time, and investigate how behaviors vary by residence.MethodsUsing 2004–2011 China Health and Nutrition Survey data, adjusted means for MET-hours/week from physical activity and hours/week from sedentary behaviors were determined for school children (6–18 years), stratifying by gender, age group, and residence. Physical activity domains included in-school physical activity, active leisure (out-of-school physical activity), active travel (walking or biking), and domestic activity (cooking, cleaning, and child care). For each physical activity domain, the MET-hours/week measure was determined from the total weekly time spent (hours) in domain-specific activities and corresponding MET-values using the Compendium of Energy Expenditures for Youth. Sedentary behaviors included television, computer use, homework, and other behaviors (board games, toys, extracurricular reading and writing). For each sedentary behavior, the hours/week measure was determined from total weekly time spent in specific sedentary behaviors. Residence groups included megacities (population ≥ 20million), cities/towns (300,000 ≤ population < 20million), and rural/suburban areas (population < 300,000). Repeated measure linear mixed and quantile regression models were used to predict adjusted means.ResultsLittle change in physical activity behaviors occurred over time, with the exception of statistically significant trends toward increased domestic activity among male children (p < .05). Across all gender and age groups, statistically significant trends over time toward an average increase in computer use were seen (p < .01); these increases were largely driven by those ≥50th percentile on the distribution. Children living in megacities (versus rural areas) reported higher levels of physical activity, homework, and computer use.ConclusionsIntensified, systematic intervention and policy efforts promoting physical activity and reducing sedentary behaviors among children are needed.

International Trends in Adolescent Screen-Time Behaviors From 2002 to 2010

PurposeEngaging in prolonged screen-time behaviors (STBs) is detrimental for health. The objective of the present analyses was to examine temporal trends in TV viewing and computer use among adolescents across 30 countries. MethodsData were derived from the cross-national Health Behaviour in School-aged Children study. Data on TV viewing and computer use for gaming and nongaming purposes were collected in 2002 (n = 139,725 [51.4% girls]), 2006 (n = 149,251 [51.3% girls]), and 2010 (n = 154,845 [51.2% girls]). The temporal trends in TV viewing and computer use were each tested for all countries combined and for each individual country by sex-specific univariate analysis of variance. ResultsBetween 2002 and 2010, TV viewing decreased slightly in most of the 30 countries among both boys and girls. This decrease was more than offset by a sharp increase in computer use, which was consistent across all countries. Overall, boys reported more hours of STBs. They also reported a slightly larger decrease in TV viewing and slightly larger increase in computer use. STBs were generally more frequent on weekend days. ConclusionsThe overall cross-national increases in STBs should be a call to action for public health practitioners, policy-makers, and researchers that interventions specifically focused on reducing STBs in youth are sorely needed. Because all countries experienced a trend in the same direction, it might be fruitful to learn more about the determinants of STBs among those countries in which hours of STBs are generally low as compared with other countries.

Cost-utility analysis of an internet and computer training intervention to improve independence and mental wellbeing of older people

BackgroundGood mental health and emotional wellbeing are as important in older age as at any other time of life. This study aimed to assess the cost-effectiveness of an intervention to improve the independence and mental wellbeing of older people. MethodsCost-consequence analysis (CCA) and cost-utility analysis (CUA) were used to assess the cost-effectiveness of an internet and computer training intervention (9 h of group training over 2 weeks) versus no training. The CCA reported a range of outcomes, including reductions in loneliness and social isolation. The CUA was conducted with a decision analytical model, and populated with published data on the effect of loneliness on health outcomes such as depression, stroke, and coronary heart disease; it adopted a lifetime horizon and health service perspective. FindingsThe original intervention study (appendix) identified no statistically significant difference between groups for loneliness after 5 months, but noted increased computer use. Increased computer use has been linked to a range of positive outcomes more generally, including social network benefits and a decrease in isolation and loneliness, and this was outlined in the CCA. The increase in computer use identified in the original study corresponded to a 1·62 decrease in loneliness (UCLA Loneliness Scale), which resulted in about 2% of the population moving from moderately lonely to not lonely. Focusing only on the health outcomes that are improved by a reduction in loneliness, the internet and computer training intervention is expected to reduce depression by 0·67%, reduce the early onset of dementia by 0·14%, and increase physical activity by 1·24% (thus reducing diabetes by 0·09%, stroke by 0·1%, and coronary heart disease by 0·17%). An intervention cost of £564 per person leads to future cost savings to the health service of £224 and a quality adjusted life years gain of 0·021 per person (all present values). The incremental cost-effectiveness ratio is £15 962 (ranging from £2735 to £42 415 in the sensitivity analysis, appendix). This excludes benefits in terms of reduced mortality, as well as other gains discussed in the CCA, such as social network benefits. InterpretationAlthough this analysis was based on extrapolation from an initial study with a fairly short follow-up, the results suggest that an internet and computer training intervention is likely to be cost effective at improving the physical and mental health of older people. FundingNational Institute for Health and Care Excellence (NICE).

