Infrequent Users Research Articles

Engagement with a preventive eHealth intervention in older adults (the HATICE trial): Predictive factors and associations with dementia and cardiovascular risk

AbstractBackgroundEngagement with digital health tools ihas not been well‐studied in older populations. We aimed to describe engagement with a preventive eHealth intervention designed to reduce dementia and cardiovascular risk, identify factors associated with engagement, and examine associations between engagement and changes in dementia and cardiovascular risk factors.MethodWe analyzed data from the 18‐month randomized controlled ‘Healthy Ageing Through Internet Counselling in the Elderly’ (HATICE) trial. Participants, enrolled in Finland, France, and the Netherlands, were aged 65+ with at least basic computer literacy and either ≥2 cardiovascular risk factors or history of cardiovascular disease/diabetes. The intervention group (N=1389) received access to an interactive Internet platform, designed to encourage lifestyle changes, with remote support from a lifestyle coach. The control group (N=1335) received access a static Internet platform containing basic health information. Engagement with the intervention platform was assessed via number of logins, lifestyle goals set, messages sent to the coach, monitoring measurements entered, and amount of advice and education materials read. These metrics were combined into a composite engagement score.ResultMost intervention group participants engaged with the platform to some extent: 90% set ≥1 goal, 86% sent ≥1 message and 80% entered ≥1 measurement. The median (IQR) number of logins per participant during follow‐up was 29 (16‐48). Regular computer use was the strongest baseline predictor of engagement. Those already working on or with short‐term plans for lifestyle improvement, and better cognition also engaged more. Compared to the control group, after adjustment, intervention group participants who engaged more with the platform showed significantly more improvement over 18‐months in systolic blood pressure, BMI, physical activity, Mediterranean diet score, and cardiovascular/dementia risk scores. Intervention group participants with a low engagement score showed no improvement compared to the control group.ConclusionEngaging older people in a digital lifestyle self‐management intervention was feasible. Better engagement led to more improvement in dementia and cardiovascular risk factors. Older adults who are infrequent computer users, have poorer cognition, and no concrete plans to change their lifestyle may need extra support for digital lifestyle interventions. Disparities in engagement may be further emphasized in real‐world settings.

Concurrent use of e-cigarettes and cannabis and associated COVID-19 symptoms, testing, and diagnosis among student e-cigarette users at four U.S. Universities

IntroductionThis investigation assessed whether current (past 30-day) electronic cigarette (e-cigarette) and cannabis use was associated with coronavirus disease 2019 (COVID-19) symptomatology, testing, and diagnosis among college student e-cigarette users. MethodsParticipants were 18–26-year-old college student e-cigarette users attending four geographically diverse, large U.S. public universities during October-December 2020 (N = 800). Multivariable logistic regression models explored associations between exclusive e-cigarette use and concurrent e-cigarette and cannabis use and COVID-19 symptoms, testing, and diagnosis. Models controlled for demographics, university site, and current use of combustible cigarettes, cigars, and smokeless tobacco. ResultsOver half of student e-cigarette users (52.0%) concurrently used cannabis. Compared to exclusive e-cigarette users, concurrent e-cigarette and cannabis users were 3.53 times more likely (95%CI = 1.96–6.36) to report COVID-19 symptoms, after adjusting for the covariates. Compared to infrequent exclusive e-cigarette users, infrequent concurrent users (AOR = 4.72, 95%CI = 1.31–17.00), intermediate concurrent users (AOR = 5.10, 95%CI = 1.37–18.97), and frequent concurrent users (AOR = 7.44, 95%CI = 2.06–26.84) were at increased odds of reporting COVID-19 symptoms. Compared to exclusive e-cigarette users, concurrent e-cigarette and cannabis users were 1.85 times more likely (95%CI = 1.15–2.98) to report a COVID-19 diagnosis. Intermediate concurrent users (AOR = 2.88, 95%CI = 1.13–7.35) and frequent concurrent users (AOR = 3.22, 95%CI = 1.32–7.87) were at increased odds of reporting a COVID-19 diagnosis, compared to infrequent exclusive e-cigarette users. ConclusionsConcurrent use of e-cigarettes and cannabis may be an underlying risk factor of COVID-19 symptomatology and diagnosis, with more pronounced odds found among intermediate and frequent users. Results highlight the need to educate students about the impacts of e-cigarette and cannabis use on respiratory, immune, and overall health.

