Non-frequent Users Research Articles

Health consumers' social media adoption behaviours in Australia.

This research identifies the underlying drivers impacting on health consumers' social media usage and acceptance behaviours using technology acceptance model (TAM) as the theoretical lens. A cross-sectional survey of 265 health consumers was conducted through a mall intercept technique. Participants in the survey were over the age of 18 and had access to a public or private healthcare service provider. The data were analysed using structural equation modelling (SEM). The major findings show that perceived ease of use, privacy threat, information quality, social influence and self-efficacy influence health consumers' social media adoption behaviours. Perceived usefulness was not found to affect health consumers' social media adoption behaviours. The moderation analysis showed that influences of privacy threats are non-significant for mature age respondents and non-frequent users of social media. This study's findings have important implications for designing social media strategies for the healthcare industry. The drivers that positively impact on health consumers' social media usages can be integrated into meaningful strategies to capture the attention of potential consumers. They need to be educated, informed and engaged as health consumers so that they employ social media effectively to their advantage.

Characteristics of frequent emergency department users in British Columbia, Canada: a retrospective analysis.

Background:Frequent emergency department users disproportionately account for rising health care costs. We aimed to characterize frequent emergency department users in British Columbia, Canada.Methods:We performed a retrospective analysis using health administrative databases. We included patients aged 18 years or more with at least 1 emergency department visit from 2012/13 to 2015/16, linked to hospital, physician billing, prescription and mortality data. We used annual emergency department visits made by the top 10% of patients to define frequent users (≥ 3 visits/year).Results:Over the study period, 13.8%–15.3% of patients seen in emergency departments were frequent users. We identified 205 136 frequent users among 1 196 353 emergency department visitors. Frequent users made 40.3% of total visits in 2015/16. From 2012/13 to 2015/16, their visit rates per 100 000 BC population showed a relative increase of 21.8%, versus 13.1% among all emergency department patients. Only 1.8% were frequent users in all study years. Mental illness accounted for 8.2% of visits among those less than 60 years of age, and circulatory or respiratory diagnoses for 13.3% of visits among those aged 60 or more. In 2015/16, frequent users were older and had lower household incomes than nonfrequent users; the sex distribution was similar. Frequent users had more prescriptions (median 9, interquartile range [IQR] 5–14 v. 1, IQR 1–3), primary care visits (median 15, IQR 9–27 v. 7, IQR 4–12) and hospital admissions (median 2, IQR 1–3 v. 1, IQR 1–1), and higher 1-year mortality (10.2% v. 3.5%) than nonfrequent users.Interpretation:Emergency department use by frequent users increased in BC between 2012/13 and 2015/16; these patients were heterogenous, had high mortality and rarely remained frequent users over multiple years. Our results suggest that interventions must account for heterogeneity and address triggers of frequent use episodes.

Use of online knowledge base in primary health care and correlation to health care quality: an observational study

BackgroundEvidence-based information available at the point of care improves patient care outcomes. Online knowledge bases can increase the application of evidence-based medicine and influence patient outcome data which may be captured in quality registries. The aim of this study was to explore the effect of use of an online knowledge base on patient experiences and health care quality.MethodsThe study was conducted as a retrospective, observational study of 24 primary health care centers in Sweden exploring their use of an online knowledge base. Frequency of use was compared to patient outcomes in two national quality registries. A socio-economic Care Need Index was applied to assess whether the burden of care influenced the results from those quality registries. Non-parametric statistical methods and linear regression were used.ResultsFrequency of knowledge base use showed two groups: frequent and non-frequent users, with a significant use difference between the groups (p < 0.001). Outcome data showed significant higher values for all seven National Primary Care Patient Survey dimensions in the frequent compared to the non-frequent knowledge base users (p < 0.001), whereas 10 out of 11 parameters in the National Diabetes Register showed no differences between the groups (p > 0.05). Adjusting for Care Need Index had almost no effect on the outcomes for the groups.ConclusionsFrequent users of a national online knowledge base received higher ratings on patient experiences, but figures on health care quality in diabetes showed near to no correlation. The findings indicate that some effects may be attributed to the use of knowledge bases and requires a controlled evaluation.

How do high school seniors get marijuana? Prevalence and sociodemographic differences

IntroductionEfforts to understand how adolescents acquire marijuana will help to contextualize its use among youth. Little is known about ways of getting marijuana and how they differ between subgroups of adolescents. The present study sought to determine how adolescents get marijuana and if modes of access vary by sociodemographic characteristics. MethodData were from the nationally representative Monitoring the Future study of 12th graders in the United States from 2012 to 2018 (N = 4262 students). Participants used marijuana in the past 12 months and were asked how they got marijuana. Multivariable logistic regression models were used to predict modes of getting marijuana based on sex, race/ethnicity, urbanicity, parental education, and survey year. Cross-tabulation analyses compared how recent frequent and non-frequent use related to ways of getting marijuana. ResultsThe most endorsed methods of getting marijuana were given for free by friends, bought from friends, and bought from a drug dealer/stranger. Differences by sociodemographic subgroup and recent frequent use emerged, including for riskier modes of obtainment such as buying from a drug dealer/stranger (for male students, urban students, and recent frequent users). Recent frequent users were more likely to endorse getting marijuana by nearly each method, except non-frequent users were more likely to be given marijuana for free by friends. DiscussionUnderstanding the prevalence of different modes of getting marijuana among adolescents and which subgroups are most susceptible to riskier means of getting marijuana will allow drug use prevention efforts to be tailored appropriately so as to maximize effectiveness.

