Low Level Of Use Research Articles

Knowledge and Practice of Fertility Behavior among the Musahar Women in Nepal

Musahars are the Terai Dalit community living in low land; basically Southern part of Nepal and the most deprived and marginalized groups. The aim of this study is to identify the nexus between knowledge, practices and its relation to fertility behavior and adoption of family planning methods. Fertility is a way through which human beings biologically substitute themselves in order to continue their existence on earth. This study reveals that married women and those who have children had relatively better knowledge about fertility behavior and methods of family planning than newly married and unmarried females. Similarly, adolescent mothers consistently had low level of use in each of the contraceptive methods mentioned by the respondents during the study. In addition, the study shows that many of older mothers enjoyed more support from their husbands compared to adolescent mothers when it comes to decision on whether fertility related issues and use method of family planning. This information suggests that interpersonal communication between husbands and wives on the use of contraceptive was relatively higher among older mothers compared with adolescent mothers. There is a huge impact of explanatory variables of the research topic like age, ethnicity, education, marital status, employment status, knowledge of family planning, number of children and attitude on the use of modern contraceptives etc. to the use of contraceptives.

Usage of agrobiodiversity conservation practices among farmers in Niger State, Nigeria

The use of agro-biodiversity practices are key coping strategies in adapting to climate change. This study determined the level of use of Agro- biodiversity conservation practices, assessed the benefits of the practice and identified constraints to its use. A three- stage sampling technique was used to select 150 respondents on which a structured interview schedule was administered. Descriptive statistics and Pearson’s Product Moment Correlation were used for data analysis. Results shows that the use of animal dungs and plant residues as bio-fertilizers was common biodiversity practice among farmers. 82.5% of the farmers were in the low level of use of these practices. Constraints such as high cost of production lack of awareness of the use of these practices, were major constraints to the use of biodiversity practices. Age, years of schooling years of farming experience were significantly related to level of usage of Agro biodiversity practices. The study concludes that the level of use of Agro biodiversity practices among farmers was low and influenced by socioeconomic characteristics of the farmers. It recommends that government and other stake holders should provide necessary facilities for this practice. Extension agents should also sensitive farmers on the usefulness of Agro-biodiversity.

Educación ambiental para el uso eficiente del agua potable en alumnos de quinto de primaria de tres instituciones educativas en la ciudad de Tacna

La investigación tuvo como objetivo la elaboración de un programa educativo ambiental para concientizar a los alumnos de las tres instituciones educativas, sobre el uso eficiente del agua potable, mediante talleres informativos, actividades recreacionales para alumnos, docentes y padres de familia, se trabajó con 265 alumnos de quinto grado de primaria de las instituciones educativas; Coronel Bolognesi, República Argentina y Santa Cruz, antes de implementar el programa aplicó de un pre test de 30 preguntas con la finalidad de conocer el desempeño en el uso eficiente, reciclaje, optimización del agua. Posteriormente se aplicó un post test para, la data fue contrastada mediante la prueba estadística de signos. Los resultados indican que los bajos niveles de uso eficiente se redujeron de 36,6 % a 1,0 %, los niveles moderados se redujeron de 59, 6 % a 34,0 %, mientras que los niveles altos de eficiencia aumentaron de 3,8 % a 65,0 %. Respecto al reciclaje del agua, los valores que expresaban bajos niveles de eficiencia se redujeron de 32,1 % a 0,0%, los niveles medios de 58,9 % a 24,2 % y los altos niveles de eficiencia de uso del agua aumentaron significativamente de 9,1 % a 75,8 %, mientras que en la optimización del agua, los resultados encontrados evidencian que los niveles bajos se redujeron de 30,6 % a 1,1 %, los niveles moderados de 66,4 % a 35,5 %, favorablemente los niveles altos de eficiencia en el uso del agua aumentaron de 3,0 % a 63,0 %, todas las comparaciones fueron al 95 % de confianza. Finalmente la institución educativa República Argentina destacó de manera sobresaliente en todos los aspectos evaluados con los niveles más altos, lo cual implica que la conciencia ambiental de sus estudiantes es adecuada

