Low Level Of Use Research Articles

Reducing information asymmetry from the management control perspective: discussion of practices in transparent companies

ABSTRACT The capital market is supplied with information daily, but when this is made available in an incomprehensible way, it becomes a potential barrier to investment. In order to overcome this shortcoming, constantly improved regulations intensify the need for more and better information. In the managerial context, empirical studies indicate that there is a low level of use of modern Management Accounting tools; however, on a theoretical level, Accounting Theory prescribes that Accounting must effectively meet the needs of its external and internal users. It is thus believed that not only financial but also management information would be apparent in its reports. This investigation aims to verify whether there are differences with regards to the level of reporting of management control practices in the financial statements of companies nominated for the Transparency Award, organized by the National Association of Finance, Administration, and Accounting Executives (ANEFAC), the Accounting, Actuarial, and Financial Research Institute (FIPECAFI) and Serasa Experian, compared with the other companies listed on the São Paulo Stock, Commodities, and Futures Exchange (BM&FBOVESPA). These elements were defined based on a discourse analysis of Management Reports (MRs) and the evidence was tested using Multiple Correspondence Analysis. The sample consists of 19 MRs from publicly-traded companies that were nominated for the Transparency Trophy and 129 MRs from companies listed on the BM&FBOVESPA. The findings show that the companies nominated for the award have some special informational categories in the discourses of their MRs and that these elements are not enough to show differences in the level of transparency of management control practices.

Haloperidol plus promethazine for psychosis-induced aggression.

Health services often manage agitated or violent people and for emergency psychiatric services such behaviour is particularly prevalent (10%). The drugs used in this situation should ensure that the person swiftly and safely becomes calm.To examine whether haloperidol plus promethazine is an effective treatment for psychosis induced agitation/aggression.We searched the Cochrane Schizophrenia Group's Register (July 2004).We included all randomised clinical trials involving aggressive people with psychosis for which haloperidol plus promethazine was being used.We reliably selected, quality assessed and extracted data from all relevant studies. For binary outcomes we calculated standard estimations of risk ratio (RR) and their 95% confidence intervals (CI). Where possible we estimated weighted number needed to treat or harm (NNT/H).We identified two relevant high quality studies. One compared the haloperidol plus promethazine mix with midazolam (n=301) and one with lorazepam (n=200). The combined results were largely heterogeneous. In Brazil, haloperidol plus promethazine was an effective means of tranquillisation with over two thirds of people being tranquil or sedated by 30 minutes, but midazolam was more swift (n=301, RR 2.9 CI 1.75 to 4.80, NNH 5 CI 3 to 12). In India, however, 95% of people were tranquil or sedated by 30 minutes if allocated to the combination treatment (vs lorazepam, n=200, RR 0.26 CI 0.10 to 0.68, NNT 8 CI 6 to 17). Over the next few hours of treatment reported differences are negligible. One person given midazolam had respiratory depression (reversed by flumazenil), one given lorazepam had respiratory difficulty. A single person given haloperidol plus promethazine had an epileptic fit. Once the initial tranquillisation was administered, few needed additional medications for continued agitation (n=501, 2 RCTs, RR needing additional tranquillising drugs by four hours 1.67 CI 0.62 to 4.54, 4% vs 2%, I squared 50%) and there were no differences in the low levels of use of restraints. About 28% of people in Brazil in both groups had another episode of aggression in the first day after the initial injection (n=301, RR 0.89 CI 0.62 to 1.29). About half of all people in the Indian study were discharged by four hours (n=200, RR 1.13 CI 0.85 to 1.50) and a similar proportion in Brazil by 15 days (n=301, RR 1.05 CI 0.84 to 1.29). Both studies attained 99% follow up for their primary outcomes. Even by two weeks only 4% of people could not be accounted for (n=501, 2 RCTs, RR 0.91 CI 0.38 to 2.17).This review suggests that both benzodiazepines work, but that midazolam has a faster onset and thereby reduces the risk of exposure to violence. Both benzodiazepines have the potential to cause respiratory depression, probably midazolam more so than lorazepam, and we would question the use of this group of drugs outside of those services fully confident of observing for and managing the consequences of respiratory distress. Most evidence, however, exists for the haloperidol plus promethazine mix, with currently more than 400 people randomised to the combination. The onset of action is swift and faster than lorazepam. The combination also seems safe with no clear longer term consequences. We would expect policy makers recommending other drug managements to have equally compelling evidence to support their guidance and hope that this would not be founded in conjecture or consensus, which may be more difficult to defend than evidence from high quality studies.

