Low Level Of Use Research Articles

A multifaceted analysis of pesticide utilization in market gardening along the Ruzizi plain: Exploring factors, farmer perceptions & media influence

Along the Ruzizi plain, subsistence agriculture constitutes households' primary food source. Regardless of the environment, the low level of pesticide use ensures less effective disease and pest control. This is why a study was carried out in the Ruzizi plain to identify the main determinants of pesticide use on vegetable crops for effective control of diseases and pests that significantly reduce the yield of these crops, which play an economically important role for producers and the role of the media in this context. The data was collected using a closed-type survey questionnaire on 90 market gardeners distributed equally between localities applying the probit model. The results of the probit model estimation reveal that about nine factors positively influence the use of pesticides: membership in a cooperative (p=0.0012), access to agricultural credit (p=0.0153), experience in agriculture (p=0.0008), experience in market gardening (p=0.0197), standard of living (p=0.0139), yield (p=0.0001), capacity building (p=0.0035), the area exploited (p=0.0011) and the cultivation system (p=0.0233). In addition, tomatoes are the leading vegetable crop grown by many market gardeners (61.1%), followed by amaranth (20%) and onions (18.9%). Also, 67.8% of market gardeners use pesticides compared to 32.2% who do not use them. Thus, considering these factors would contribute to decision-making when carrying out certain activities to improve market gardening, contributing considerably to the fight against food insecurity. Also, it is advised that the media work harder to inform rural residents and areas about the agenda for rural development.

Societal Upheaval and the Contraceptive Transition

AbstractHuman development and family planning programs since the 1970s have led to a fast‐rising prevalence of modern contraceptive means at the global level. However, countries with rising but still low levels of contraceptive use experienced an increasing number of societal upheavals, including armed conflicts, sudden and high‐intensity natural disasters, as well as dramatic effects of health epidemics. This may challenge the continued diffusion of modern means of birth regulation as well as their adherent use. To better understand the role of societal upheavals in the contraceptive transition, we provide a narrative literature review of their multidimensional pathways of influence in the contraceptive decision‐making process. The review suggests four main findings. First, well‐known contemporary barriers to contraceptive use become more salient during societal upheavals. Second, historical barriers reemerge predominantly. Third, societal upheavals exert specific effects on the contraceptive transition, such as through birth replacement, the repopulation of communities, and the sexual vulnerability of girls and young women. Fourth, there are more pathways leading to a reduced (rather than a heightened) contraceptive prevalence. The conclusion discusses the implications of those insights for the contraceptive transition, provides a critical perspective of the literature, and draws avenues for future research.

Beliefs of Moroccan patients with chronic inflammatory rheumatic diseases regarding medication: related factors and correlation with therapeutic adherence

BackgroundMedication adherence is one of the key elements of the management of patients with chronic inflammatory rheumatic diseases (CIRDs), adherence/medication regimes are prone to being influenced by beliefs about medicines; such beliefs can influence the management and quality of life of patients. Several factors may be associated with these beliefs, including demographic and clinical factors, as well as socio-psychological factors. The aim of this study is to assess beliefs regarding medications among Moroccan patients with CIRDs, the factors associated with these beliefs, and the correlation of these factors with medication adherence.Material and methodThis cross-sectional study included patients with CIRDs. Sociodemographic data, comorbidities, and information about CIRDs (type, disease duration, pain evaluation, disease activity and treatments) were collected. Beliefs regarding medication were assessed by the Belief about Medicine Questionnaire (BMQ). Therapeutic adherence was assessed using the Arabic version of the Compliance Questionnaire in Rheumatology (CQR). Sociopsychological factors, such as catastrophism and trust in physicians, were assessed by the Pain Catastrophizing Scale (PCS) and the Trust in Physicians Scale (TPS), respectively.ResultOur sample included 189 patients. The average age was 47.49 ± 13.7; 52.4% had comorbidities; and 49.2% had a low level of education. Of the patients, 49.7% were on glucocorticoids, 61.9% on conventional synthetic disease-modifying antirheumatic drugs and 6.3% on biologics. The median necessity-concern differential was 6 [1–12]. Of the patients, 67.4% strongly believed that medication was essential to maintain their health. The long-term side effects were the main concerns about medicines (51.3%). In a multivariate analysis, there was a statistically significant association between low level of education, catastrophizing, methotrexate use, and trust in the physician as independent factors and the BMQ necessity-concern differential as the dependent factor. There was also a significant correlation between CQR and the BMQ necessity score.ConclusionMoroccan patients with CIRDs have a rather positive perception of their medication. This perception seems to influence their adherence to treatment. Low levels of education, catastrophizing, methotrexate use, and trust in physicians are the most important factors associated with patients’ beliefs regarding medication.

