Lower Rates Of Use Research Articles

Barriers to the Use of Web-Based Mental Health Programs for Preventing Depression: Qualitative Study.

BackgroundDepression has a profound impact on population health. Although using web-based mental health programs to prevent depression has been found to be effective in decreasing depression incidence, there are obstacles preventing their use, as reflected by the low rates of use and adherence.ObjectiveThe aims of the study are to understand the barriers to using web-based mental health programs for the prevention of depression and the possible dangers or concerns regarding the use of such programs.MethodsBroMatters and HardHat were two randomized controlled trials (RCTs) that evaluated the effectiveness of e–mental health programs for preventing workplace depression. In the BroMatters RCT, only working men who were at high risk of having a major depressive episode were included. The participants were assigned to either the control group or 1 of 2 intervention groups. The control participants had access to the general depression information on the BroMatters website. Intervention group 1 had access to BroMatters and BroHealth—the depression prevention program. Intervention group 2 had access to BroMatters and BroHealth along with weekly access to a qualified coach through telephone calls. The HardHat trial targeted both men and women at high risk of having a major depressive episode. The participants in the intervention group were given access to the HardHat depression prevention program (which included a web-based coach), whereas HardHat access was only granted to the control group once the study was completed. This qualitative study recruited male participants from the intervention groups of the two RCTs. A total of 2 groups of participants were recruited from the BroMatters study (after a baseline interview: n=41; 1 month after the RCT: n=20; 61/744, 8.2%), and 1 group was recruited from the HardHat RCT 1 month after the initial quantitative interview (9/103, 8.7%). Semistructured interviews were performed with the participants (70/847, 8.3%) and analyzed using content analysis.ResultsThere were both personal and program-level barriers to program use. The three personal barriers included time, stress level, and the perception of depression prevention. Content, functionality, and dangers were the program-level barriers to the use of web-based mental health programs. Large amounts of text and functionality issues within the programs decreased participants’ engagement. The dangers associated with web-based mental health programs included privacy breaches and inadequate help for severe symptoms.ConclusionsThere are personal and program-level barriers to the use of web-based mental health programs. The stigmatization of help seeking for depression symptoms affects the time spent on the program, as does the public perception of depression. Certain barriers may be mitigated by program updates, whereas others may require a complete shift in the perception of depression prevention.

Profile of drugs used in patients with covid-19 in two hospitals in santa catarina

Introduction: the first reports of the disease caused by SARS-Cov-2 emerged in Wuhan, China in late 2019, and the causative agent and its ability to cause pneumonia, respiratory failure, and eventually death were soon identified more clearly. Based on the accurate study of the disease, several studies have emerged in an attempt to find a treatment, and there are currently more than 4,000 clinical studies related to the subject. Objectives: to perform a data research regarding the main drugs used in patients with COVID-19 in two hospitals in Santa Catarina, using these data to improve care. Method: a retrospective analysis of 683 medical records of patients admitted to infirmary and ICU beds in two hospitals in Santa Catarina. Results: in our study, high rates of antimicrobial use were observed, especially ceftriaxone and azithromycin, among the glucocorticoids dexamethasone was the most commonly used, anti-coagulant in varying doses was also common, other drugs such as hydroxychloroquine, ivermectin and hydrocortisone had lower rates of use. Discussion: currently the only drug with evidence of benefit in the outcome of mortality is dexamethasone when used in patients with moderate to severe symptoms, the other drugs should follow precise indications to have their use rationalized. Conclusion: to date, we still do not have a specific and effective therapy that results in clinical benefit in all cases of COVID-19, however, several drugs are still being tested, therefore, it is up to us to wait and act according to the current evidence.

Evaluation of Patients Who were Referred to Our Outpatient Clinic with Suspicious Sexual Contact