DETERMINANTS OF ADOPTION OF POTATO PRODUCTION TECHNOLOGY PACKAGE BY SMALLHOLDER FARMERS: EVIDENCES FROM EASTERN ETHIOPIA

Potato production plays an important role in improving household income and nutrition and thereby contributes to food security. Despite of this, the current productivity of the crop is below the potential. Low level of use of improved potato technology package is among the causes for low productivity. In this context, this study analysed the factors influencing adoption of potato technology package by smallholder farmers in Gurawa, Haramaya, Kombolcha, Meta, and Habro districts of Eastern Ethiopia. The analysis was based on a household survey conducted on 214 randomly selected potato growing households. A two-limit Tobit model was used to analyse the factors affecting adoption which is measured in an index computed from five components of the technology package. Variation in districts, access to irrigation, farm size, membership to cooperatives, and annual income of the households were found to significantly affect the adoption of potato technology package. Policy makers, planners and development practitioners are required to give due attention to these determinants in order to support smallholder farmers in production and productivity improvements from potato production.

Unintended Consequences of Adjusting Citalopram Prescriptions Following the 2011 FDA Warning

In 2011, the U.S. Food and Drug Administration (FDA) issued a safety announcement cautioning providers against prescribing citalopram above 40 mg per day given concerns for QT prolongation. We assessed the impact of a health system quality improvement initiative to identify patients taking higher than the recommended dose of citalopram. Retrospective cohort study. Nine primary care clinics within the University of Michigan from March 2012 to February 2013. Adult patients taking a higher-than-recommended dose of citalopram following the FDA warning in 2011 (N = 199). Frequency of EKG monitoring, clinical factors associated with patients whose citalopram dose or use was adjusted, and potential impact of these changes on overall health care utilization was assessed. In patients prescribed higher-than-recommended doses of citalopram and who received a note from a pharmacist regarding the FDA warnings, only 8.5% received electrocardiogram (EKG) monitoring. Patients who were converted to an alternative antidepressant from citalopram were more likely to receive subsequent new prescriptions for benzodiazepines and sedative hypnotics (χ2 = 7.9, p = 0.048). Patients who had any adjustments to their antidepressant medication had greater overall health care utilization (OR: 25.0; 95% CI: 5.7-109.6; p < 0.001) than patients remaining on the same dose of citalopram. Despite a targeted quality intervention to address the FDA warning regarding citalopram, the warning was associated with low levels of EKG monitoring, increased anxiolytic and sedative medication use, and higher healthcare utilization. This finding may represent destabilization of patients on previously therapeutic doses of their antidepressant and an unintended consequence of the FDA warning.

Causes of nursing home placement for older people with dementia: a systematic review and meta-analysis.

Up to half of people with dementia in high income countries live in nursing homes and more than two-thirds of care home residents have dementia. Fewer than half of these residents report good quality of life and most older people are anxious about the prospect of moving into a nursing home. Robust evidence is needed as to the causes of admission to nursing homes, particularly where these risk factors are modifiable. We conducted a systematic literature search to identify controlled comparison studies in which the primary outcome was admission to nursing home of older adults with dementia. Identified studies were assessed for validity and 26 (17 cohort and 9 case-control) were included. Qualitative and quantitative analyses were conducted, including meta-analysis of 15 studies. Poorer cognition and behavioral and psychological symptoms of dementia (BPSD) were consistently associated with an increased risk of nursing home admission and most of our meta-analyses demonstrated impairments in activities of daily living as a significant risk. The effects of community support services were unclear, with both high and low levels of service use leading to nursing home placement. There was an association between caregiver burden and risk of institutionalization, but findings with regard to caregiver depression varied, as did physical health associations, with some studies showing an increased risk of nursing home placement following hip fracture, reduced mobility, and multiple comorbidities. We recommend focusing on cognitive enhancement strategies, assessment and management of BPSD, and carer education and support to delay nursing home placement.

Patient reported outcome measures in child and adolescent mental health services: associations between clinician demographic characteristics, attitudes and efficacy.