Analysis of household food procurement practices from a sustainability perspective in grand Lomé, Togo

Over the past ten years, African cities have been trying to move towards sustainable food supply by setting up short food distribution circuits (CCs). This article analyzes household behavior towards CCs in Grand Lomé, Togo, using a survey of 963 randomly sampled households, 13 focus groups, 6 individual interviews, as well as observation. Excel spreadsheets and R-Studio software were used to process and analyze quantitative data, while content analysis was applied to the verbal statements collected. At the end of the surveys, multiple-choice questions enabled us to detect, firstly, a low level of use of CCs, with 8.79%, 7.73% and 4.66% of respondents respectively resorting to "online purchasing", "self-production of food" and "the farmer's home". On the other hand, 92.37% of households go to public markets and 81.99% use informal food shops. Next, a correlation was observed between the "type of shop" frequented and "profession" : salaried workers, shopkeepers and students go to quality shops, while artisans make do with lower-quality shops. Finally, the main reasons for visiting markets are "affordability" and "physical proximity", while "quality" and the "local character of the food" are less important. Actions are proposed to increase the role of CCs in this city.

Continuous data-gathering system on migrants: a critical review

The investigation examines the continuous system as one of the two most common forms of migrant data-gathering today. The system is defined as a set of tools that obtains migration data on changes in the registration of the place of previous residence within the country or immigration record, including the total number of individuals entering or leaving the country and the type of visa issued to them. The strengths of the continuous system are noted, which lie in its ability to generate data on a regular basis and be useful to the authorities at the national level during the management of migration challenges and forecasting of various processes. The factors that influence the rejection of this data-gathering form today are highlighted, such as: 1) difficulty of conducting a comparative analysis between countries; 2) blurring of the entry category, which makes its unification problematic; 3) issues with monitoring of persons with unsettled (legal) status; 4) lack of recording of undocumented individuals in the continuous record of migrants; 5) system bias in focusing on emigration, ignoring the dimension of immigration. The idea about the lower level of use of the continuous system in our time due to the need for large financial resources, technological support, real agreement and coordination of joint actions between the governments of national states is substantiated as an unlikely scenario, taking into account the political, economic, cultural and social, etc. differentiation in the world. Attention is paid to the issue of prospects for the implementation of a continuous data-gathering system in the future based on the analysis of recent research and changes in the status of migration in the context of sustainable development. It is emphasized that, given the current challenges, the form will be used in the future, continuously recording data on displaced persons, but not claiming primacy in the process of systematizing information on global flows of migrants.

Patterns of parent media use: The influence of parent media use profiles on parental mediation, technoference, and problematic media use

Mothers play an important role in setting the overall media culture within the home. Research suggests that children model parental behavior in many ways, including in media use habits. The current study explores profiles or patterns of maternal media use and associations between these patterns and parenting behaviors surrounding media use and parent and child problematic media use two years later. In our sample of 268 mothers of young children in a large Mountain West city, latent profile analysis was utilized, and four distinct profiles of media users were identified. Results suggest that mothers in a low media use profile set limits around their child's media use and report low levels of both technoference and parent problematic media use. Conversely, mothers in a higher social use profile exhibit high levels of parent and child problematic media use compared to other profiles. We encourage mothers to be mindful users of media, remembering that their media use behaviors can impact the overall media use climate in the home.