TECHNOLOGICAL INNOVATIONS AND OPPORTUNITIES FOR ENTREPRENEURSHIP DEVELOPMENT IN GEORGIA

Given the modern global conjuncture, technological innovation and creative thinking play a major role in the process of implementing entrepreneurial activities. The rapid development of digital technologies and the emergence of diverse digital platforms have given impetus to the transformation of entrepreneurial behavior and the conduct of entrepreneurial activities from the real - to the virtual environment. In the modern digital world, there is no alternative to technological entrepreneurship. 5G network, blockchain, 3D printing and other technological innovations make business processes faster, more reliable and flexible. The generation and implementation of continuous innovative ideas in technology has led to the emergence and development of information technology, digital technology, digital platforms, on which the modern form of entrepreneurship - digital entrepreneurship is based. One of the obstacles to the development of digital entrepreneurship in Georgia is the lack of proper access to digital technologies. At the same time, the population of Georgia has not yet developed the digital culture and skills that ensure the implementation of commercial activities in the virtual space. According to the National Statistics Office of Georgia in July 2019 in the country: 70.6% of households actively used the Internet, only 20.8% of them purchased goods and/or services through digital channels. In 2018, only 3.2% of enterprises received an order through the website. These data indicate the low level of Internet use by the public and, consequently, enterprises for commercial purposes. This untapped segment, at the same time, creates a solid potential for further development of digital entrepreneurship. Especially today, when physical mobility is restricted due to the worldwide pandemic COVID-19. Innovations and technologies are the main driving forces of modern entrepreneurship. Therefore, the emphasis of the Government of Georgia in this direction and the launch of appropriate economic policy instruments should positively support the transformation of the entrepreneurial environment and entrepreneurial behavior in the country. Given the current situation in Georgia, in order to identify and develop digital entrepreneurial opportunities, it would be appropriate to take the following measures: First, the state must ensure that more people have access to the Internet and digital technologies; Second, increase the scale of financial support programs for innovative and digital entrepreneurial initiatives, also, to help startups attract funding sources, to consult on opportunities to attract venture investments, to make it possible to implement a more technologically innovative idea; Third, primacy should be given to Georgian universities in the fields of entrepreneurship, innovation and technology, computer science; Fourth, the network of innovation centers should be expanded and similar educational spaces should be created to ensure the development of technical and entrepreneurial skills of the population (especially the rural population) in the field of innovation and technology.

Contraceptive use and associated factors among sexually active reproductive age HIV positive women attending ART clinic at Felege Hiwot Referral Hospital, Northwest Ethiopia: A cross-sectional study

BackgroundContraception helps prevent unplanned pregnancies and mother to child Human Immune Virus (HIV) transmission among human immune virus positive women. Ethiopia has made remarkable progress in increasing contraceptive use rate but there is still a disparity of contraceptive use within the country. Although there were some studies about contraceptive use in Ethiopia, evidences about contraceptive use among sexually active HIV positive women was limited. Understanding the extent of and barriers in Ethiopia is important for learning how to best improve level of contraceptive use. Therefore, this study aimed to assess contraceptives use and associated factors among HIV positive sexually active women at anti-retroviral therapy clinic at Felege Hiwot Referral Hospital ART clinic in Bahir Dar, Ethiopia. MethodA facility-based cross-sectional study was conducted from June 01–30, 2018 among (n = 308) randomly selected HIV positive women at Felege Hiwot Referral Hospital. Data were collected using a pretested interviewer-administered questionnaire and analyzed using SPSS version 20. Survey logistic regression analysis was employed to identify determinants of contraceptive use. Statistical significance was declared at p-value <0.05. ResultsOut of three hundred eight participants, 118 (38.3%) reported contraceptive use at the time of the study. Injectable is the most preferred (43.5%) contraceptive method. Participants with age 15–34 years (AOR = 3.09, 95%CI: 1.59–5.99), disclosed their status to sex partner, (AOR = 2.7, 95%CI: 1.14–6.66), had history of contraception use; (AOR = 3.36, 95%CI: 1.68–6.74), were sexually active (AOR = 5.45, 95%CI: 2.72–10.91) had higher odds of contraceptive use. However, participants who had drinking habit (AOR = 4.35, 95%CI: 1.82–10.38) had lower odds of contraceptive use. ConclusionA significant proportion of HIV positive women had low level of contraceptive use that was lower than the national recommended level. Participants with younger age (15–34years), who disclosed HIV status to sex partner, had history of contraceptive use, and who were sexually active six months prior to the study were more likely to use contraception. However, participants who had drinking habit were less likely to use contraception. These results suggest that multi-sectorial and multi-disciplinary approaches are needed to increase contraceptive use in the HIV positive women.