Aim: Sexually transmitted infections are preventable, common diseases with serious complications and high morbidity. Patients with suspicious sexual contact in Turkish society, find it difficult to consult a physician due to public pressure. Patients with suspicious sexual contact who applied to the Infectious Diseases and Clinical Microbiology outpatient clinic were analyzed. Material and Methods: Patients (62 patients) over the age of 18, who applied to Infectious Diseases and Clinical Microbiology outpatient clinic with suspicious sexual contact, between March 2018-January 2019, were included in the study. The demographic characteristics of the patients such as age, gender, marital status; also complaints, using of condom, physical examination findings, and all examinations during the six-month follow-up were recorded. Results: In this study, 56 (90%) male and 6 (10%) female patients with a mean age of 33.40 ± 14.11 years were included. High percentage (58;93%) of patients didn’t use condoms during sexual contact, 21(34%) of the patients had more than one partner, the most common diagnosis was urethritis (21; 34%), one patient in a bisexual relationship was diagnosed with acute HIV infection, and was observed that the diagnosis of syphilis (9; 15%) was quite high. Conclusion: Results such as the low rate of use of condoms made us think that there is a lack of knowledge about sexually transmitted diseases in the society. Considering the possibility of increasing infection rates in the coming years; we think that the necessary importance should be given to sexually transmitted diseases and frequent public trainings should be provided.

Characteristics of Survivors of Suicide Seeking Counseling From an NGO in Denmark: Analyses of a National Database

Objective The loss of a friend or family member to suicide, i.e., surviving suicide, can be devastating. Yet, little is known regarding the support received by survivors of suicide. We aimed to examine the characteristics of survivors of suicide who sought counseling from a Danish volunteer organization. Method Data on all users of the Danish Network for those Affected by Suicidal Behavior (NASB) were obtained during 2012–2018. Information on age, sex, relation, time of loss, municipality was analyzed, and geographical driving distances calculated. Results Altogether, 1,268 survivors of suicide (mean age 43.3; 29.8% of all suicides) received counseling from NASB. In all, 81.8% of service users had lost a partner or first-degree relative; those being spouses/partners (15.3%), parents (28.5%), children (19.0%), and siblings (15.4%). Female service users (71.1%) outnumbered males (28.7%). A third of users sought counseling within 6-months of the death. A help-seeking rate of 6 users per 10 suicide deaths was found within close proximity to a counseling venue; equivalent of 5.5 (95% CI: 5.0–6.0) users per 100,000 inhabitants. Each additional 10 km of driving distance was associated with a 15% lower rate of use (b: −0.015; 95% CI: 0.027 to 0.003; p = 0.013). Conclusion Geographical proximity to help centers was important and could suggest that support might be lacking in some parts of the country. It seems likely that more than 0.6 persons per suicide might seek counseling from volunteer organizations if services were available within short driving distance. HIGHLIGHTS More than one out of three who sought support after a suicide death were partners or first-degree relatives and only a third of users who sought counseling did so within 6-months of the death. Also, female sought counseling more frequently than males. Approximately 5.5 people per 100,000 inhabitants sought help after a suicide in areas where a counseling venue was within short driving distance. Based on the region with most counseling venues, 6 survivors would seek support per 10 suicide deaths.

Tendencia en España en el uso de artroplastia total de tobillo frente a artrodesis en el periodo 1997-2017

ObjectiveThe main objective of this study is to compare proportionally the incidence of total ankle arthroplasty (TAA) versus ankle arthrodesis and to determine the variables that may have influenced its indication. The secondary objective is to analyse the trend in the use of TAA using a population-based analysis and to compare our results with those reported by national registries in other countries. Material and methodA retrospective review of the Minimum Basic Data Set from 1997-2017 was performed. Subjects were categorised according to surgical procedure. Their temporal evolution was analysed and hospital variables associated with the indication (age, sex, hospital complexity) were identified. In order to compare the trend in Spain with respect to other countries, the information was standardised as number of procedures per 100,000 inhabitants/year and a projection was made for the five-year period 2020-2025. ResultsIn the period 1997-2017, 11,669 ankle arthrodesis and 1,049 TAAs were performed. The trend was increasing and significant for both procedures, however, in the last 10 years analysed the proportional trend of TAA decreased significantly. Being female (OR 1.32), being 65 years or older (OR 1.50) and being operated in a complex hospital (OR 1.31) were associated with the indication for a TAA. Compared to other countries, Spain has much lower rates of TAA utilisation, with minimal growth estimated for the year 2025. ConclusionAlthough the use of TAA has increased, its growth has been lower than that of ankle arthrodesis and its current trend is proportionally decreasing, with female sex, age≥65 years and the patient being operated in a medium/high complexity hospital being associated with the indication for TAA. Compared with other countries, Spain has much lower rates of use and its projection over the next five years, although increasing, is expected to be minimal.