Consequences in cost and time in construction projects due to the low level of BIM methodology use

Consequences in cost and time in construction projects due to the low level of BIM methodology use

DeliVERy of optimal blood pressure coNtrol in afrICA (VERONICA)-Nigeria study: Rationale and design of a randomized clinical trial

BackgroundBlood pressure (BP) control among treated patients in Africa is very suboptimal, with low levels of combination therapy use and therapeutic inertia being among the major barriers to effective control of hypertension. The VERONICA-Nigeria study aims to evaluate, among Black African adults with hypertension, the effectiveness and safety of a triple pill-based treatment protocol compared to Nigeria hypertension treatment protocol for the treatment of hypertension. MethodsThis study involves a randomised, parallel-group and open-label trial. Adults with uncontrolled hypertension (n=300), untreated or receiving monotherapy, with no contraindication to study treatments will be randomly assigned 1:1 to treatment with a triple pill based-treatment protocol or Nigeria hypertension treatment protocol. Follow-up is for 6 months, with interim follow up visits at month 1, 2, and 3. In a non-comparative extension treatment period, participants completing the 6 months randomised period and on ≤3 BP-lowering drugs will receive treatment with the triple pill-based treatment protocol for 12 months. The primary outcome is change in home mean SBP from baseline to month 6, and key secondary efficacy outcome is percentage of participants with clinic BP <140/90 mmHg at month 6. The primary safety outcome is discontinuation of trial treatment due to adverse events from randomization to month 6. Economic evaluation will be conducted to assess the cost-effectiveness of the triple pill-based treatment protocol, and process evaluation will be conducted to understand the context in which the trial was conducted, implementation of the trial and interventions and mechanisms of effect, and potential barriers and facilitators to implementing the intervention in clinical practice. ConclusionThe VERONICA-Nigeria trial will provide evidence of effectiveness and safety of the triple-based treatment protocol for the pharmacological management of hypertension, in Black African adults. Trial RegistrationPACTR202107579572114

Disentangling policy and structural effects on car-ownership for car-owning and carless US households during and after the COVID-19 pandemic

This research analyzed car-ownership in the US during and after the COVID-19 pandemic, by utilizing a nationally representative household survey spanning from January 2020 to March 2022. Using a multilevel Hurdle model with month and state random effects, vehicle ownership trends are separately modeled for car-owning and carless households within the same modeling framework, while accounting for endogeneity and unobserved heterogeneity. An increase in the total amount of economic stimulus funding received increased the odds of vehicle ownership, while high car prices, high levels of housing expenditures, living in multi-family dwelling, and being from minority and low-skilled worker families negatively affected car-ownership. Greater household labor force participation, increases in household size and young persons in the household, living in states with high COVID caseloads and with moderately stringent Stay-at-Home social distancing mandates affected car-ownership propensities differently for car-owning and carless households. The significance of the research is that it disentangled pandemic-related and transportation policy variables from changes in household structure, living arrangements and employment-related characteristics. The analysis jointly considered how short-term pandemic-related influences as well as long-term demographic and occupational factors differently affect car-ownership for car-owning households and those without cars. Policy implications are drawn for consumer protection in the car ownership process, auto loan forbearance in future economic disruptions, strategies for public transportation which has continued to suffer from lower levels of use, and sustainability programs due to higher volumes of older used cars.