Exploring the relationship of sleep quality with drug use and substance abuse among university students: a cross-cultural study

BackgroundThere is a growing interest in studying the area of drugs and college students due to the negative effects that drugs have on a student’s social life, academics, psychology, finances, and health. So, this study aims to identify the relationship between drug/substance abuse and quality of sleep among university students in Yemen and Saudi Arabia.The sample size was 935 (43.21% N = 404 female, 56.79% N = 531 male, 55.40% N = 518 Yemeni, and 44.60% N = 417 Saudi). Students responded to the Drug Abuse Screening Test (DAST-10), the Pittsburgh Sleep Quality Index (PSQI), and the Substance Abuse Questionnaire.ResultsThe results showed a high prevalence of drug use: 43.1% of respondents (27.27% N = 219 Yemenis and 15.83% N = 148 Saudis) abuse drugs, 29.41% were in the low level of drug use, 10.48% were in the moderate level of drug use, 2.46% were in the substantial level of drug, and 0.75% were in the severe level of drug use as per the DAST-10. The differences between both countries in terms of drug use were significant (X2 19.394, P < 0.001). The prevalence rate of inhalants was 16.36% and of sedatives was 12.09%, and the differences between countries were significant. The prevalence of poor sleep quality was 24.81%; a total of 7.91% of respondents had very poor sleep quality, while 16.90% had poor sleep quality. The differences between countries were not significant.The relationship between sleep quality and drug use, smoking, and substance abuse was significant. The quality of sleep decreased consistently with a high level of drug use or substance abuse.ConclusionsPoor sleep quality is significantly associated with drug use and substance abuse, and it is important to recognize the factors affecting drug and substance abuse among university students. A significant contribution can make for the protection of university students by guaranteeing that psychological interventions for high-risk groups are planned in advance.

Гормональна контрацепція в аспекті профілактики порушень та реабілітації гінекологічного здоров’я жінок-військовослужбовців. Огляд літератури та результати власних досліджень

SummaryIncreasing the representation of women in the modern army requires improvedgynecological care. If the issue of women’s reproductive health holds a special place inmodern medicine, the development of safe and effective contraceptive methods,including hormonal, remains one of the priorities in gynecology.The benefits of hormonal contraception, namely the foolproof birth control andincreased regulation of the menstrual cycle or suppression of menstruation may be moreattractive to active duty women than to women in the general population.The use of hormonal contraception, in addition to contraceptive action has adistinctive therapeutic effect and prophylactic value, which is especially important forwomen while serving in areas of military operations. The use of hormonal contraceptives can prevent the development of menstrual-associated and cyclical complications, bleeding and anemia, which according to the literature, are almost 2 times morecommon among military women than among civilians, even in peacetime.The participation of women in hostilities is expected to increase the negative impacton women’s reproductive health. The protective capabilities of various methods andregimes of hormonal contraception can be effectively used to maintain the health andrehabilitation of reproductive potential of military women who have been adverselyaffected by physical, chemical and psychological factors of the military environment.The low level of military use of effective modern methods of hormonal contraceptionmay lead to an increase in the number of unplanned pregnancies in the militaryenvironment belonging to the high-risk group, abortions and complications, andconsequently reduce the operational efficiency and combat capability of the militaryunit.The reserve of preserving women’s health at various stages of military careers,especially during military operations is ensuring access to contraception andcounseling, as well as improving the education of military medical providers in thesphere of reproductive health and contraception.