Society for Vascular Surgery best practice recommendations for use of social media

The use of social media (SoMe) in medicine has demonstrated the ability to advance networking among clinicians and other healthcare staff, disseminate research, increase access to up-to-date information, and inform and engage medical trainees and the public at-large. With increasing SoMe use by vascular surgeons and other vascular specialists, it is important to uphold core tenets of our commitment to our patients by protecting their privacy, encouraging appropriate consent and use of any patient-related imagery, and disclosing relevant conflicts of interest. Additionally, we recognize the potential for negative interactions online regarding differing opinions on optimal treatment options for patients. The Society for Vascular Surgery (SVS) is committed to supporting appropriate and effective use of SoMe content that is honest, well-informed, and accurate. The Young Surgeons Committee of the SVS convened a diverse writing group of SVS members to help guide novice as well as veteran SoMe users on best practices for advancing medical knowledge-sharing in an online environment. These recommendations are presented here with the goal of elevating patient privacy and physician transparency, while also offering support and resources for infrequent SoMe users to increase their engagement with each other in new, virtual formats.

Latent class analysis of use frequencies for multiple tobacco products in US adults

A persistent challenge is characterizing patterns of tobacco use in terms of product combinations and frequency. Using Wave 4 (2016–17) Population Assessment of Tobacco and Health Study adult data, we conducted latent class analyses (LCA) of past 30-day frequency of use for 9 tobacco products. One-step LCA with joint multinomial logistic regression models compared sociodemographic factors between users (n = 13,716) and non-users (n = 17,457), and between latent classes of users. We accounted for survey design and weights. Our analyses identified 6 classes: in addition to non-users (C0: 75.7%), we found 5 distinct latent classes of users: daily exclusive cigarette users (C1: 15.5%); occasional cigarette and polytobacco users (C2: 3.8%); frequent e-product and occasional cigarette users (C3: 2.2%); daily smokeless tobacco (SLT) and infrequent cigarette users (C4: 2.0%); and occasional cigar users (C5: 0.8%). Compared to C1: C2 and C3 had higher odds of being male (versus female), younger (especially 18–24 versus 55 years), and having higher education; C2 had higher, while C3 and C4 had lower, odds of being a racial/ethnic minority (versus Non-Hispanic White); C4 and C5 had much higher odds of being male (versus female) and heterosexual (versus sexual minority) and having higher income; and C5 had higher odds of college or more education. We identified three classes of daily or frequent users of a primary product (cigarettes, SLT or e-products) and two classes of occasional users (cigarettes, cigars and polytobacco). Sociodemographic differences in class membership may influence tobacco-related health disparities associated with specific patterns of use.

Applying behaviour change theory to understand the barriers to implementing routine outcome monitoring.