Self-Use of Aspirin Among Mothers in Management of Fever in Children Khartoum, Sudan 2022

Background: Fever is one of the most frequent symptoms of disease in childhood and a common cause of emergency admissions in infants and children. Aspirin is salicylic acid and is used to treat pain and fever. Aspirin should not be administrated to a child under 16 years old of age because it might lead to a serious and sometime fatal condition in children called Reye’s syndrome. Reye syndrome is a rare and potentially fatal pediatric illness defined as acute noninflammatory encephalopathy with fatty liver failure. Objective: To assess attitude and practice among mothers towards self-use of aspirin in management of fever in children under 5 years and its complication in Dar-alsalam almaghariba. Method: A descriptive, cross- sectional community-based study applied in sample size of 195 using non probability convenience sampling method, among mothers in Dar-alslam almaghariba area in February 2022. The data was collected by interview questionnaire. Which include sociodemographic data, close end questions contain 21 questions about knowledge, attitude and practice of self-use of aspirin, Data analysis was done by SPSS program and Microsoft excel. Results: the study report that (41.5%) of the respondents aged more than 40 years, (95,9%) of them were married, (75.4%) were housewife, (20%) were employee, (2.1%) were students and (2.6%) work, Majority of mother (87.2%) measured children’s temperature when felt subjectively rises by touch, irrespective to their beliefs about home management of fever (73.8%) used antipyretics. most of them know about complications of high-grade fever (93.8%) said high grade fever can cause convulsions. About (97.9%) of the participants know Aspirin and most of them (48.7%) get it from booth. Most of the participants (65.1%) used aspirin to lower temperature of their children, about (78.5%) of mothers know how to use aspirin. Majority of mothers (71.8%) don&amp;apos;t know the side effect of the irrational aspirin to the children, about (96.4%) don&amp;apos;t heard of Reye’s syndrome. Conclusion: Study concludes nearly all mothers used aspirin without prescription to reduce children’s body temperature, mothers’ awareness about hazardous use of aspirin and the Reye’s syndrome is extremely low, there is relation between low level of education and irrational use of aspirin by mothers. Ministry of health should increase the awareness of mothers about complications of aspirin aimed at eradication of the practice.

Identification of Evaluation Results in E-Banking Services Transaction for Product Recommendation using the BIRCH and Davies Bouldin Index Method

E-banking transaction services in the banking world include many products offered to customers. However, the existence of regulatory factors may limit the extent to which banks can promote e-banking services, especially in cases where promotions involve incentives or special offers. Besides, there is a need for data analysis that is used to help the process of recommending product promos from these services. Recommendations for this product promo can be known from the evaluation process of data collected from e-banking transaction services for purchases and payments. The clustering method suitable for providing significant and influential results compared to other methods is BIRCH, which is assisted by the Davies Bouldin Index method to determine the list of product groups with the lowest value. The results of this evaluation process show that data can be grouped based on which services have low levels of use. The services in question are Deposits, Credit Cards on Mobile Services, OVB, and Inter-Bank Transfers on Mobile Services. Therefore, this service can be used as a reference to increase product promotion by the bank.

Characteristics of women concordant and discordant for urine drug screens for cannabis exposure and self-reported cannabis use during pregnancy