\u201cCrazy person is crazy person. It doesn\u2019t differentiate\u201d: an exploration into Somali views of mental health and access to healthcare in an established UK Somali community

BackgroundMental health conditions have been shown to disproportionately affect those from Black, Asian and Minority Ethnic (BAME) communities. Somali communities globally have relatively high levels of mental illness, but low levels of mental health service use, with numerous barriers to care identified.This study was conducted in an established UK Somali community in the South West of England and aimed to explore community beliefs and views about the causes of mental illness, treatment for mental illness, and access to medical services in general. Participants were asked about how mental health and illness are understood and conceptualised, along with the cultural meaning of mental illness and its manifestations in relation to men, women and young people.DesignUsing a community-based participatory research design, in partnership with local Somali community organisations, the research team conducted four focus groups with a total of 23 participants aged over 18. Open-ended questions were used to facilitate discussion. Transcripts were analysed thematically.ResultsThe participants discussed the role of migration and associated stress from the civil war and how that could contribute to mental illness.Participants tended to view the symptoms of mental illness as physical manifestations such as headaches and to describe a strong community stigma where those with mental health conditions were viewed as “crazy” by others. Barriers to accessing healthcare included language barriers, waiting times and a mistrust of doctors. Various ideas for improvements were discussed, including ideas to reduce stigma and ideas for community initiatives.ConclusionCultural considerations and reducing stigma are vital in improving understanding of mental illness and improving access to mental health services, along with building relationships and trust between the Somali community and health care workers.

Patterns of Parental Adherence and the Association to Child and Parenting Outcomes Following a Multicomponent School-Home Intervention for Youth With ADHD

The goal of the present study was to evaluate the role of parent adherence in the Collaborative Life Skills (CLS) program, a multicomponent school-home intervention, for predicting child and parenting outcomes. A sample of 129 children (63% male; M age = 8.22, SD = 1.10; grades 2–5) with attention-deficit/hyperactivity disorder (ADHD) and their parents participated in CLS, which included 10 weekly behavioral parent training group sessions. Each week, parents provided information on their CLS skill use between sessions (at home) as part of the intervention. Outcome measures included parent and teacher ratings of child behavior and parenting at post-intervention and 6 months follow-up. Growth mixture models examining weekly parent skill use trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes including parent-rated child behavior, teacher-rated academic competence, and positive parenting behaviors. Fifty-two percent of parents displayed moderate skill use throughout the intervention, whereas the remaining parents had either low (20%) or high (28%) initial levels of use but demonstrated high skill utilization by the middle of the intervention. Results highlight the importance of examining individual differences in parents between session strategy use for behavioral parent training interventions targeting child and parenting outcomes.

Sustainability indicators for sustainably-farmed fish in Bangladesh

To be sustainable, farmed fish should be environmentally suitable, biologically ideal, socially acceptable and economically viable. As these sustainability indicators (SIs) strongly influence consumers’ fish purchase intent, farms should report them as a balanced source of sustainability information. However, in the literature, little attention has been paid to biological indicators in assessing aquaculture sustainability, nor to the extent of the SIs. Furthermore, the assessed SIs have not been examined by consumers. Therefore, this study measures consumers’ perceived value of these. Consumers’ sustainability knowledge and attitude towards farm-raised fish are also taken into account. Multinomial logit and basic latent class logit models are employed, together with a direct survey of households in Bangladesh. The results demonstrate that a low level of water use and appropriate feeding in the production process (e.g., environmental and biological indicators) of farmed fish increase consumers’ utility and that they are willing to pay a price premium for these attributes. Consumers look for the ‘safety label’, which indicates intermediately, averagely, and fairly sustainable farmed fish. Initially, consumers prefer averagely sustainable fish, but when they eat a high amount of farmed fish in their total fish consumption, they are more likely to prefer fairly sustainable ones, which are high sustainable. Therefore, the study results indicate that produced fish should be marketed with environmental and biological sustainability indicators, including food safety labels. Additionally, a close monitoring system will increase social acceptability, leading to sustainable fish farming and consumption.