Utilization of Routine Medical Checkup and Factors Influencing Use of Routine Medical Checkup among Saudi Students Studying in the USA in 2019

Introduction: The few studies that have investigated patterns of routine checkup (hereafter routine checkups) among Saudis have found overall low rates of use. Those studies focused mainly on understanding the influence of individual characteristics on use of routine checkup. Aims: The main purpose of this study was to consider a wider array of factors beyond individual characteristics, including system-based factors, beliefs, attitudes, and satisfaction, and to examine their influence on use of routine checkup among Saudi students studying in the United States. Methods: A cross-sectional survey targeting Saudi students studying in the United States aged 19 years or older was conducted to gather information about their sociodemographic characteristics, needs for healthcare, use of routine checkup and satisfaction with access to primary care services. Descriptive statistics and logistic regression analysis were conducted to determine factors influencing use of routine checkup among Saudis. Results: 381 surveys were eligible to be included in the analyses. Among the included participants, only 25.5% had a routine checkup after the age of 18 years. The likelihood of having routine checkup after the age of 18 was significantly higher among those who trusted provided primary care, believed in the importance of routine checkup, had health insurance, had chronic conditions and were physically active, and was significantly lower among married individuals. Conclusions: The use of routine checkup is low among Saudis and this study has laid the foundation for future research that can inform policy and decision-making related to improving use of routine care in Saudi Arabia.

Use of Backup Stem Cells for Stem Cell Boost and Second Transplant in Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplantation

Autologous hematopoietic stem cell transplantation (ASCT) is a standard treatment for multiple myeloma (MM). Consensus guidelines recommend collecting sufficient stem cells in case there is a need for stem cell boost for delayed/poor engraftment or for future second ASCT. However, collecting and storing backup stem cells in all patients requires significant resources and cost, and the rates of backup stem cell utilization are not well studied. We sought to examine the utilization of backup stem cells (BSCs) in patients with MM undergoing ASCT. Patients with MM aged ≥18 years old who underwent first ASCT at our institution from January 2010 through December 2015 and collected sufficient stem cells for at least 2 transplants were included in this single-center retrospective study. This timeframe was selected to allow for adequate follow-up. A total of 393 patients were included. The median age was 58 years (range, 25-73). After a median follow-up of 6 years, the median progression-free survival (PFS) of the cohort was 3 years. Sixty-one percent (n=240) of patients progressed or relapsed. Chemotherapy-based mobilization was used in almost all patients (98%). The median total CD34+ cells collected was 18.2×106/kg (range, 3.4-112.4). A median of 5.7×106 CD34+ cells/kg (range, 1.8-41.9) was infused during the first ASCT, and a median of 10.1×106 CD34+ cells/kg (range, 1.5-104.5) was cryopreserved for future use. Of the patients, 6.9% (n=27) used backup stem cells, with 2.3% (n=10) using them for stem cell boost, 4.6% (n=18) for a second salvage ASCT, including 1 patient for both stem cell boost and second ASCT. Rates of backup stem cell use among patients aged <60, 60-69, and ≥70 years were 7.8%, 5.7%, and 5.9%, respectively. There was a trend toward higher rates of backup stem cell use for second ASCT in patients who were younger, had suboptimal disease control at time of first ASCT, and longer PFS. The median dose of stem cell boost given was 5.6×106 CD34+ cells/kg (range, 1.9-20). The median time from stem cell boost to neutrophil, hemoglobin, and platelet engraftment was 4 (range, 2-11), 15 (range, 4-34), and 12 (range, 0-34) days, respectively. Lower CD34+ dose and older age at time of ASCT predicted need for stem cell boost. With new salvage therapies for relapsed MM, the rates of second ASCT are very low. The low rates of use suggest that institutional policies regarding universal BSC collection and long-term storage should be reassessed and individualized. However, need for stem cell boost in 2.3% of patients may present a challenge to that.