BackgroundIncreasing cannabis use among pregnant people and equivocal evidence linking prenatal cannabis exposure to adverse outcomes in offspring highlights the need to understand its potential impact on pregnancy and child outcomes. Assessing cannabis use during pregnancy remains a major challenge with potential influences of stigma on self-report as well as detection limitations of easily collected biological matrices. ObjectiveThis descriptive study examined the concordance between self-reported (SR) cannabis use and urine drug screen (UDS) detection of cannabis exposure during the first trimester of pregnancy and characterized concordant and discordant groups for sociodemographic factors, modes of use, secondhand exposure to cannabis and tobacco, and alcohol use and cotinine positivity. Study designThe Cannabis Use During Development and Early Life (CUDDEL) Study is an ongoing longitudinal study that recruits pregnant individuals presenting for obstetric care, who report lifetime cannabis use as well as using (n = 289) or not using cannabis (n = 169) during pregnancy. During the first trimester pregnancy visit, SR of cannabis use and a UDS for cannabis, other illicit drugs and nicotine are acquired from eligible participants, of whom 333 as of 05/01/2023 had both. ResultsUsing available CUDDEL Study data on both SR and UDS (n = 333; age 26.6 ± 4.7; 88.6% Black; 45.4% below federal poverty threshold; 56.5% with paid employment; 89% with high school education; 22% first pregnancy; 12.3 ± 3.6 weeks gestation), we classified pregnant individuals with SR and UDS data into 4 groups based on concordance (k = 0.49 [95% C.I. 0.40–0.58]) between SR cannabis use and UDS cannabis detection during the first trimester: 1) SR+/UDS+ (n = 107); 2) SR-/UDS- (n = 142); 3) SR+/UDS- (n = 44); 4) SR-/UDS+ (n = 40). Those who were SR+/UDS- reported less frequent cannabis use and fewer hours under the influence of cannabis during their pregnancy. Those who were SR-/UDS+ were more likely to have joined the study at a lower gestational age with 62.5% reporting cannabis use during their pregnancy prior to being aware that they were pregnant. Of the 40 SR-/UDS+ women, 14 (i.e., 35%) reported past month secondhand exposure, or blunt usage. In the subset of individuals with SR and UDS available at trimester 2 (N = 160) and 3 (N = 140), concordant groups were mostly stable and > 50% of those in the discordant groups became concordant by the second trimester. Classifying individuals as exposed or not exposed who were SR+ and/or UDS+ resulted in minor changes in group status based on self-report at screening. ConclusionOverall, there was moderate concordance between SR and UDS for cannabis use/exposure during pregnancy. Instances of SR+/UDS- discordancy may partially be attributable to lower levels of use that are not detected on UDS. SR-/UDS+ discordancy may arise from recent use prior to knowledge of pregnancy, extreme secondhand exposure, deception, and challenges with completing questionnaires. Acquiring both self-report and biological detection of cannabis use/exposure allows for the examination of convergent evidence. Classifying those who are SR+ and/or UDS+ as individuals who used cannabis during their first trimester after being aware of their pregnancy resulted in only a minor change in exposure status; thus, relying on self-report screening, at least in this population and within this sociocultural context likely provides an adequate approximation of cannabis use during pregnancy.

Work-, lifestyle-, and health-related factors among women and men working in the emergency medical services

Objectives. This study aimed to describe work-, lifestyle-, and health-related factors among ambulance personnel, and to analyse differences between women and men. Methods. The cross-sectional study (N = 106) included self-reported and objective measures of work, lifestyle, and health in 10 Swedish ambulance stations. The data collection comprised clinical health examination, blood samples, tests of physical capacity, and questionnaires. Results. A high proportion of the ambulance personnel reported heavy lifting, risk of accidents, threats and violence at work. A low level of smoking and alcohol use, and a high level of leisure-time physical activity were reported. The ambulance personnel had, on average, good self-rated health, high work ability and high physical capacity. However, the results also showed high proportions with risk factors for cardiovascular disease (CVD), e.g., high blood pressure, and high levels of blood lipids. More women than men reported high work demands. Furthermore, women performed better in tests of physical capacity and had a lower level of CVD risk factors. Conclusions. Exposure to work-related factors that might affect health was common among ambulance personnel. Lifestyle- and health-related factors were somewhat contradictory, with a low proportion reporting lifestyle-related risk factors, but a high proportion having risk factors for CVD.

Contraceptive Utilization and Its Associated Factors Among Married Women in West African Countries: A Population-Based Survey Using Multinomial Logistic Regression.