Policy recommends using patient reported outcome measures (PROMs), yet their use is persistently low. Our aim was to examine the association between PROM use and clinician demographic characteristics, attitudes and efficacy. A sample of N=109 clinicians completed an online survey. Clinicians who reported higher levels of use of cognitive behaviour or humanistic approaches had higher levels of PROM use than clinicians who reported lower levels of use of these approaches. Clinicians who reported having received training had higher levels of self-efficacy regarding PROMs than clinicians who reported not having received training, but the effects of training on PROM attitudes and use were not significant. Still, clinicians with more positive attitudes or self-efficacy regarding PROMs had higher levels of PROM use than clinicians with less positive attitudes or self-efficacy regarding PROMs. Clinicians should be supported to have the knowledge, skills and confidence to effectively use PROMs in their clinical practice.

An Exploration of Human Well-Being Bundles as Identifiers of Ecosystem Service Use Patterns.

We take a social-ecological systems perspective to investigate the linkages between ecosystem services and human well-being in South Africa. A recent paper identified different types of social-ecological systems in the country, based on distinct bundles of ecosystem service use. These system types were found to represent increasingly weak direct feedbacks between nature and people, from rural “green-loop” communities to urban “red-loop” societies. Here we construct human well-being bundles and explore whether the well-being bundles can be used to identify the same social-ecological system types that were identified using bundles of ecosystem service use. Based on national census data, we found three distinct well-being bundle types that are mainly characterized by differences in income, unemployment and property ownership. The distribution of these well-being bundles approximates the distribution of ecosystem service use bundles to a substantial degree: High levels of income and education generally coincided with areas characterised by low levels of direct ecosystem service use (or red-loop systems), while the majority of low well-being areas coincided with medium and high levels of direct ecosystem service use (or transition and green-loop systems). However, our results indicate that transformations from green-loop to red-loop systems do not always entail an immediate improvement in well-being, which we suggest may be due to a time lag between changes in the different system components. Using human well-being bundles as an indicator of social-ecological dynamics may be useful in other contexts since it is based on socio-economic data commonly collected by governments, and provides important insights into the connections between ecosystem services and human well-being at policy-relevant sub-national scales.

ПРАВОВЫЕ ОСНОВЫ ПРОВЕДЕНИЯ bcg-ТЕРАПИИ ДЛЯ ЛЕЧЕНИЯ РАКА МОЧЕВОГО ПУЗЫРЯ В УСЛОВИЯХ МУНИЦИПАЛЬНЫХ ПОЛИКЛИНИК

The article presents brief data from the literature about the history of BCG vaccine development (Bacille bilie' Calmette-Gue'rin), results of meta-analyses aimed at the evaluation of BCG-therapy efficiency in Ta-T1 bladder cancer. Below one can read descriptions of clinical cases when side effects and complications of this method developed according to the literature data and results of authors' personal observations. The main reason of low level of BCG-therapy use in Russia is low awareness of medical workers about the legal grounds for application of this method. The article gives the list of acting legal acts regulating provision of epidemiological safety when applying BCG-therapy and describes the technique for using this method in municipal polyclinics in compliance with the above legal acts.

Perceptions of traditional, complementary and alternative medicine among conventional healthcare practitioners in Accra, Ghana: Implications for integrative healthcare

ObjectiveIntegrative medicine refers to ongoing efforts to combine the best of conventional and evidence-based complementary therapies. While this effort for collaboration is increasing, traditional complementary and alternative medicine (TM-CAM) remains poorly integrated into the current healthcare system of Ghana. At present, it is not clear if practitioners of mainstream medicine favor integrative medicine. The present study, therefore, sought to explore the perceptions of conventional healthcare professionals on integrative medicine. MethodsA qualitative design composed of semi-structured interviews was conducted with 23 conventional healthcare professionals comprising pharmacists, physicians, nurses and dieticians from two quasi-government hospitals in Accra, Ghana. ResultsParticipants' knowledge of TM-CAM was low, and although they perceived alternative medicine as important to current conventional healthcare in Ghana, they expressed anxieties about the potential negative effects of the use of TM-CAM. This paradox was found to account for the low levels of use among these professionals, as well as the low level of recommendation to their patients. The practitioners surveyed recommended that alternative medicine could be integrated into mainstream allopathic healthcare in Ghana through improving knowledge, training as well as addressing concerns of safety and efficacy. These findings are discussed under the themes: the knowledge gap, the paradox of TM-CAM, experience of use and prescription, and guided integration. We did not observe any differences in views among the participants. ConclusionThe conventional healthcare professionals were ready to accept the idea of integrative medicine based on knowledge of widespread use and the potential role of TM-CAM products and practices in improving healthcare delivery in the country. However, to achieve an institutional integration, practitioners' understanding of TM-CAM must be improved, with specific attention to issues of safety, regulation and evidence-based practice of TM-CAM products and services in Ghana.