Selection of enteral nutrition regimens for children with abdominal Henoch-Schönlein purpura

OBJECTIVE To explore the reasonable and effective enteral nutrition regimen for children with abdominal Henoch-Schonlein purpura (HSP). METHODS A retrospective analysis was performed on the medical data of children with abdominal HSP who were hospitalized from August 2013 to August 2018. According to the starting time of enteral nutrition after abdominal pain relief, the children were divided into three groups: < 24 hours (n=68), 24-48 hours (n=64), and 48-72 hours (n=60). According to the type of enteral nutrition, they were divided into another three groups:amino acid-based formula (n=53), extensively hydrolyzed lactoprotein formula (n=67), and normal diet (n=72). The recurrence rate of clinical symptoms and degree of satisfaction among family members were compared between groups. Based on the retrospective analysis, 166 children with abdominal HSP were enrolled in a prospective study. They were given extensively hydrolyzed lactoprotein formula after abdominal pain relief. According to the feeding time after abdominal pain relief, they were divided into three groups: < 24 hours (n=52), 24-48 hours (n=59), and 48-72 hours (n=55). The three groups were compared in terms of the recurrence rates of abdominal pain, rash, and hematochezia, the rate of use of parenteral nutrition and intravenous steroids, and the incidence rate of weight loss at discharge. RESULTS The retrospective analysis showed that the children who were given extensively hydrolyzed lactoprotein formula for enteral nutrition at 24-48 hours after abdominal pain relief had a lower recurrence rate of clinical symptoms and the highest degree of satisfaction among their family members (P < 0.0167). The prospective study showed that the children who were given extensively hydrolyzed lactoprotein formula for enteral nutrition at 24-48 hours after abdominal pain relief had lower recurrence rates of rash and abdominal pain, a lower rate of use of parenteral nutrition, and a lower incidence rate of weight loss at discharge (P < 0.05). CONCLUSIONS It is reasonable and effective to start the feeding with extensively hydrolyzed lactoprotein formula at 24-48 hours after abdominal pain relief in children with abdominal HSP.

Influence of premature rupture of membranes on the early prognosis of extremely premature infants

OBJECTIVE To study the influence of premature rupture of membranes (PROM) on the early prognosis of extremely premature infants, and to provide a basis for the management of extremely premature infants and prenatal consultation. METHODS A total of 179 extremely premature singleton infants who were born from 2017 to 2019 were enrolled. According to the presence or absence of PROM, they were divided into two groups: PROM group (n=69) and non-PROM group (n=110). A statistical analysis was performed for maternal data and early prognostic indicators. RESULTS Compared with the non-PROM group, the PROM group had significantly higher incidence rates of earlyonset sepsis and necrotizing enterocolitis (NEC) (P < 0.05) and significantly lower rate of use of pulmonary surfactant and incidence rate of hemodynamically significant patent ductus arteriosus (P < 0.05). The multivariate logistic regression analysis showed that chorioamnionitis was an independent risk factor for early-onset sepsis and NEC (OR=11.062 and 9.437 respectively, P < 0.05), and PROM was an independent protective factor against the use of pulmonary surfactant (OR=0.363, P < 0.05). CONCLUSIONS PROM increases the incidence rates of early-onset sepsis and NEC in extremely premature infants and does not increase the incidence rates of other adverse outcomes. For pregnant women with PROM at the risk of extremely preterm delivery, prevention of miscarriage and chorioamnionitis is recommended to prolong gestational weeks, reduce the incidence rate of infection, and thus improve the outcome of extremely premature infants.

Innovative human resource management practices for the talent management implementation

The central topic of the paper is talent management. It is a highly topical subject matter in science and theory of business management, particularly human resource management. Attracting and retaining talented employees has become one of the key roles of modern human resource management. The paper aims to provide an analytical view of the use of selected innovative human resource management (HRM) practices through a comparison of companies that implemented talent management practices and companies that did not implement talent management practices. In addition to processing the theoretical basis of talent management, the paper presents the research results carried out on a sample of 187 Slovak companies. Primary data were collected in person and through a questionnaire from January to June 2021. The research aimed to determine the current state of implementation of talent management practices in the Slovak Republic and verify the existence of statistically significant differences in the rate of use of selected innovative HRM practices methods between companies that implemented talent management practices and companies that did not implement talent management practices. For the research purposes, HRM practices directly related to the acquisition, development, and retention of talented employees were selected, particularly training and development, evaluation of individual performance, and remuneration. In the case of HRM practices, the research focused on methods used in the implementation of individual practices. In contrast, the rate of use of each method was determined on a Likert scale 1-5, with a value of 1. It expresses a low rate of use of the method and a value of 5 a high rate of use. To meet the aim of the research, research hypotheses for individual HRM practices were tested, in particular the H1 (training and development), H2 (performance evaluation), H3 (remuneration). For each HRM practice, three partial hypotheses were tested. The Mann-Whitney U test at a significance level of 5% was used to test the hypotheses, i.e., to determine statistically significant differences between the companies that implemented talent management practices and companies that did not implement talent management practices. The research results confirmed statistically significant differences in the use of selected HRM practices between companies that implemented talent management practices and companies that did not implement talent management practices in the case of 8 variables. In the case of 1 variable, the hypothesis was not confirmed.