Profiles of Mobile Phone Problem Use in Bullying and Cyberbullying Among Adolescents.

Technology is being used by individuals of all ages; young children show a high tendency of problematic use of devices such as smartphones. This study aimed to identify different profiles that vary in conflicts related to problematic mobile phone use and maladaptive communication and emotional patterns. Therefore, we examined whether there are significant differences in bullying and cyberbullying among teenagers who have a problem utilizing mobile phones. The study participants were 810 students of Compulsory Secondary Education (M = 13.99, SD = 1.32), with 52.2% being girls. Questionnaires on school violence and experiences related to mobile phones were administered. The latent profile analysis identified three different types of problematic mobile phone use: (a) low levels of conflict was associated with mobile phone abuse and low levels of communication and emotional use; (b) moderate levels of conflict was associated with mobile phone abuse and moderate levels of communication and emotional use; and (c) high levels of conflict was associated with mobile phone abuse and high levels of communication and emotional use. The study results highlight significant differences in the manifestations of school violence between the profiles. Finally, this study’s findings form the basis for the development of education programs to prevent mobile phone abuse and school violence and therefore academic adjustment.

A Randomized Trial Comparing Brief Advice and Motivational Interviewing for Persons with HIV-HCV Co-infection Who Drink Alcohol.

Alcohol use contributes to the progression of liver disease in HIV-HCV co-infected persons, but alcohol interventions have never addressed low levels of alcohol use in this population. We enrolled 110 persons consuming at least 4 alcoholic drinks weekly in a clinical trial comparing two active 18-month long interventions, delivered every 3months by phone, brief advice about drinking versus a motivational intervention. Final assessment was at 24months. MI had larger reductions in alcohol use days than the BA arm at all follow-up assessments. The treatment by time effect was not significant for days of drinking (p = 0.470), mean drinks per day (p = 0.155), or for the continuous FIB-4 index (p = 0.175). Drinking declined in both conditions from baseline, but given the small sample, we do not have sufficient data to make any conclusion that one treatment is superiorto the other.Trial Registry Trial registered at clinicaltrials.gov; Clinical Trial NCT02316184.

Epidemiology of the extent of recreational noise exposure and hearing protection use: cross-sectional survey in a nationally representative UK adult population sample

BackgroundHearing loss is prevalent and disabling, yet little is known about the extent of recreational noise exposure and hearing protection use. The aim of the present research was to estimate the extent of recreational noise exposure and hearing protection use in a sample representative of the UK adult population.MethodsWe conducted a cross-sectional survey of 10,401 UK adults who were representative of the population.ResultsMore than 7000 people (n = 7590, 73.0%) reported exposure to recreational noise excluding headphone and earphone use in the last 12 months. Just 158 people (2.1%) reported wearing hearing protection for every noisy recreational activity. Age (younger people) and beliefs of a behavioral (as opposed to genetic) cause of hearing loss were predictive of both higher recreational noise exposure and greater hearing protection use. Men were more exposed to recreational noise but women were less likely to use hearing protection.ConclusionsFor the first time, the present research quantifies the recreational noise exposure and low levels of hearing protection use in a representative sample of the UK population. The biggest public health gains are likely to be achieved through interventions targeted at younger people and in explaining behavioral (as opposed to genetic) causes of hearing loss.