The international development agenda emphasizes universal access to family planning, as seen in Sustainable Development Goal 3.7. However, the use of modern contraceptive methods remains low in developing countries, specifically in West Africa. This study aimed to assess the current status of contraceptive use in the region, focusing on different methods. We analyzed Demographic and Health Survey data from 13 West African nations (2012-2022) involving 117,165 married women. Using binary and multiple multinomial logistic regression, we identified key factors associated with contraceptive use. Adjusted odds ratios with 95% confidence intervals were utilized, and significance was determined at p ≤ 0.2 for binary regression and p < 0.05 for multiple multinomial regression. About 80.86% of women did not use any method, while 16.56% of women used modern methods. Maternal age of 35-49 years (RRR=0.77, 95% CI, 0.72,0.82), had given first birth after 20 years (RRR=0.80,95% CI, 0.77,0.83), cohabitation after 20 years old (RRR=1.24,95% CI, 1.18,1.29), being employed (RRR=1.38,95% CI, 1.33,1.43), women who have from 3-5, and more than five living children (RRR=2.06,95% CI,1.97,2.16, and (RRR=2.57, 95% CI, 2.42,2.74), primary(RRR=1.59, 95% CI, 1.52,1.66), secondary/higher education (RRR=2.08, 95% CI, 1.99,2.18), antenatal visit (RRR= 1.38, 95% CI 1.28,1.49), institutional delivery(AOR=1.42, 95% CI, 1.35,1.49), husband working status (RRR=1.39, 95% CI, 1.28,1.51), media exposure(RRR=1.23, 95% CI, 1.19,1.28), visited health facility more than once (RRR=1.09, 95% CI, 1.05,1.13), rural women (RRR=0.89,95% CI,0.85,0.93), female households (RRR=0.79, 95% CI,0.76,0.83), richer (RRR=1.42, 95% CI,1.33,1.51), and richest wealth indexes (RRR=1.69,95% CI,1.58,1.82) were associated. This study revealed a low level of contraceptive use among women in West Africa. Strengthening maternal reproductive health services, such as antenatal care, institutional delivery, and health visits, while also targeting mass media and disadvantaged women, has the potential to significantly increase the adoption of modern contraception techniques.

Online dating: predictors of problematic tinder use

BackgroundGeolocation apps have radically transformed dating practices around the world, with profound sociocultural implications. Few studies, however, have explored their addictive potential or factors that are associated with their misuse.ObjectiveThe present study aimed to assess the level of problematic Tinder use (PTU) in an adult sample, using a machine learning algorithm to determine, among 29 relevant variables, the most important predictors of PTU.Methods1,387 users of Tinder (18–74 years-old; male = 50.3%; female = 49.1%) completed an online questionnaire, and a machine learning tool was used to analyze their responses.ResultsOn 5-point scale, participants’ mean PTU score was 1.91 (SD = 0.70), indicating a relatively low overall level of problematic app use. Among the most important predictors of Problematic use were the use of Tinder for enhancement (reduce boredom and increase positive emotions), coping with psychological problems, and increasing social connectedness. The number of “matches” (when two users show mutual interest), the number of online contacts on Tinder, and the number of resulting offline dates were also among the top predictors of PTU. Depressive mood and loneliness were among the middle-ranked predictors of PTU.ConclusionIn accordance with the Interaction of Person-Affect-Cognition-Execution model of problematic internet use, the results suggest that PTU relates to how individual experience on the app interacts with dispositional and situational characteristics. However, variables that seemed to relate to PTU, including lack of self-esteem, negative mood states and loneliness, are not problems that online dating services as currently designed can be expected to resolve. This argues for increased digital services to identify and address potential problems helping drive the popularity of dating apps.

Regional cortical brain volumes at treatment entry relates to post treatment WHO risk drinking levels in those with alcohol use disorder