DIABEO System Combining a Mobile App Software With and Without Telemonitoring Versus Standard Care: A Randomized Controlled Trial in Diabetes Patients Poorly Controlled with a Basal-Bolus Insulin Regimen.

Background: The DIABEO® system (DS) is a telemedicine solution that combines a mobile app for patients with a web portal for health care providers. DS allows real-time monitoring of basal-bolus insulin therapy as well as therapeutic decision-making, integrating both basal and bolus dose calculation. Real-life studies have shown a very low rate of use of mobile health applications by patients. Therefore, we conducted a large randomized controlled trial study to investigate the efficacy of DS in conditions close to real life (TELESAGE study).Methods: TELESAGE was a multicenter, randomized, open study with three parallel arms: arm 1 (standard care), arm 2 (DIABEO alone), and arm 3 (DIABEO+telemonitoring by trained nurses). The primary outcome assessed the reduction in HbA1c levels after a 12-month follow-up.Results: Six hundred sixty-five patients were included in the study. Participants who used DIABEO once or more times a day (DIABEO users) showed a significant and meaningful reduction of HbA1c versus standard care after a 12-month follow-up: mean difference −0.41% for arm 2—arm 1 (P = 0.001) and −0.51% for arm 3—arm 1 (P ≤ 0.001). DIABEO users included 25.1% of participants in arm 2 and 37.6% in arm 3. In the intention-to-treat population, HbA1c changes and incidence of hypoglycemia were comparable between arms.Conclusions: A clinical and statistically significant reduction in HbA1c levels was found in those patients who used DIABEO at least once a day.

Utilization of Guidelines-recommended secondary cardiovascular preventive medications in a decade or more survivors after coronary revascularization in the Middle East; analysis form the DECADE PLUS S

Abstract Background There is scarcity of studies from the Middle East had address the use of guideline-recommended secondary cardiovascular prevention medications among individuals who survived at least one decade after coronary revascularization (CR) by percutaneous coronary intervention (PCI) or coronary bypass graft surgery (CABG). Purpose An objective of the DECADE-PLUS study was to evaluate the use of antiplatelet agents (APA), statins, beta blockers (BB) and renin-angiotensin system inhibitors (RASI) in such patients. Methods We enrolled consecutive patients seen at ambulatory or in-patient settings with the following inclusion criteria: patient had PCI or CABG &amp;gt;10 years ago, age &amp;gt;18 years at the time of the index CR, and availability of data of currently used medications. Results Of 892 patients enrolled, 600 (67.3%) had PCI and 292 (32.7%) had CABG. Patients had CR &amp;gt;20 years ago (100; 11.2%), 11–19 years ago (536; 60.1%) or 10 years ago (256; 28.7%). Women comprised 13.8% of the whole cohort, and mean age at index CR was 53.4+9.4 years. Hypertension, diabetes mellitus, and dyslipidemia were present in 398 (44.6%), 351 (39.3%) and 290 (32.5%), respectively at the time of CR. Overall, aspirin was used in 745 (83.5%), and a second APA in 329 (36.9%). Statins, BB and RASI were used in 83.7%, 71.7% and 54.3%, respectively. Univariate analysis of predictors of lower rates of use of these medications showed that survival time (10 years vs. &amp;gt;20 years), and revascularization type (PCI vs. CABG) had no impact on use of these medications. However, nondiabetics were less often prescribed second APA (odds ratio (OR) 0.78, p=0.005) and RASI (OR 0.85, p=0.007) compared with diabetics. Furthermore, compared with men, women were less often prescribed aspirin (OR 0.66, p&amp;lt;0.0001), statin (OR 0.67, p&amp;lt;0.0001), BB (OR 0.71, p=0.005), and RASI (OR 0.79, p=0.005). Conclusion Middle East patients surviving at least one decade after coronary revascularization have a high rate of utilization of secondary cardiovascular medications compared with western data. However, women and non-diabetic individuals have lower rate of use of these medications compared with diabetics and men, respectively. Larger studies are warranted to explore the reasons behind these discrepancies and thus represent potential targets for positive intervention. Funding Acknowledgement Type of funding source: None