Assessment of Behavioral Health Services Use Among Low-Income Medicare Beneficiaries After Reductions in Coinsurance Fees

Medicare has historically imposed higher beneficiary coinsurance for behavioral health services than for medical and surgical care but gradually introduced parity between 2009 and 2014. Although Medicare insures many people with serious mental illness (SMI), there is limited information on the impact of coinsurance parity in this population. To examine the association between coinsurance parity and outpatient behavioral health care use among low-income beneficiaries with SMI. This cohort study used Medicare claims data for a 50% national sample of lower-income Medicare beneficiaries from January 1, 2007, to December 31, 2016. The study sample included patients with SMI (schizophrenia, bipolar disorder, or major depressive disorder). Data analysis was performed from August 1, 2018, to July 15, 2020. Reduction in behavioral health care coinsurance from 50% to 20% between January 1, 2009, and January 1, 2014. Total annual spending for outpatient behavioral health care visits and the percentage of beneficiaries with an annual outpatient behavioral health care visit overall, with a prescriber, and with a psychiatrist. A difference-in-difference approach was used to compare outcomes before and after the reduction in coinsurance for beneficiaries with and without cost-sharing decreases. Linear regression models with beneficiary fixed effects that adjusted for time-changing beneficiary- and area-level covariates were used to examine changes in outcomes. The study included 793 275 beneficiaries with SMI in 2008; 518 893 (65.4%) were younger than 65 years (mean [SD] age, 57.6 [16.1] years), 511 265 (64.4%) were female, and 552 056 (69.6%) were White. In 2008, the adjusted percentage of beneficiaries with an outpatient behavioral health care visit was 40.7% (95% CI, 40.4%-41.0%) among those eligible for the cost-sharing reduction and 44.9% (95% CI, 44.9%-45.0%) among those with free care. The mean adjusted out-of-pocket costs for outpatient behavioral health care visits decreased from $132 (95% CI, $129-$136) in 2008 to $64 (95% CI, $61-$66) in 2016 among those with reductions in cost-sharing. The adjusted percentage of beneficiaries with behavioral health care visits increased to 42.2% (95% CI, 41.9%-42.5%) in the group with a reduction in coinsurance and to 47.2% (95% CI, 47.0%-47.3%) in the group with free care. The cost-sharing reduction was not positively associated with visits (eg, relative change of -0.76 percentage points [95% CI, -1.12 to -0.40 percentage points] in the percentage of beneficiaries with outpatient behavioral health care visits in 2016 vs 2008). This cohort study found that beneficiary costs for outpatient behavioral health care decreased between 2009 and 2014. There was no association between cost-sharing reductions and changes in behavioral health care visits. Low levels of use in this high-need population suggest the need for other policy efforts to address additional barriers to behavioral health care.

Winter-forage crop grazing in the Gore-Mataura area of Southland: using time-series mapping to estimate location and frequency of cropping

Winter grazing of forage crops is a key land-use in southern New Zealand, providing important feed for livestock but has been identified as risky if not managed well, potentially resulting in soil degradation and nutrient losses. We hypothesised that analysing an existing time series of winter-forage maps, derived from satellite imagery could be used to identify how often paddocks are re-used for winter forage. A pilot study was undertaken to explore the practicality and utility of this new method by examining maps derived from satellite images of the Gore-Mataura area, Southland taken in 2013, 2014, 2017, and 2018. Within the study site (67,618 ha), 8925 ha was classed as winter forage in one or more of the source maps. Eighty-five percent of this area was used in only one of the four years, and just 1% in three or four years. High-certainty class pairs for 2013/14 and 2017/18 show two consecutive years of winter forage in the same paddock, 31% or 21% of the time, respectively. These winter-forage crops were generally grown on Brown soils (63%), followed by Pallic and Gley soils. Although, this study was limited by differences in the mapping methodologies of the source maps, it nonetheless demonstrated that potentially valuable data can be derived. It showed a low level of repeat use of paddocks for winter forage grazing over all the years studied, and that Brown soils are more commonly used for winter forage than previous studies suggested.