Abstinence following treatment for alcohol use disorder (AUD) is associated with significant improvements in psychiatric and physical health, however, recent studies suggest resumption of low risk levels of alcohol use can also be beneficial. The present study assessed whether post-treatment levels of alcohol use were associated with cortical brain volumedifferences at treatment entry. Individuals seeking treatment for AUD (n=75) and light/non-drinking controls (LN, n=51) underwent 1.5T magnetic resonance imaging. The volumes of 34 bilateral cortical regions of interest (ROIs) were quantitated via FreeSurfer. Individuals with AUD were classified according to post-treatment alcohol consumption using the WHO risk drinking levels (abstainers: AB; low risk: RL; or higher risk: RH). Regional volumes for AB, RL and RH, at treatment entry, were compared to LN. Relative to LN, AB demonstrated smaller volumes in 18/68 (26%), RL in 24/68 (35%) and RH in 34/68 (50%) ROIs with the largest magnitude volume differences observed between RH and LN. RH and RL reported a higher frequency of depressive disorders than AB. Among RH and RL, level of depressive and anxiety symptomatology were associated with daily number of drinks consumed after treatment. Volumetric differences, at treatment entry, in brain regions implicated in executive function and salience networks corresponded with post-treatment alcohol consumption levels suggesting that pre-existing differences in neural integrity may contribute to treatment outcomes. Depressive and anxiety symptomatology was also associated with brain morphometrics and alcohol use patterns, highlighting the importance of effectively targeting these conditions during AUD treatment.

Factors associated with the use of digital health among healthcare workers in the Buea and Tiko health districts of Cameroon: a cross-sectional study.

digital health has been demonstrated to improve the efficiency and scale of health service delivery in resource-limited settings. Understanding factors influencing its use could accelerate the process of its implementation in routine practice. we conducted a cross-sectional analytic study in Buea and Tiko health districts from January to May 2021. We included healthcare workers selected using multistage stratified sampling. Use of digital health was defined as using at least two digital tools and one digital health intervention (DHI) or at least two DHIs by a healthcare worker. Epi Info was used for statistical analysis. Binary logistic regression was used to evaluate factors associated with the use of digital health. in total, 221 participants were included in the study. The mean age was 33±9.1 years and 76.5% were female. Only 39.4% (n=87) of participants used digital health. The most frequently used digital tools for health-related purposes included: Microsoft (MS) Excel (29.9%), MS PowerPoint (26.8%) and MS Word (39.1%). The main DHIs used were research (30.2%) and diagnosing (24.1%) software. The main use of digital health was for research (75.6%). Owning a laptop (adjusted odds ratio (aOR)=1.98, 95% CI, 1.01 - 3.86), availability of internet connection in the health facility (1.99, 1.05 - 3.7) and receiving professional training in ICT/Computer Sciences (2.04, 1.06 - 3.93), were associated with higher odds of using digital health. this study shows a low level of use of digital health by healthcare workers. Providing newer devices, internet connection in health facilities and training in ICT for healthcare workers could improve its uptake.

Mind the gap! Factors that predict progression to bariatric surgery indicate that more psychological treatment may be required.

In the UK, the number of adults living with obesity is increasing. Bariatric surgery is an available treatment for those living with a BMI (kg/m2 ) ≥40 and above, or ≥35 with obesity-related comorbidities. Guidelines highlight the importance of providing psychological support pre- and post-surgery owing to the complex psychopathology present in those living with obesity. There are a lack of studies examining which patients proceed to surgery and the factors that predict progression. Routine patient data were collected within one NHS regional service in the UK, comprising 733 patients between 3 August 2018 and 26 July 2019, aged between 17 and 76 years (M = 43.20, SD = 12.32). The only exclusion criteria were patients still awaiting a final decision for surgical outcome at the point of analysis (N = 29), which resulted in 704 patients included in analysis. Binary Logistic Regression revealed those who were more likely to progress to surgery had a lower-level use of maladaptive external substances; lower level of self-harm and/or suicidality, were older in age; had a lower BMI; and had less comorbidities than those who did not progress. Findings support existing literature in that bariatric patients often present with physical and mental health complexity. Two thirds of patients in this study did not progress to surgery. Service commissioning decisions meant that these patients did not have access to psychology treatment. Consequently, in cases where bariatric surgery is considered, a final treatment option and otherwise clinically appropriate, lack of access to specialist services may result in unmet patient need owing particularly to a lack of psychological treatment provision.