Routine outcome monitoring (ROM) is a valuable tool for monitoring client progress and pre-empting deterioration, however, there is considerable variation in how data are collected and recorded and uptake in clinical practice remains low. The aim of this study was to develop a self-report measure of practitioner attitudes to ROM in order to better understand the barriers to successful implementation in Child and Adolescent Mental Health Services (CAMHS). An anonymous survey was completed by 184 CAMHS practitioners in the United Kingdom. The survey was designed using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B). Practitioners who reported using ROM frequently in their clinical work (53%) were compared to those who used ROM infrequently (47%) across dimensions of the COM-B survey subscales. Confirmatory factor analysis confirmed the proposed four-factor structure, showing acceptable model fit, with high factor loadings and good reliability for all subscales. Frequent users of ROM exhibited significantly higher psychological capability, physical opportunity, social opportunity, and motivation, compared to infrequent users F (4, 140) = 14.76, p < .0001; Pillai's Trace = .297, partial η2 = .30. Results highlight several barriers to ROM, including the belief that there is not a strong evidence base for ROM, not receiving external training, and not discussing feedback and outcome data in supervision. In the hope of improving the successful implementation of ROM, this research provides an evidence-based tool for assessing practitioners' attitudes to ROM, which map on to intervention functions and represent targets for future implementation efforts. The value of routine outcome monitoring (ROM) as a means to measure client progress and to elevate the efficiency and quality of mental health care is well-documented in the research literature, however, uptake in practice remains relatively low. This study applied behaviour change theory to develop a psychometrically sound self-report measure of practitioners' perspectives and practices to understand the barriers to implementation in child and adolescent mental health services in the United Kingdom. The complex and multifaceted nature of the barriers to implementation requires multilevel behaviour change strategies at the client, clinician, and organisational level. Recommendations for practice include the need for integrated, multilevel strategies aimed at improving practitioners' capabilities and motivations, strong organisational leadership and a culture of data gathering and sharing, and implementation interventions, which are tailored to target local barriers.

Polysubstance Use Is Positively Associated with Gaming Disorder Symptom Severity: A Latent Class Analytical Study

Introduction: The link between gaming disorder (GD) and substance use amongst adolescents is not clear. Some studies reported positive associations, whereas others suggested that alcohol and illicit drug use are not related to GD severity. Objectives: The present study aimed to identify empirically based latent classes of alcohol and illicit drug use amongst adolescents and explore their associations with GD symptom severity and whether endorsement of specific criteria of GD is linked to the membership of latent classes of alcohol and illicit drug use. Methods: Data of the national sample of Hungarian adolescents from the Health Behaviour in School-aged Children survey (N = 2,768; females: 52.08%; mean age: 16.73 years) were analysed. Measures for frequency of alcohol and illicit drug use, gaming, GD symptom severity, and life satisfaction were included in the analyses. Results: Latent class analysis discriminated 4 subgroups of alcohol and illicit drug use: polysubstance users, high-risk alcohol users, moderate alcohol users, and infrequent substance users. Polysubstance users presented significantly higher levels of GD symptom severity and higher odds for endorsement of criteria of “giving up other activities” and “negative consequences.” Conclusions: Positive associations were shown between higher GD severity and the polysubstance using class. The roles of criteria of “giving up other activities” and “negative consequences” were highlighted in more severe substance use patterns. However, GD severity and criteria did not differ as a function of the level of alcohol use. These findings may imply common roots of GD and illicit drug use in adolescents.

Why do Americans use marijuana?

BackgroundMarijuana is the most commonly used illicit drug in the United States; yet, little is known about why adults use it. We examined the prevalence of past-month marijuana use by users’ reasons for use—medical, recreational, and both—and identified correlates of each group. MethodsData from 20 states, which participated in the 2017–2019 Behavioral Risk Factor Surveillance System and fielded the marijuana use module, and multinomial logistic regression analysis were used to identify risk factors for past-month marijuana use by reason for use. User profiles were developed to illustrate how states’ policy environments influenced reported reasons for use. ResultsThe average predicted probabilities of past-month marijuana use for medical, recreational, and both reasons were 28.6 %, 38.2 %, and 33.1 %, respectively. Age, gender, marital and employment status, income, mode and frequency of administration, and health status were associated with reasons for use. The reasons that young adult males who were infrequent marijuana users and binge drinkers gave for their marijuana use varied by state policy environment—in legal states, the average predicted probabilities were 5.3 % lower for recreational reasons and 5.0 % higher for both reasons. Reported reasons for past-month marijuana use did not significantly differ by state policy environment among daily users who were older women in poor mental and physical health. DiscussionSignificant differences existed in the characteristics of past-month marijuana users by reasons for use. Our estimates can serve as a baseline against which post-legalization marijuana users’ reasons for use can be compared as state policy environments shift.