Effect of Tebuconazole on Growth Processes, Content and Redistribution of Carbohydrates in Horse Bean Seedlings under Scotomorphogenesis

The article presents a study of changes in the functioning of the source-sink system in the heterotrophic phase of development of horse beans (Vicia faba L.) under the conditions of the artificial combination of external (darkness) factor and internal factor (antigiberelline retardant) during germination. It was found that the action of the drug significantly reduced the length of the epicotyl, root and total seedling. Similarly, the dry matter mass of the seedling organs decreased. The level of using seed spare substances under the influence of retardant decreased, as evidenced by the maximum dry matter of cotyledons in plants of this variant and a decrease in the utilization of reserve substances for root and epicotyl formation during germination. Tebuconazole inhibited the breakdown of starch in the dark. The higher content of sugars in the seeds of scotomorphic plants in comparison with the control is associated with a less intensive outflow for the needs of organogenesis – the formation of root and epicotyl structures. Quantitative changes in nitrogen content in scotomorphic seeds were much smaller than changes in starch content. This indicates that the retardant in the dark inhibits the hydrolysis of the reserve protein of the seed, but the process is started after the hydrolysis of starch. The purpose of the study was to establish the effect of tebuconazole on the processes of germination and redistribution of carbohydrates in seedlings of Vicia faba L. Material and methods. The work was carried out on seedlings of horse beans (Vicia faba L.) of Vivat variety, which is a medium-ripe high-yielding variety with a vegetation period of 100-105 days. The variety is technological, resistant to major diseases, has high resistance to lodging, shedding of beans and their cracking. Results and discussion. The combined effect of darkness and the drug of anti-gibberellin action of tebuconazole were used to regulate the intensity of source-sink relations during the germination of horse bean seeds. The seeds of the experimental variant were soaked for a day in 0.5% solution of the triazole-derived drug tebuconazole. Tebuconazole is a transparent crystalline substance of hazard class 3. The seeds of the control variant were soaked for 24 hours in distilled water and sown in cuvettes with wet sand. The biological replication of the experiments is fivefold. The experiment was performed under the action of light and in dark in order to study the implementation of programs of skoto-and photomorphogenesis. Morpho-biometric parameters (root length, seedling length, dry matter weight of individual organs and the whole plant) were determined on the day of 18 of germination. Determination of nitrogen content was carried out according to Keldal method, starch in the organs of seedlings was performed by iodometric method, to determine the content of total sugar and reducing sugar we used Bertrand method in modification by V. Kosolapov. Conclusion. The combination of exogenous and endogenous factors during seed germination significantly changed the intensity of donor-acceptor relations in horse bean seedlings. Under the action of the drug significantly slowed the growth of seedlings in the dark. There was the decrease in the dry matter of the organs of the seedling in dark and noted lower rates of use of reserve substances for organogenesis during germination

Herbicide mixtures affect adsorption processes in soils under sugarcane cultivation

The use of herbicide mixtures has been a common practice in the control of weeds in sugarcane crops. The concern with the interactions between the molecules of different herbicides has been limited to compatibility before application. In this sense, little is known about the interactions between mixed herbicides and the soil. The objectives of this study were to investigate the sorption process of diuron, hexazinone, and sulfometuron-methyl in isolated and mixed conditions to soils under sugarcane cultivation. Kinects and isotherms models were used to understand the behavior of herbicides in the soils. The adsorption time and the sorption capacity of the herbicides had the following order of diuron > hexazinone > sulfometuron-methyl in the dystrophic red Oxisol and diuron > sulfometuron-methyl > hexazinone in the red-yellow Oxisol. Herbicide mixtures reduced the maximum adsorption (qe) in ≈50 (diuron), 56 (hexazinone), and 55% (sulfometuron-methyl) compared isolated tests. Also, herbicide mixtures reduced the sorption rate (Kf) 24 (diuron), 89 (hexazinone), and 66% (sulfometuron-methyl) compared to conditions isolated tests. Desorption process was higher for herbicides when mixed in binary and ternary condition. The sorption and desorption of hexazinone in soils is most affected by mixing with other herbicides. Sulfometuron-methyl promotes greater reduction in the sorption of diuron (≈33%) compared to hexazinone (≈21%). The mixture between diuron, hexazinone, and sulfometuron-methyl increases the availability of these herbicides in the aqueous phase of the soil allowing the use of lower rates in the application compared to isolated applications. Higher availability also indicates a greater potential for environmental contamination via leaching or surface runoff.