Profiling farming management strategies with contrasting pesticide use in France

Reducing pesticide use in agriculture is a major challenge to improve sustainability of cropping systems. It is critical to identify effective integrated farming strategies able to decrease substantially pesticide use. This study is based on a unique French national network of 1012 arable commercial farms involved in a pesticide reduction program. These farms displayed contrasting levels of pesticide use, and covered a large diversity of environmental characteristics and farming practices. Our objective was to identify profiles of management strategies showing contrasting pesticide use levels in France. Two categories of factors potentially related to pesticide use were considered successively, namely factors describing production situations and factors describing management strategies. Regression tree methods were applied to the dataset to identify combinations of factors associated with low vs. high pesticide use levels. Results showed that, among the factors describing production situations, the presence of livestock, climate conditions, and to a lesser extent soil characteristics were able to discriminate groups of farms with contrasting pesticide use levels. Among the factors describing management strategies, the crop sequence, the crop diversity, the pesticide spraying techniques, and soil tillage were frequently selected for discriminating farms characterised by low vs. high pesticide use levels, whereas specific factors such as mechanical weeding, crop cultivars and sowing dates were related with pesticide use in some production situations only. Across production situations, several contrasting strategies led to low levels of pesticide use. Besides, within each considered production situation, different strategies appeared associated with low levels of pesticide use. Our results reveal that a large diversity of strategies exists for controlling pests, weeds and diseases without high levels of pesticide use.

The influence of civic mindedness, trustworthiness, usefulness, and ease of use on the use of government websites

Civic mindedness and the perceptions of trustworthiness, usefulness, and ease of use seem to explain much of the effective use of websites. This article discusses the extent to which such factors influence the use of government websites based on a study with 210 citizens who were doing their biometric electoral registration in João Pessoa – a major city in Brazil. With the help of ordinary least squares and quantile regression models, we found that there is mixed influence of those factors on the use of government websites. On average, perceived usefulness and perceived ease of use had a significant influence; but for low levels of use, only perceived usefulness had an influence, whereas perceived ease of use had an influence for moderate and high levels of use. In terms of trustworthiness, only the dimension about trust in government had an influence for all levels of use. In terms of civic mindedness, only the dimension about civic engagement had an influence, except for moderate levels of use. Our results reinforce that the development of government websites should focus on the citizens’ individual profiles and levels of use, that is, focus should be directed to the demand side (users) besides merely addressing the legal requirements and the provision of services by the supplier (government).

The use of self-regulation strategies by foreign language learners and its role in language achievement

Studies show that incorporating self-regulated learning (SRL) strategies into foreign language teaching encourages the development of autonomous learners. However, interviews with teachers ( n = 51) indicate that they mostly do not consider SRL in classroom practices. The present study attempts to highlight the significance of SRL in language teaching by exploring its impact on language achievement. It investigates learner reported use of SRL, focusing on its three main components – orientation, performance, and evaluation – and their power in predicting foreign language achievement. A total of 222 undergraduate foreign language learners at a state university participated in the study. Data was collected from two sources: a five-point Likert-type self-regulated language learning questionnaire, adapted from models and research instruments used in previous studies to investigate SRL and language learning strategies, and the university’s English achievement exam. Quantitative analyses indicated that although participants reported moderate to low levels of SRL use, it is a significant predictor of foreign language achievement and had significant correlations with language achievement. The results are meant to draw attention to the importance of SRL research within the foreign language teaching field as well as foster SRL implementation in language instruction.