Youth, family and society: Examining the dynamics of e-cigarette use in Latino college students

Objectives We aimed to document the social factors encouraging and discouraging e-cigarette use amongst Latino college students. Participants Participants were second-generation Latino male college students. Methods We interviewed 20 second-generation Latino male college students, 10 regular smokers and 10 infrequent smokers, at the University of California, Irvine and the University of California, Riverside. Results Regular and infrequent smokers present similar motivations that either encourage or discourage e-cigarette use. Repeated peer-exposure, skepticism of the harmfulness of recreational use, and disagreement with familial views of substance use encourage e-cigarette use. High costs, weak nicotine euphoria, and evidence of health risks discourage e-cigarette use. Conclusions Our results suggest that motivations for e-cigarette use in Latino college students are similar to those of young, non-Latinos and that regular and infrequent users may be determined by temporal circumstances and opportunity as opposed to unique social factors. Further research is warranted to comprehensively investigate this phenomenon.

Assessment of cognitive and psychomotor impairment, subjective effects, and blood THC concentrations following acute administration of oral and vaporized cannabis.

Cannabis legalization is expanding, but there are no established methods for detecting cannabis impairment. Characterize the acute impairing effects of oral and vaporized cannabis using various performance tests. Participants (N = 20, 10 men/10 women) who were infrequent cannabis users ingested cannabis brownies (0, 10, and 25 mg Δ-9-tetrahydrocannabinol, THC) and inhaled vaporized cannabis (0, 5, and 20 mg THC) in six double-blind outpatient sessions. Cognitive/psychomotor impairment was assessed with a battery of computerized tasks sensitive to cannabis effects, a novel test (the DRiving Under the Influence of Drugs, DRUID®), and field sobriety tests. Blood THC concentrations and subjective drug effects were evaluated. Low oral/vaporized doses did not impair cognitive/psychomotor performance relative to placebo but produced positive subjective effects. High oral/vaporized doses impaired cognitive/psychomotor performance and increased positive and negative subjective effects. The DRUID® was the most sensitive test to cannabis impairment, as it detected significant differences between placebo and active doses within both routes of administration. Women displayed more impairment on the DRUID® than men at the high vaporized dose only. Field sobriety tests showed little sensitivity to cannabis-induced impairment. Blood THC concentrations were far lower after cannabis ingestion versus inhalation. After inhalation, blood THC concentrations typically returned to baseline well before pharmacodynamic effects subsided. Standard approaches for identifying impairment due to cannabis exposure (i.e. blood THC and field sobriety tests) have severe limitations. There is a need to identify novel biomarkers of cannabis exposure and/or behavioral tests like the DRUID® that can reliably and accurately detect cannabis impairment at the roadside and in the workplace.

Longitudinal Analysis of Transit-Integrated Ridesourcing Users and Their Trips

Several municipal transit agencies have partnered with transportation network companies to provide a range of services, but data restrictions have limited research on trip-level observations of transit-integrated ridesourcing users. The goal of this study was to understand how users’ trip-making behaviors adapted to a transit-integrated ridesourcing pilot in Waterloo, Ontario. This research conducted a longitudinal analysis of 178 unique users and temporal analyses of their 4,536 ridesourcing trips (rides) taken throughout the pilot from November 2018 to December 2019. Trip type and frequency changes over time were measured for frequent, average, and infrequent users. Transit, walking, and cycling alternatives to the pilot rides were generated and characterized based on their complementarity with transit. The number of unique users and daily ridership increased over time, as new users made their first trips and existing users made trips more frequently. Frequent users shifted toward less transit-competitive trip types whereas average and infrequent users had a sporadic but larger share of more transit-competitive trip types. The pilot was mostly used during off-peak service periods, when transit was less frequent, which suggests these systems are valuable for nonwork trips. Transit trip alternatives were not temporally competitive with rides. Cycling was competitive with 5% to 10% of rides and was consistently faster than walking and transit alternatives. Walking was not a practical alternative to rides in most cases. This analysis may inform other agencies of performance evaluation techniques for their transit-integrated ridesourcing pilots and the unique characteristics of trips taken by users of this mode.