The process of implementation of the diabetes register in Primary Health Care

According to Swedish law, all health care units must have a system for quality improvement. The aim of this study was to follow an implementation process of a uniform routine for quality control of diabetes care in Primary Health Care in one county. Primary Health Care had a decentralized organization and patients with type 2 diabetes were served at 42 different Primary Health Care Centres. As the Swedish Diabetes Register (National Diabetes Register, NDR) holds the most important quality indicators, implementation of the NDR registration at all centres was chosen to be the best way to follow up quality in diabetes care. The process of implementing the NDR went through different phases and the main way to encourage commitment to the process was to reward performance in a progressively more differentiated way. During the implementation process (2001-05) there was an increasing rate of registration. When the programme ceased, the registration rate had reached a level of 75%, which has remained stable and was still in 2010 one of the highest rates in Sweden. Important factors for success were the initiative taken by the profession itself and strong support from the leaders of the county council. It was also important to let the process develop gradually in order to get all staff involved. Among the outcomes was an increase in computer use in clinical practice among the diabetes nurse specialists and a structured way of encouraging the patients' participation in self-care.

Prevalence and risk factors associated with spinal pain in adolescent computer users: a systematic review.

Increased computer use has been suggested as a contributing factor for a rapid increase in the prevalence of neck and back pain in adolescents in the late 1990s and the beginning of 2000. The overall objective of this review was to synthesise the best available evidence on the estimates of prevalence of, and risk factors associated with, spinal discomfort in adolescent computer users. This review considered cross-sectional, case-control, or cohort studies. Studies were considered for inclusion if they reported either prevalence or risk factors associated with spinal pain in adolescents aged between 13 and 18 years using computer in school or at home. The search included The Cochrane Library, JBI Library of Systematic Reviews, PEDro, MEDLINE, CINAHL, Web of Science, ERIC, PsycINFO, EMBASE, and CEPS. The grey literature was also searched. The search was limited to English and Chinese language papers, and spanned from the inception of each database to May 2011. Two review authors independently evaluated the methodological quality of the included studies using the standardised Joanna Briggs Institute instruments. Data was extracted using the standardised Joanna Briggs Institute data extraction form. Meta-analysis was not appropriate because there was considerable heterogeneity between studies. The findings were summarised in tables and in narrative form. Seven studies were included in this review: three studies were carried out in Finland, two in the USA, one in Sweden, and one in South Africa. There was marked variability in the period prevalence data across different studies: 15-60% for cervical pain and 12-53% for lumbar pain. None of the reviewed studies reported the confidence intervals for prevalence estimate. Four studies investigated the association between the duration of computer use and cervical pain, two studies for lumbar pain and none for thoracic pain. Positive associations between the duration of computer use and cervical pain were found in three out of four studies, with the odds ratio ranged from 1.3 (95% CI 1.1 to 1.6) to 2.3 (95% CI 1.5 to 3.6). One study found that weekly internet use greater than 42 hours predicted the occurrence of lumbar pain, and the odds ratio was 1.9 with 95% CI of 1.1 to 3.4. The other study reported non-significant association without providing statistical evidence. This systematic review suggests a relatively high prevalence of spinal pain in adolescents. The cervical spine region appears to be more prone to musculoskeletal pain than the lumbar or thoracic regions. Cervical spine pain was statistically significantly associated with duration of computer use, however the odds ratio may be too small to be considered clinical significant. There is conflicting evidence on the association with duration of computer use and lumbar pain and no evidence for thoracic spine. The relatively high prevalence of spinal pain in adolescents highlights the need for preventative and treatment strategies. Further research, preferably prospective cohort studies utilising physical examination, is required to more rigorously investigate the issue of computer use and spinal pain among adolescents. There is a need to conduct more research in Asian or developing countries to reflect any cultural or socioeconomic differences that may influence the amount of computer exposure and its potential impact on musculoskeletal health in adolescent computer users.