P64 Are new LARC users less likely to use condoms than new moderately effective hormonal method users? An analysis of us women ages 15–44

Objectives: The revival of long-acting reversible contraceptives (LARC) in the US has renewed concerns regarding low levels of dual method use as a strategy for STI prevention. Whether new LARC users are less likely to use condoms than new moderately effective hormonal method (MEHM) users has yet to be examined at a population-based level.

A Qualitative Study of Barriers to Personal Protective Equipment Use among Laundry Workers in Government Hospitals, Hawassa, Ethiopia.

Background The need to reduce the transmission of infectious diseases makes the use of personal protective equipment and safety medical devices compulsory among hospital laundry staff. The practice, however, remains to be low among hospital laundry staff members. Globally, not many studies seem to have been carried out to sufficiently tell us about the barriers to personal protective equipment use among hospital laundry workers. Related studies in Ethiopia are even fewer. This study assessed the barriers to personal protective equipment use among laundry staff of government hospitals in Hawassa City, Southern Ethiopia, 2019. Methods Two qualitative data-gathering methods—focus group discussions and key informant interviews—were used to collect data for this study. Eight focus group discussions were conducted with hospital laundry workers. Similarly, six key informant interviews were held with Infection Prevention and Patient Safety Officers. Thematic analysis was performed using Open Code 4.02. Result Organizational- and individual-level barriers such as unavailability of essential personal protective equipment, a disharmonious work environment, low perception of susceptibility, and belief about personal protective equipment interference with work performance were identified as the major barriers to personal protective equipment use in the present study. Conclusion Organizational- and individual-level barriers have been identified as causes for the low level of personal protective equipment use among hospital laundry workers. Therefore, improving institutional supplies in quantity and quality may have a positive implication for the improvement of infection prevention practices in the study area. Also, designing sustainable strategies and raising laundry workers' awareness of a safe work environment may lead to the improvement of infection prevention practices.

Ethnic Identity, Empowerment, Social Support and Sexual Risk Behaviors Among Black Adolescent Girls: Examining Drug Use as a Mediator.

Substance abuse and sexual health research tends to overlook the resiliency skills that Black adolescent girls possess. Using a strengths-based lens, this study examines the role of protective factors: (e.g. ethnic identity, social support, and psychological empowerment) on sexual risk behaviors testing drug use as a mediator among a sample of Black adolescent girls. The study uses a sample (N = 340) female adolescents (13-17 years old) who identified as being Black only and reside in a northeastern urban community in New Jersey. Structural equation modeling was employed to test the hypothesized model of the mediating role of drug use on sexual risk behaviors among this sample. Findings revealed that drug use significantly mediated the relationship between social support, ethnic identity, and psychological empowerment on sexual risk behaviors, with high ethnic identity scores having the strongest relationship on low sexual risk behaviors and low levels of drug use. Given the rise of sexually transmitted infections (STIs) in the United States among Black adolescent girls, findings from this study can contribute to development of culturally appropriate and innovative strategies to reduce risky behaviors by promoting social and cultural strengths among Black girls living in urban communities.

The domestic consumption of firewood in preindustrial Seville, 1518–1775. An intensive bias driven by the Mediterranean diet

AbstractFuelwood was the main domestic fuel in the Mediterranean Basin during the early modern age, although the consumption level was lower than in other latitudes. The calculation of annual real prices and per capita household consumption figures in Seville from 1518 to 1775 reveals a complex evolution connected to a European-wide scenario. As expected, low levels of domestic fuelwood use were maintained in accordance with climate and heating requirements, but contrary to prior assumptions, a substantial increase is evidenced as of 1630. The growing supply of firewood from tree-crops, leading to a decrease in real prices, ran parallel to an early diet shift to pulses and the corresponding extension of cooking times.