The XPS library website: A resource for the XPS community including - The XPS library of information, XPS spectra-base having >70,000 monochromatic XPS spectra, and spectral data processor (SDP) v8.0 software

Surface chemical analysis by XPS is more than 60 years old. During the last 15 years ther-e has been an explosive growth in the publication of XPS peak-fits and interpretations. Unfortunately, these publications suffer from a variety of problems in reliability and usefulness because the new authors are not familiar enough with the science and application of XPS, chemical state assignments, and peak-fitting. Efforts to help new users include journal publications such as self-training guides for peak-fitting, international standards, collections of BEs, examples of peak-fitting, and more. These user guides are useful and are published in journals that are known to publish XPS information. The basics of XPS are taught at a few graduate level courses in universities and there are 3–5 day training courses at conferences, but the need is much greater. To help the international XPS community and the infrequent users of XPS to overcome these limitations, problems and needs, The XPS Library™ was formed as a non-profit institute to provide an on-line resource of XPS information, self-training material, free >70,000 monochromatic XPS reference spectra, free spectral data processing software, reference tables, links, examples of good and bad peak-fitting, and more. In 1986, this author began to build The XPS Spectra-Base™ by collecting and organizing detailed sets of “self-consistent” monochromatic XPS spectra from reference materials, natural crystals, man-made single crystals, and commercial products. The current number of individual spectra in digital form is >70,000 and the number of materials is >9,000. Each set of spectra (4–10) is stored inside individual data directories having the name of the material analyzed. Multiple data directories belonging to the same category are placed in a directory with the name of that category. Each category name is distinct and is based on the chemistry of the materials. Currently, “XPS Library” members must download individual sets of spectra or full directories that are stored in ZIP files. To view, peak-fit, export, analyze, overlay, process, or print the spectra provided by The XPS Spectra-Base the library member needs a software that can import or directly open spectra having: VAMAS-ISO 14,976 ASCII file format, other ASCII file formats (XY, XYZ), or the SDP binary file format. Most software from the instrument makers can import these types of spectra. The “Spectral Data Processor” (SDP™) v8.0 is a 32-bit Windows™ (v7−10 compatible) software is provided free of charge to library members. Using SDP v8 the user can: (a) access and open the raw or processed spectra downloaded from The XPS Spectra-Base, (b) save all processing results and labels to permanent memory, (c) completely reprocess, peak-fit, analyze, overlay, process, or print the spectra, (d) export or save the raw or processed spectra in VAMAS-ISO ASCII and other ASCII file formats, and (e) import spectra having VAMAS-ISO 14,976 ASCII file format and other ASCII file formats (XY, XYZ). Several thousand High Energy Resolution Auger Electron Spectra (HER-AES) from insulators, conductors, and native oxides will be added. All spectra are owned, copyrighted, and are the property of The XPS Library and are protected by a registered international copyright (TX 4−560-881).

The failings of per se limits to detect cannabis-induced driving impairment: Results from a simulated driving study

Objective Many jurisdictions use per se limits to define cannabis-impaired driving. Previous studies, however, suggest that THC concentrations in biological matrices do not reliably reflect cannabis dose and are poorly correlated with magnitude of driving impairment. Here, we first review a range of concerns associated with per se limits for THC. We then use data from a recent clinical trial to test the validity of a range of extant blood and oral fluid THC per se limits in predicting driving impairment during a simulated driving task. Methods Simulated driving performance was assessed in 14 infrequent cannabis users at two timepoints (30 min and 3.5 h) under three different conditions, namely controlled vaporization of 125 mg (i) THC-dominant (11% THC; <1% CBD), (ii) THC/CBD equivalent (11% THC; 11% CBD), and (iii) placebo (<1% THC & CBD) cannabis. Plasma and oral fluid samples were collected before each driving assessment. We examined whether per se limits of 1.4 and 7 ng/mL THC in plasma (meant to approximate 1 and 5 ng/mL whole blood) and 2 and 5 ng/mL THC in oral fluid reliably predicted impairment (defined as an increase in standard deviation of lateral position (SDLP) of >2 cm relative to placebo). Results For all participants, plasma and oral fluid THC concentrations were over the per se limits used 30 min after vaporizing THC-dominant or THC/CBD equivalent cannabis. However, 46% of participants failed to meet SDLP criteria for driving impairment. At 3.5 h post-vaporization, 57% of participants showed impairment, despite having low concentrations of THC in both blood (median = 1.0 ng/mL) and oral fluid (median = 1.0 ng/mL). We highlight two individual cases illustrating how (i) impairment can be minimal in the presence of a positive THC result, and (ii) impairment can be profound in the presence of a negative THC result. Conclusions There appears to be a poor and inconsistent relationship between magnitude of impairment and THC concentrations in biological samples, meaning that per se limits cannot reliably discriminate between impaired from unimpaired drivers. There is a pressing need to develop improved methods of detecting cannabis intoxication and impairment.