The association of calcium supplementation and incident cardiovascular events in the Multi-ethnic Study of Atherosclerosis (MESA)

Background and aimsMany US adults use calcium supplements to address inadequate dietary intake and improve bone health. However, recent reports have suggested that use of calcium supplements may elevate cardiovascular disease (CVD) risk. In this study, we examined associations between baseline calcium supplement use and incident myocardial infarction (MI) (n = 208 events) and CVD events (n = 641 events) over 10.3 years in men and women from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort (n = 6236), with dietary calcium intake at baseline also examined as a supplementary objective. Methods and resultsUsing Cox proportional hazards models, no compelling associations between calcium intake from supplements or diet and incident CVD events were observed upon multivariate adjustment for potential confounders. An association with lower MI risk was observed comparing those with low levels of calcium supplement use (1–499 mg) to those using no calcium supplements (hazard ratio 0.69, 95% CI 0.48, 0.98, p = 0.039). Relationships were homogeneous by gender, race/ethnicity, or chronic kidney disease. Results were also similar when the analysis was limited to postmenopausal women only. ConclusionAnalysis of incident MI and CVD events in the MESA cohort does not support a substantial association of calcium supplement use with negative cardiovascular outcomes.

Racial differences in heritability of cigarette smoking in adolescents and young adults

IntroductionAlthough epidemiologic studies suggest low levels of cigarette use among African American adolescents relative to White U.S. adolescents, it is not known whether this may be due to racial differences in the relative contribution of genes and environment to cigarette use initiation and progression to regular use. MethodsUsing data from White (n=2665) and African American (n=809) twins and full siblings sampled in the National Longitudinal Study of Adolescents, we fitted age-, sex- and race-specific variance decomposition models to estimate the magnitude of genetic and environmental effects on cigarette use initiation and cigarette use quantity in Whites and African Americans across adolescence and adulthood. We employ a causal-contingent-common pathway model to estimate the amount of variance explained in quantity of cigarettes smoked contingent on cigarette use initiation. ResultsAfrican Americans had lower cigarette use prevalence from adolescence through adulthood, and used cigarettes less heavily than Whites. Race-specific causal-contingent-common pathway models indicate that racial differences in genetic and environmental contributions to cigarette use initiation and cigarette use quantities are not present in adolescence but appear in young adulthood. Additive genetic factors were an important risk factor for cigarette use initiation for White but not African American young adults and adults. ConclusionsGenetic and environmental contributions for cigarette use are similar by race in adolescence. In adulthood, genes have a stronger influence for cigarette use among White adolescents while the influence of the environment is minimal. For African Americans, both genetic and environmental influences are important in young adulthood and adulthood.

Cross-Cultural Comparison of Adolescents' Online Self-Presentation Strategies

Studying how social network site (SNS) users from different countries present themselves is crucial for inquiring into the dynamics of culture and youth. This study of 100 adolescents age 14-18 (Mage= 15.90, SD = .1.48) was designed to determine whether cultural differences between adolescents in the U.S. and Turkey would manifest themselves in their online self-presentation strategies on Facebook. Snowball sampling was used to reach U.S. and Turkish adolescents (50 participants from each country) who were using Facebook. The study provides novel insights into how adolescents from each country, in relation to its specific cultural framework, display certain kinds of self-presentation strategies. By coding Facebook profiles of adolescents, the authors found that the sharpest cross-cultural contrast was found in the frequency of the self-promotion strategy, which was more frequent in the United States. There was also a significant difference in use of exemplification strategy between the two countries; it was more widely used in Turkey. The high level of the ingratiation strategy in both countries may reflect the importance of “likes” in the Internet culture. There was also a significant cross-national difference in the ingratiation strategy, which U.S. teens used more. Finally, the authors also found a low level of use of the intimidation and supplication strategies in both countries. The study highlights the importance of self-exploration in constructing identities that conform to desirable cultural roles.

87 Knowledge and practices for the prevention of pre-eclampsia (pe) among frontline health care providers in Bangladesh and nigeria: A call for action