An online supported self-management toolkit for relatives of people with psychosis or bipolar experiences: the IMPART multiple case study

Background Digital health interventions have the potential to improve the delivery of psychoeducation to people with mental health problems and their relatives. Despite substantial investment in the development of digital health interventions, successful implementation into routine clinical practice is rare. Objectives Use the implementation of the Relatives’ Education And Coping Toolkit (REACT) for psychosis/bipolar disorder to identify critical factors affecting uptake and use, and develop an implementation plan to support the delivery of REACT. Design This was an implementation study using a mixed-methods, theory-driven, multiple case study approach. A study-specific implementation theory for REACT based on normalisation process theory was developed and tested, and iterations of an implementation plan to address the key factors affecting implementation were developed. Setting Early-intervention teams in six NHS mental health trusts in England (three in the north and three in the south). Participants In total, 281 staff accounts and 159 relatives’ accounts were created, 129 staff and 23 relatives took part in qualitative interviews about their experiences, and 132 relatives provided demographic data, 56 provided baseline data, 21 provided data at 12 weeks’ follow-up and 20 provided data at 24 weeks’ follow-up. Interventions REACT is an online supported self-management toolkit, offering 12 evidence-based psychoeducation modules and support via a forum, and a confidential direct messaging service for relatives of people with psychosis or bipolar disorder. The implementation intervention was developed with staff and iteratively adapted to address identified barriers. Adaptations included modifications to the toolkit and how it was delivered by teams. Main outcome measures The main outcome was factors affecting implementation of REACT, assessed primarily through in-depth interviews with staff and relatives. We also assessed quantitative measures of delivery (staff accounts and relatives’ invitations), use of REACT (relatives’ logins and time spent on the website) and the impact of REACT [relatives’ distress (General Health Questionnaire-28), and carer well-being and support (Carer Well-being and Support Scale questionnaire)]. Results Staff and relatives were generally positive about the content of REACT, seeing it as a valuable resource that could help services improve support and meet clinical targets, but only within a comprehensive service that included face-to-face support, and with some additional content. Barriers to implementation included high staff caseloads and difficulties with prioritising supporting relatives; technical difficulties of using REACT; poor interoperability with trust information technology systems and care pathways; lack of access to mobile technology and information technology training; restricted forum populations leading to low levels of use; staff fears of managing risk, online trolling, or replacement by technology; and uncertainty around REACT’s long-term availability. There was no evidence that REACT would reduce staff time supporting relatives (which was already very low), and might increase it by facilitating communication. In all, 281 staff accounts were created, but only 57 staff sent relatives invitations. In total, 355 relatives’ invitations were sent to 310 unique relatives, leading to the creation of 159 relatives’ accounts. The mean number of logins for relatives was 3.78 (standard deviation 4.43), but with wide variation from 0 to 31 (median 2, interquartile range 1–8). The mean total time spent on the website was 40.6 minutes (standard deviation 54.54 minutes), with a range of 0–298 minutes (median 20.1 minutes, interquartile range 4.9–57.5 minutes). There was a pattern of declining mean scores for distress, social dysfunction, depression, anxiety and insomnia, and increases in relatives’ well-being and eHealth literacy, but no changes were statistically significant. Conclusions Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, with staff and service user input, as part of a long-term strategy to develop integrated technology-enabled services. Implementation strategies must instil a sense of ownership for staff and ensure that they have adequate training, risk protocols and resources to deliver the technology. Cost-effectiveness and impact on workload and inequalities in accessing health care need further testing, along with the generalisability of our findings to other digital health interventions. Limitations REACT was offered by the same team running the IMPlementation of A Relatives’ Toolkit (IMPART) study, and was perceived by staff and relatives as a time-limited research study rather than ongoing clinical service, which affected engagement. Access to observational data was limited. Trial registration Current Controlled Trials ISRCTN16267685. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 37. See the NIHR Journals Library website for further project information.