Changes in participant behaviour and attitudes are associated with knowledge and skills gained by using a turtle conservation citizen science app

Abstract Citizen science has become a popular way to collect biodiversity data and engage the wider public in scientific research. It has the potential to improve the knowledge and skills of participants, and positively change their behaviour and attitude towards the environment. Citizen science outcomes are particularly valuable for wildlife conservation, as they could help alleviate human impacts on the environment. We used an online questionnaire to investigate the consequences of participating in an Australian turtle mapping app, TurtleSAT, on skills and knowledge gain, and test for any association between these gains and behavioural or attitudinal changes reported by the participants. One hundred and forty‐eight citizen scientists completed our questionnaire, mostly from the states of New South Wales and Victoria. TurtleSAT was the third most common source of correct answers about turtle ecology and conservation, after a talk about turtles and personal observations/research. Citizen scientists who participated more often were more knowledgeable about turtles than infrequent users. Self‐reported gains in knowledge and skills were positively linked to attitudinal and behavioural changes, such as being more aware of turtles on roads. However, behaviour and attitude changes were not related to participation rate. Respondents also reported that after learning about the current decline in turtle populations, they adopted several turtle‐friendly practices, such as habitat restoration or moving turtles out of harm's way, underlining the importance of increasing people's awareness on species declines. The reported changes in attitudes and behaviours are likely to positively impact the conservation of Australian freshwater turtles. Engagement with citizen science projects like TurtleSAT may result in participants being more interested in the natural world, by learning more about it and being more exposed to it, and therefore contributing more actively to its protection. A free Plain Language Summary can be found within the Supporting Information of this article.

Nonprescription Stimulant Use at a Public University: Students’ Motives, Experiences, and Guilt

We examined the use of nonmedical prescription stimulants (NPSs) among students ( N = 1,208) at a large public university in southeastern United States. After students who had been prescribed stimulants had been removed from the sample, 202 of the remaining 1,067 students (i.e., 18.9%) reported having engaged in NPS use in their lifetime. NPS use was strongly associated with membership in Greek societies and with binge drinking behavior. NPS users overwhelmingly reported engagement in NPS use for academic rather than for recreational purposes, and as anticipated, NPS users with academic motives reported stronger academic benefits than NPS users with social/recreational motives. Reports of guilt were low, and frequent users reported less guilt than infrequent users. Implications for interventions are discussed.

Pilot Randomized Controlled Trial in Women With Non-Small Cell Lung Cancer to Assess the Feasibility of Delivering Group-Based Psychosocial Care via Videoconference.

Background:The goal of this pilot randomized controlled trial was to examine the feasibility and acceptability of delivering group-based psychosocial care via videoconference (ie, Zoom) to women with lung cancer undergoing treatment.Methods:At baseline, women indicated their typical computer and internet use and were then randomized to a group-based intervention that either focused on mindfulness training or psychoeducation. Participants completed 1 Zoom “practice run” prior to starting the 5 group sessions (1 per week). After the last session, they evaluated their experiences with the intervention and its delivery.Results:With a consent rate of 68%, 54 women (mean age = 66 years; 69% non-Hispanic White; 48% with stage IV disease) were equally randomized. Attendance was high in both arms (session mean, mindfulness = 4.38; education = 4.75; 85% attended all sessions). Across arms, all women rated the program as useful; most preferred group-based delivery (67%) and remote delivery (50%) or had no preference. Although the sample’s typical computer use was relatively low (eg, 19% said that they rarely or never use a computer), most women (76%) indicated that Zoom was “very easy” or “easy” to use. After only 0 to 1 attempts, 56% felt comfortable but 26% stated that they never felt comfortable with the technology.Conclusions:It seems to be feasible to deliver group-based psychosocial interventions via videoconference in women with lung cancer undergoing treatment. Challenges regarding scheduling the group sessions and familiarizing older rather than infrequent computer users with the technology were encountered but resolved over the course of the trial.