Assessment of Primary Care Clinician Concordance With Guidelines for Use of Magnetic Resonance Imaging in Patients With Nonspecific Low Back Pain in the Veterans Affairs Health System

Magnetic responance imaging (MRI) of the lumbar spine that is not concordant with treatment guidelines for low back pain represents an unnecessary cost for US health plans and may be associated with adverse effects. Use of MRI in the US Department of Veterans Affairs (VA) primary care clinics remains unknown. To assess the use of MRI scans during the first 6 weeks (early MRI scans) of episodes of nonspecific low back pain in VA primary care sites and to determine if historical concordance can identify clinicians and sites that are the least concordant with guidelines. Retrospective cohort study of electronic health records from 944 VA primary care sites from the 3 years ending in 2016. Data were analyzed between January 2017 and August 2019. Participants were patients with new episodes of nonspecific low back pain and the primary care clinicians responsible for their care. MRI scans. The proportion of early MRI scans at VA primary care clinics was assessed. Clinician concordance with published guidelines over 2 years was used to select clinicians expected to have low concordance in a third year. A total of 1 285 405 new episodes of nonspecific low back pain from 920 547 patients (mean [SD] age, 56.7 [15.8] years; 93.6% men) were attributed to 9098 clinicians (mean [SD] age, 52.1 [10.1] years; 55.7% women). An early MRI scan of the lumbar spine was performed in 31 132 of the episodes (2.42%; 95% CI, 2.40%-2.45%). Historical concordance was better than a random draw in selecting the 10% of clinicians who were subsequently the least concordant with published guidelines. For primary care clinicians, the area under the receiver operating characteristic curve was 0.683 (95% CI, 0.658-0.701). For primary care sites, the area was under this curve was 0.8035 (95% CI, 0.754-0.855). The 10% of clinicians with the least historical concordance were responsible for just 19.2% of the early MRI scans performed in the follow-up year. VA primary care clinics had low rates of use of early MRI scans. A history of low concordance with imaging guidelines was associated with subsequent low concordance but with limited potential to select clinicians most in need of interventions to implement guidelines.

A protocol for a pilot cluster randomized control trial of e-vouchers and mobile phone application to enhance access to maternal health services in Cameroon

BackgroundCameroon still has relatively high maternal mortality rate (MMR) of 596/100,000 live births. Approximately 40% of births are unattended by skilled healthcare personnel with high out-of-pocket expenditures. Poor resource allocation, poorly functioning referral systems, long trekking distances to health facilities, all of which lead to low rates of use of maternal health services.ObjectivesThe aim of this pilot study is to explore perception and acceptability of mobile health (mhealth) and e-voucher and to determine the feasibility of conducting a large cluster randomized trial to determine the effects of combining e-vouchers and a mobile application compared with usual care in improving access to and use of maternal health services.MethodsThis is a multimethod study that comprises two phases. The first phase is the development of the mobile phone app, which includes a qualitative formative study through in-depth key informant interviews and focus group discussions. The second phase is a cluster randomized control trial assessing the combination of e-vouchers and a mobile application compared with usual care in improving access to and use of maternal health services. Feasibility will be determined based on evaluating randomization, contamination, enrollment rate, complete follow up, compliance rate, success in matching data from different sources, and data completeness.Ethics and discussionEthics approval has been granted, and the trial has been registered in the Pan-African Clinical Trials Registry. We will disseminate our findings through peer-reviewed manuscripts and conference presentations. Findings from this study will inform the design and conduct of a larger randomized trial.Trial registrationPACTR201808703097367. The trial on the Pan African Clinical Trials Registry.

E-Learning como estrategia pedagógica en la educación superior

Las tecnologías de la información y la comunicación (TIC) en el momento presente han tomado un rol protagónico en la sociedad, que son indispensables en el ámbito pedagógico. Esta investigación se llevó a cabo en la plataforma educativa Docentes 2.0, con el fin de proponer recomendaciones para promover la plataforma. En la metodología se definieron indicadores de la plataforma E-Learning en tres dimensiones: organizacional, funcional y pedagógica. Además, fueron analizados registros históricos en las bases de datos de la plataforma. A través de esta investigación se detectó una baja tasa de utilización de las plataformas E-Learning por parte de los docentes, sin embargo, se observó una total aceptación de las plataformas existentes por parte de sus usuarios.