Evidence for the effectiveness of aspirin and supplemental calcium in populations with low dietary calcium intake as prophylaxis for pre-eclampsia have been firmly established, are recommended by the World Health Organization (WHO), and a guiding practice in many developed countries. However PE prophylaxis for high risk pregnant women has not been institutionalized in Bangladesh and Nigeria despite significant contribution of PE and eclampsia (E) to maternal and perinatal deaths. To examine the gaps in knowledge and practice among frontline health care providers in relation to the preventive strategies for PE in Bangladesh and Nigeria, and to chart pathways for improvement. From May to September 2015, Population Council conducted interviews with health care providers on their knowledge and practice for the prevention of PE as part of a landscaping analysis in Bangladesh and Nigeria. The study was conducted across 134 health care facilities (289 PHC providers interviewed) and 96 health care facilities (379 care providers interviewed) in Bangladesh and Nigeria respectively. Only health care providers who work at antenatal and maternity units were eligible for inclusion. We used a combination of self-administered questionnaires and check-list to determine knowledge and practice of providers around aspirin prophylaxis and calcium supplementation for the prevention of PE among high risk women. Descriptive (frequencies and percentages) and inferential (Chi-square test) analyses were conducted to identify factors associated with the outcomes of interest. Of the 379 care providers interviewed (doctors, nurses/midwives and community health extension workers – CHEWs) in Nigeria, only 2.9% and 1.1% mentioned aspirin and supplemental calcium, and only 9% of those who mentioned aspirin ever used it. No provider has ever used supplemental calcium. Low knowledge and use persist across all cadres of health care providers interviewed. Similarly in Bangladesh, the knowledge of PE prophylaxis was extremely poor. Among 289 service providers, none mentioned supplemental calcium. There is no policy on aspirin use during antenatal care (ANC). Only 2% of the service providers (6% of doctors interviewed) were aware of the use of aspirin. The lack of knowledge of calcium supplementation in Bangladesh may be due to the fact that it is routinely supplied to ANC clients. The specific role of calcium appears unknown to them. Low level of knowledge and use of preventive strategies against PE in these settings with relatively high burden of deaths from PE/E indicates missed opportunities. Capacity building of service providers is imperative to prevent PE. Program managers and policy-makers should ensure that service providers use these highly-effective, low-cost interventions (prophylactic aspirin and supplemental calcium) to improve the care of pregnant women. The importance of these intervention lies in the fact that over two-thirds of pregnant women in the two countries receive some form of ANC services, and daily dietary calcium intake is known to be inadequate in Bangladesh.

Attitude as a Mediator between Acculturation and Behavioral Intention

Immigrants, specifically African-born black persons, are affected by the HIV epidemic in the U.S. The low level of condom use among immigrants is a risk factor for contracting HIV and STIs. Immigrants go through acculturation process in their new adopted countries-a process reported to influence many health risks and protective factors; however, the mechanism through which acculturation influences health behaviors is not well understood. Thus, study examined the mediating role of attitude in the relationship between acculturation and the intention to use male condoms in steady heterosexual relationships among Somali and Ethiopian immigrants in Minnesota. The study was a regression analysis and the method of data collection cross-sectional. Participants were (n=205) Somali and Ethiopian immigrants in Minnesota who volunteered for the study. Study participants responded to questions on attitudes, behavioral intention, and acculturation levels. The indirect effect of acculturation through the mediator, attitude, was not significant, product coefficient (a×b)=0.04, 95% CI: [0.00, 0.11]; hence attitude did not mediate the relationship between acculturation and the intention to use condoms in the study population. However, there were significant direct and total effects of acculturation (c'=.27, p<.05; c=.31, p<.05), respectively, on intention to use condoms. Results of the study may suggest that public health intervention strategies targeting condom use among immigrants should incorporate programs that improve English language training tailored to the cultural practices and values of the immigrants, and consider the effect of acculturation on condom use.

The Women's International League for Peace and Freedom and the Challenges of Intersectionality Praxis

Black feminist scholars argued decades ago for working for peace and justice from the intersections of people's multiple identities. A body of scholarship focused on intersectionality subsequently arose since doing so is thought to have broader appeal and be more efficacious. However, the degrees to which social movements actually use intersectional discourses is undetermined. Quantitative and qualitative data analyses from a longitudinal study (1990–2005) of peace movement organizations (PMOs) reveals surprisingly low levels of use. A subset of data from the Women's International League for Peace and Freedom (WILPF), a group thought to be highly likely to use intersectional discourses, was used to further explore the disconnect between public statements and organizational sensibility. Findings show that while WILPF historically did not use intersectionality discourses, usage significantly increased in their recent civil society consultation process regarding women and security issues. The findings suggest that an ideological commitment to inclusion alone was not sufficient to produce intersectional discourses; a combination of an external mediated political opportunity and an internal demographic threat to the movement's longevity were necessary before discursive change occurred.