As the Pandemic Progresses, How Does Willingness to Vaccinate against COVID-19 Evolve?

Controversy around the safety and efficacy of COVID-19 vaccines may lead to low vaccination rates. Survey data were collected in April and August 2020 from a total of 2343 Australian adults. A quarter (n = 575, 24%) completed both surveys. A generalized linear mixed model analysis was conducted to determine whether willingness to vaccinate changed in the repeated sample, and a multinominal logistic regression was conducted in all participants to determine whether willingness to vaccinate was associated with demographics, chronic disease, or media use. Willingness to vaccinate slightly decreased between April (87%) and August (85%) but this was not significant. Willingness to vaccinate was lower in people with a certificate or diploma (79%) compared to those with a Bachelor degree (87%), p < 0.01 and lower in infrequent users of traditional media (78%) compared to frequent users of traditional media (89%), p < 0.001. Women were more likely to be unsure if they would be willing to vaccinate (10%) compared to men (7%), p < 0.01. There were no associations between willingness to vaccinate and age, chronic disease, or social media use. Promotion of a COVID-19 vaccine should consider targeting women, and people with a certificate or diploma, via non-traditional media channels.

Financial benchmarking on dairy farms: Exploring the relationship between frequency of use and farm performance

The importance of financial benchmarking has increased in recent years as European Union milk quota abolition has facilitated rapid change in the dairy sector. This study evaluates the association between usage frequency of a financial benchmarking tool [Profit Monitor (PM)] and farm changes on spring-calving pasture-based dairy farms. To this end, physical and financial data for 5,945 dairy farms, representing 20,132 farm years, for the years 2010 to 2018 were used. Farms were categorized by frequency of annual financial benchmarking over the 9-yr period into frequent PM users (7-9 yr), infrequent PM users (4-6 yr), low PM users (1-3 yr), and nonusers. We use a mixed model framework and econometric models to characterize farms and to explore characteristics and determinants of economic performance and user groups. The most frequent users of the financial benchmarking tool had the greatest increase in intensification (measured by change in farm stocking rate), productivity (measured by change in milk production per hectare), and financial performance (measured by change in farm gross output and net profit per hectare) across the study period. Infrequent and low PM users of the benchmarking tool were intermediate for all variables measured, whereas nonusers had the least change. Empirical results indicated that economic performance was positively associated with dairy specialization and pasture utilization for all groups. Despite considerable fluctuations over the observation period, the overall change in total farm net profit between 2010 and 2018 was greatest for the frequent PM users (an increase of 70%, or €37,639), followed by farms in the infrequent PM user category (a 71% increase corresponding to an increase of €28,008 in net profit); meanwhile, low PM user and nonuser categories showed increases of 69% (€26,270) and 42% (€10,977), respectively. The results of this study also clearly indicated the existence of a strong positive association between frequency of financial benchmarking and greater technical and financial efficiency. The econometric analysis revealed that financial benchmarking users are more likely than nonusers to have larger herds, and that regional differences exist in usage rates. Finally, the study concludes by suggesting that the development of simplified financial benchmarking technologies and their support are required to increase benchmarking frequency, which may also help to facilitate a more sustainable and resource efficient dairy industry.

Treatment of adult atopic dermatitis patients according to disease characteristics and demographics.