Abstract TP123: Baseline Differences in Risk Factor Control Between CREST-2 and SAMMPRIS

Baseline Differences in Risk Factor Control and Medication Use Between 2 Trials Employing Intensive Medical Management (SAMMPRIS &amp; CREST2) Background: The CREST2 trial Intensive Medical Management (IMM) protocol was adapted from the SAMMPRIS trial. However, since the 2011 publication of initial results of SAMMPRIS, there has been a greater appreciation for the importance of risk factor control in patients at risk of stroke associated with atherosclerosis. Therefore, we sought to determine differences in baseline risk factor control and medication use between SAMMPRIS and CREST2. Methods: Baseline risk factor and medication use data from 451 patients enrolled in SAMMPRIS (2008-2011) with severe symptomatic intracranial atherosclerosis and 1473 patients enrolled in CREST2 (2014-2019) with severe asymptomatic carotid stenosis were compared using the Chi-square test and t-test. Results: The Table shows baseline risk factor values and medications. SAMMPRIS patients were younger but had significantly worse risk factor control than CREST2 patients for all measures. There was no significant difference in statin use at baseline, but the mean SAMMPRIS subjects’ LDL was 16.1 mg/dL higher than in CREST2. CREST2 patients had higher rates of use of angiotensin receptor blockers (ARB), calcium channel blockers (CCB), and thiazides, but lower rates of use of angiotensin converting enzyme (ACE) inhibitors. Conclusions: Despite being older, CREST2 patients have significantly better baseline risk factor profiles than SAMMPRIS patients. This could be due to greater appreciation of the importance of risk factor control and healthy lifestyle habits for stroke prevention or more aggressive treatment targets in guideline recommendations. Although risk factor control appears to be improving since SAMMPRIS, many CREST2 patients are still not meeting recommended risk factor goals at baseline and may benefit from IMM protocols.

Understanding How Clinicians Use a New Web-based Tool for Disseminating Evidence-Based Practices for the Treatment of PTSD: The PTSD Clinicians Exchange.

Web-based interventions hold great promise for the dissemination of best practices to clinicians, and investment in these resources has grown exponentially. Yet, little research exists to understand their impact on intended objectives. The Post-Traumatic Stress Disorder (PTSD) Clinicians Exchange is a website to support clinicians treating veterans and active duty military personnel with PTSD, evaluated in a randomized controlled trial (N=605). This manuscript explores how a subset of clinicians, those who utilized the intervention (N=148), engaged with it by examining detailed individual-level web analytics and qualitative feedback. Stanford University and New England Research Institutes Institutional Review Boards approved this study. Only 32.7% of clinicians randomized to the intervention ever accessed the website. The number of pages viewed was positively associated with changes from baseline to 12months in familiarity (P=0.03) and perceived benefit of practices (P=0.02). Thus, engagement with the website did predict an improvement in practice familiarity and benefit outcomes despite low rates of use. This study demonstrates the importance of methodologically rigorous evaluations of participant engagement with web-based interventions. These approaches provide insight into who accesses these tools, when, how, and with what results, which can be translated into their strategic design, evaluation, and dissemination.

A SURVEY OF FACTORS INFLUENCING SPREADSHEET RISK AWARENESS

Motivated both by reports on devastating financial and reputation-related consequences of spreadsheet errors and the results of previous studies suggesting a significant lack of users awareness of spreadsheet risks, this paper provides insight into factors that influence users perception of risks associated with creating and using spreadsheets. The survey was conducted on a sample of 161 spreadsheet users, whose attitudes were analyzed in accordance with 17 attributes. Statistically significant differences were detected among groups with different levels of self-estimated proficiency in spreadsheets, groups of users that spend different amount of time working with spreadsheets during a typical workday, groups of users who attribute greater subjective significance to spreadsheets in the tasks they perform, as well as groups of users from different management levels. Results of the statistical analysis also suggest that the perception of risks associated with spreadsheets is influenced by existence of standards and rules for spreadsheet development and uses within an organization. Results of the research presented in this paper, which point to an alarmingly low rate of use of spreadsheet features useful for risk mitigation, as well as to a prevalent lack of standards and rules for development and use of spreadsheets among the surveyed organizations, may stimulate managers to introduce such initiatives.