Abstract 5769: Opioid prescription characteristics associated with frequent emergency department use among hospitalized cancer patients: a comparative cohort study

Abstract Background: Opioid use is associated with greater health resource utilization, namely unplanned emergency department (ED) visits. The purpose of this study was to characterize ED visit patterns by patients hospitalized for cancer based on their use of prescription opioids in the community. Design &amp; Methods: A prospective cohort study of cancer patients discharged from medical and surgical units at an academic health center in Montreal (Canada) between October 2014 and November 2016 was assembled. The main outcome was frequent ED use (≥4 ED visits) in the year following hospital discharge. Clinical information linked to health administrative claims from the provincial universal health care program (RAMQ) was used in multivariable logistic regression to model patient and opioid prescription characteristics, comparing frequent ED users to non-frequent ED users. Potential predictors included history of chronic pain condition, mental health diagnoses, type of cancer, receipt of radiotherapy/chemotherapy, medication history (previous use of opioids, history of antidepressant use, benzodiazepines), receipt of surgery during the hospitalization as well as characteristics of the discharge prescription (e.g: receipt of an opioid, presence of a multi-modal pain regimen). Results: A cohort of 1253 cancer patients discharged from the medical and surgical units was assembled. The mean age for these patients was 70.9 (11.8) and the most frequent cancers included 488 (38.9%) respiratory and 309 (24.6%) upper digestive cancer. Overall, 54% of cancer patients (n =654) had at least one ED visit in the year post-discharge. Of these, all had filled at least one opioid prescription during the follow-up period. Of patients with at least one ED visit in the one year post-discharge, 29% (n = 188) became frequent ED users. In adjusted multivariable logistic model, the strongest associations of frequent ED use were receipt of chemotherapy one year before their index hospitalization (odds ratio (OR) 1.67; 95% CI: 1.08 - 2.61) and respiratory cancer diagnoses (OR 1.69; 95% CI: 1.07 - 2.67). With respect to opioid prescribing, most the dispensations were for oxycodone (51.4%) and hydromorphone (33.6%). Patients receiving a daily dose &amp;gt;90 MME (morphine milligram equivalents) had an odds ratio of 2.24 (95% CI: 1.14- 4.40) of becoming frequent ED users. Those who filled more than one type of opioid during the follow-up were 1.81 times more likely to become repeated ED users (95% CI: 1.23 - 2.70). Conclusions: Cancer patients with higher opioid use after hospital discharge and active use of more than two different type of opioids within one year time of discharge are at higher risk of encoring unplanned health visits in the ER. A new approach to care planning and coordination is recommended to better monitor opioid prescribing practices and improve outcomes. Citation Format: Siyana Kurteva, Robyn Tamblyn, Ari Meguerditchian. Opioid prescription characteristics associated with frequent emergency department use among hospitalized cancer patients: a comparative cohort study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5769.

Methamphetamine, Amphetamine, and MDMA Use and Emergency Department Recidivism.

Emergency department (ED) recidivism and the use of amphetamine and associated derivatives such as methamphetamine and MDMA (MAE), are intersecting public health concerns. This study aims to determine the frequency of ED recidivism of patients who use MAE and associated factors. The study was a retrospective 6-year electronic medical record review of patients with MAE-positive toxicology screens and single and multiple ED visits in the span of 12months. There were 7844 ED visits by 5568 MAE-positive patients. Average age was 42±13years. The majority were male (65%), white (46%), tobacco smokers (55%), and in the psychiatric discharge diagnostic-related group (41%), followed by blunt trauma (20%). Admission rate was 35%, with another 17% transferred to inpatient psychiatric treatment facilities. Occasional (2-5 visits/year), heavy (6-11 visits/year), and super users (≥12 visits/year) altogether accounted for 20% of patients and 43% of visits. Heavy and super users combined represented 2% of patients and 10% of visits, with significant differences for race/ethnicity, health insurance, tobacco smoking, and psychiatric/cardiovascular/trauma discharge diagnostic-related groups. Heavy and super users were less likely to be admitted and more likely to be discharged to an inpatient psychiatric treatment facility. Regression analysis revealed racial/ethnic differences, female gender, and tobacco smoking to be associated with super and heavy use. Heavy users were more likely to have cardiovascular-related discharge diagnoses. The prevalence of ED recidivism in patients who use MAE is similar to published ranges for general ED users. Significant differences in demographics, discharge diagnoses, insurance, smoking, and disposition exist between nonfrequent and frequent ED users.