IBC-Oxford University2023_BJSOral_5Comparative Effectiveness of Bupivacaine-Dexamethasone and Liposomal Bupivacaine for Autonomic Neural Blockade in Laparoscopic Sleeve Gastrectomy: A Study on Pain, Postoperative Nausea and Vomiting and Analgesic Consumption

Abstract Background Pain is increasingly recognised as a syndrome not merely a symptom, emphasizing the importance of pain management. Visceral pain impacts up to 75% of bariatric patients during recovery. Concurrently, postoperative nausea and vomiting (PONV) persist as challenges after laparoscopic sleeve gastrectomy (LSG). An earlier RCT demonstrated the safety and effectiveness of para-gastric autonomic neural blockade (ANB) as a novel strategy to manage these issues in the first 24 hours after a laparoscopic sleeve gastrectomy. A limitation of using bupivacaine for ANB is its half-life, with clinical effects limited to 14 to 18 hours. This study compares the effectiveness of ANB using a combination of bupivacaine and Dexamethasone with that of liposomal bupivacaine. Methods This research represents a secondary analysis of an earlier RCT titled "Impact on Anaesthetic Agents Consumption Following Autonomic Neural Blockade as Part of a Combined Anaesthesia Protocol," currently under review. This secondary analysis focuses on two patient groups; one where ANB was performed with a mix of 5% bupivacaine and Dexamethasone (47 patients), and another with liposomal bupivacaine (25 patients). Data on pain, PONV, and analgesic requirements at 1, 8, and 24 hour post-surgery were recorded and analysed. Results Both treatment groups demonstrated low levels of pain, PONV incidence, and analgesic usage. No significant differences in pain scores or analgesic use were found between the groups at the selected postoperative time points. However, the liposomal bupivacaine group exhibited a reduced incidence of PONV, statistically significant only for vomiting. Discussion Visceral pain and PONV significantly affects patients' quality of life, recovery time, nursing time allocation, the risk of opioid abuse and readmission rates. Various strategies have been explored to manage visceral pain and associated symptoms. ANB has proven safe and effective in reducing pain, PONV, and analgesic consumption post-LSG. This study confirms that application of either 5 % bupivacaine plus Dexamethasone or liposomal bupivacaine during ANB results in very low levels of pain, PONV incidence, and analgesic use, outperforming the results of the original RCT using only 5% bupivacaine. These results may be attributed to the local anaesthetic used or the improved proficiency in performing the ANB. The similar low pain level and analgesic needs in both groups may render any statistical difference undetected due to the sample size. However, liposomal bupivacaine demonstrated a clinical advantage in reducing PONV after LSG. Conclusion ANB utilizing 5% bupivacaine plus Dexamethasone or liposomal bupivacaine effectively mitigates pain, PONV, and analgesic use following LSG. Liposomal bupivacaine appears more effective in managing nausea and vomiting.

Evaluation of the effectiveness of strategies under the perspectives of the Balanced ScoreCard

The objective of this research is to know the effectiveness of business strategies from the perspective of the Balanced ScoreCard in medium-sized companies in the city of Ambato. The research consisted of an explanatory methodology with a qualitative and quantitative approach with a descriptive research design, the study population was based on micro-enterprises in the province of Tungurahua, in this sense for the sample, 22 medium-sized companies. of the city of Ambato were determined. A survey structured by 16 questions distributed in four dimensions was applied: financial perspective, customer perspective, internal processes perspective and learning and growth perspective. Among the main results is the low financial perspective (27,3 %). The customer perspective is the lowest point in 45,4 % of companies, on the other hand, there is a very low perspective of internal processes (27,3 %) and finally, the management focused on learning and knowledge perspective maintains the same deficiencies of the previous dimensions (22,7 %). In this context, it is concluded that the companies selected for the study have a low level of use of the Balanced ScoreCard perspectives. The results of the correlation analysis show that the financial perspective varies directly with the change in customer perspectives and internal processes and the customer perspective varies directly with respect to internal processes