Little is currently known about possible associations between disease specific characteristics of atopic dermatitis (AD) and use of medical treatments. We explored the use of AD treatments within the past 12 months in Danish adults according to distinct patient characteristics. Patients who had received a diagnosis of AD in a hospital in- or outpatient setting as adults were surveyed and data cross-linked to a national prescription registry. AD severity was measured by the Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD). A total of 3834 patients participated. Use of topical medication in the past 12 months increased with increasing AD severity, whereas no difference was observed for systemic medication use. Positive associations between AD in the face and neck, and use of mild and moderately potent topical corticosteroids were observed, while involvement of palms and chest was associated with use of more potent topical corticosteroids. The mean DLQI, skin pain, and itch severity scores were lower in patients managed only with topical corticosteroids (5.5, 3.2, and 4.3, respectively) compared to patients treated with both oral and topical medication (7.1, 3.8, and 5.0, respectively). Patients with frequent topical corticosteroid use tended to be older (50.7 vs 48.6 years), males (50.0% vs 33.6%), current daily smokers (17.3% vs 13.7%), and having asthma (59.1% vs 43.8%) compared with infrequent users of topical corticosteroids. We found a disconnect between the severity of AD signs and symptoms, and use of AD therapies. In particular, a very modest use of systemic immunosuppressants was seen even among patients with severe AD symptoms. However, the underlying clinical decisions and reasons behind this disconnect is not clear based on the current data.

General practitioner follow-up after hospitalisation in Central and Eastern Sydney, Australia: access and impact on health services.

Objectives General practitioner (GP) follow-up after a hospital admission is an important indicator of integrated care. We examined the characteristics of patients who saw a GP within 2 weeks of hospital discharge in the Central and Eastern Sydney (CES) region, Australia, and the relationship between GP follow-up and subsequent hospitalisation. Methods This data linkage study used a cohort of 10240 people from the 45 and Up Study who resided in CES and experienced an overnight hospitalisation in the 5 years following recruitment (2007-14). Characteristics of participants who saw a GP within 2 weeks of discharge were compared with those who did not using generalised linear models. Time to subsequent hospitalisation was compared for the two groups using Cox proportional hazards regression models stratified by prior frequency of GP use. Results Within 2 weeks of discharge, 64.3% participants saw a GP. Seeing a GP within 2 weeks of discharge was associated with lower rates of rehospitalisation for infrequent GP users (i.e. <8 visits in year before the index hospitalisation; hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.70-0.97) but not frequent GP users (i.e. ≥8 plus visits; HR 1.02; 95% CI 0.90-1.17). Conclusion The effect of seeing a GP on subsequent hospitalisation was protective but differed depending on patient care needs. What is known about the topic? There is general consensus among healthcare providers that primary care is a significant source of ongoing health care provision. What does this paper add? This study explored the relationship between GP follow-up after an uncomplicated hospitalisation and its effect on rehospitalisation. What are the implications for practitioners? Discharge planning and the transfer of care from hospital to GP through discharge arrangements have substantial benefits for both patients and the health system.

Who is the typical psychedelics user? Methodological challenges for research in psychedelics use and its consequences.

Aims:This article argues that despite a resurgence in research on psychedelics over the last two decades, we still have little insight into the psychedelics user population. Furthermore, there is currently little agreement between researchers as to the long-term mental health consequences of psychedelics use.Design:In a methodological review of a range of studies in psychedelics use, it is demonstrated that these studies tend to focus on specific segments of the user population while excluding others. These population segments are probably connected to different patterns of use, which in turn are likely to result in different long-term consequences.Results:The divergent findings on the consequences of psychedelics use may be explained, at least in part, by the fact that different research strategies explore different segments of the user population. Studies focusing on user segments with problematic usage patterns tend to find that psychedelics use is negative for mental health, while studies on infrequent users tend to find that psychedelics use is positive for mental health.Conclusion:Because the field of psychedelics studies lacks a reliable model of the user population, it is difficult for researchers to contextualise and assess the broader validity of their findings. To remedy this situation, the article presents three theoretical models of the user population that afford us with tentative means of contextualising findings and thereby may clarify present disagreements.