Assessing the risk of marijuana use disorder among adolescents and adults who use marijuana

ABSTRACTBackground: The changing political and social climate surrounding marijuana use, coupled with the fact that available estimates of marijuana use disorder prevalence are outdated and do not adequately represent adolescents, underscore the need for up-to-date and comprehensive prevalence estimates of marijuana use disorder. Objectives: To provide recent national estimates of marijuana use disorder as a function of usage patterns, age, and other sociodemographic, substance use, and mental health variables. Methods: Analyses of data from the 2014 National Survey on Drug Use and Health examined the prevalence of marijuana use disorder among respondents (N = 55,271) with various sociodemographic, substance use, and mental health characteristics. Logistic and multinomial regression analyses examined the correlates of marijuana use disorder as a function of these variables, with a special focus on age. Results: In 2014, 3.49% of lifetime, 11.62% of past-year, and 15.32% of past-30-day marijuana users met DSM-IV criteria for a marijuana use disorder; rates among youth generally were at least double those of adults across reported time frame and intensity of use. Regression analyses indicated that young age, black race/ethnicity, greater intensity of use, current tobacco/nicotine use, and alcohol and other drug use disorders were associated with increased odds of a marijuana use disorder. Conclusions: A significant proportion of marijuana users, especially youth, are at risk for having a marijuana use disorder, even at relatively low levels of use.

Implementation of coordinated global serotype 2 oral poliovirus vaccine cessation: risks of inadvertent trivalent oral poliovirus vaccine use.

BackgroundThe endgame for polio eradication includes coordinated global cessation of oral poliovirus vaccine (OPV), starting with the cessation of vaccine containing OPV serotype 2 (OPV2) by switching all trivalent OPV (tOPV) to bivalent OPV (bOPV). The logistics associated with this global switch represent a significant undertaking, with some possibility of inadvertent tOPV use after the switch.MethodsWe used a previously developed poliovirus transmission and OPV evolution model to explore the relationships between the extent of inadvertent tOPV use, the time after the switch of the inadvertent tOPV use and corresponding population immunity to serotype 2 poliovirus transmission, and the ability of the inadvertently introduced viruses to cause a serotype 2 circulating vaccine-derived poliovirus (cVDPV2) outbreak in a hypothetical population. We then estimated the minimum time until inadvertent tOPV use in a supplemental immunization activity (SIA) or in routine immunization (RI) can lead to a cVDPV2 outbreak in realistic populations with properties like those of northern India, northern Pakistan and Afghanistan, northern Nigeria, and Ukraine.ResultsAt low levels of inadvertent tOPV use, the minimum time after the switch for the inadvertent use to cause a cVDPV2 outbreak decreases sharply with increasing proportions of children inadvertently receiving tOPV. The minimum times until inadvertent tOPV use in an SIA or in RI can lead to a cVDPV2 outbreak varies widely among populations, with higher basic reproduction numbers, lower tOPV-induced population immunity to serotype 2 poliovirus transmission prior to the switch, and a lower proportion of transmission occurring via the oropharyngeal route all resulting in shorter times. In populations with the lowest expected immunity to serotype 2 poliovirus transmission after the switch, inadvertent tOPV use in an SIA leads to a cVDPV2 outbreak if it occurs as soon as 9 months after the switch with 0.5 % of children aged 0–4 years inadvertently receiving tOPV, and as short as 6 months after the switch with 10–20 % of children aged 0–1 years inadvertently receiving tOPV. In the same populations, inadvertent tOPV use in RI leads to a cVDPV2 outbreak if 0.5 % of OPV RI doses given use tOPV instead of bOPV for at least 20 months after the switch, with the minimum length of use dropping to at least 9 months if inadvertent tOPV use occurs in 50 % of OPV RI doses.ConclusionsEfforts to ensure timely and complete tOPV withdrawal at all levels, particularly from locations storing large amounts of tOPV, will help minimize risks associated with the tOPV-bOPV switch. Under-vaccinated populations with poor hygiene become at risk of a cVDPV2 outbreak in the event of inadvertent tOPV use the soonest after the tOPV-bOPV switch and therefore should represent priority areas to ensure tOPV withdrawal from all OPV stocks.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1537-8) contains supplementary material, which is available to authorized users.