Managing Free-Range Laying Hens-Part A: Frequent and Non-Frequent Range Users Differ in Laying Performance but Not Egg Quality.

Simple SummaryFree-range laying hens are allowed to roam around and exhibit their desired behaviours including usage of the outdoor range. Consequently, flock sub-populations of high-range users (“rangers”) and low-range users (“stayers”) appear. The subpopulation effect on egg production and egg quality has not been studied to date. Rangers were more consistent in their range use, while stayers increased their range use over time. Rangers came into lay earlier compared to the stayers but their egg production dropped during mid-lay until the end of lay when they were outperformed by the stayers. The flock sub-populations did not differ in their egg quality during the production period. These findings are of relevance to egg producers, as it allows them to manage their flock knowing that they can encourage them to range/stay in the shed without compromising egg quality, including off-grade eggs. In the future, it would be interesting to investigate if increased egg performance was triggered by the more frequent range usage.Little is known about the impact of ranging on laying performance and egg quality of free-range hens. The aim of this study was to characterise egg production of commercial free-range laying hen sub-populations of low-, moderate- and high-range use at an early age. A total of five flocks with 40,000 hens/flock were investigated where 1875 hens/flock were randomly selected at 16 weeks of age, monitored for their range use and subsequently grouped into “stayers” (the 20% of hens that spent the least time on the range), “roamers” (the 20% of the hens that used the range more than stayers but less than rangers) and “rangers” (the 60% of the hens that spent the most time on the range). Eggs from the individual groups were collected in 10-weekly intervals until hens were 72 weeks of age, commercially graded and tested for several quality parameters. Significant differences were noted for hen-day production. For example, at 22 weeks of age, rangers enjoyed a laying rate of 88.0% ± 1.1%, while stayers performed at 78.2% ± 1.9% but at 72 weeks of age egg production of rangers was 85.1% ± 0.9% and of stayers was 95.5% ± 0.9% (p < 0.05). Range use was of minor importance to the egg quality.

Differences in Clinical Characteristics and Utilization of Emergency Department by High-Frequency Users.

Knowing the distinctive features of patients with the highest utilization of the emergency department (ED) is paramount to finding adequate alternatives to ED care for selected patients and improving health care quality and efficiency. This study aimed to identify ED high-frequency users and compare their clinical and utilization characteristics with other ED users. Secondary data analysis of ED visits and patients database from a Portuguese public urban hospital. Retrospective study of adults visiting the ED in 2016 (61,403 patients; 95,643 visits), comparing demographic and clinical characteristics of patients and clinical and temporal characteristics of ED visits between high-frequency users (>10 ED visits in 2016) and frequent (4-10 ED visits) and nonfrequent (1-3 ED visits) users. We identified 169 high-frequency users (0.3% of patients and 3.0% of ED visits) with an average number of 16.9 visits in 2016. Patients in this group were older (61.8years; frequent users: 61.2years; nonfrequent users: 53.4years; p<0.01) and required immediate and mental health care more frequently (18.6% of high-frequency users, 17.4% of frequent users, 13.5% of nonfrequent users, and 6.6%; 3.3%, 2.3%; p<0.01). High-frequency users also used the ED for nonurgent reasons more than remaining groups (6.1%, 3.5%, 3.1%; p<0.01). High-frequency users are an aged and heterogeneous group, requiring tailored interventions to improve care.

Using life course charts to assess and compare trajectories of amphetamine type stimulant consumption in different user groups: a cross-sectional study

BackgroundAmphetamine-type stimulants (ATS) are the second most commonly used illicit drugs in Europe and globally. However, there is limited understanding of what shapes patterns of ATS use over the life course. The ATTUNE project “Understanding Pathways to Stimulant Use: a mixed methods examination of the individual, social and cultural factors shaping illicit stimulant use across Europe” aims to fill this gap. Here we report initial findings from the life course chart exercise conducted as part of qualitative interviews with ATS users and nonusers.MethodsTwo hundred seventy-nine in-depth qualitative interviews were conducted with five ATS user groups (current and former dependent users;current and former frequent users;non-frequent users) and one group of exposed non-ATS users in five European countries (Germany, UK, Poland, Netherlands and Czech Republic). As part of the interviews, we used life course charts to capture key life events and substance use histories. Life events were categorised as either positive, neutral or negative, and associated data were analysed systematically to identify differences between user groups. We applied statistical analysis of variance (ANOVA) and analysis of covariance (ANCOVA) to test for group differences.ResultsOut of 3547 life events documented, 1523 life events were categorised as neutral, 1005 life events as positive and 1019 life events as negative. Current and formerly dependent ATS users showed more negative life events for the entire life course after age adjustment. Although some group differences could be attributed to the individuals’ life course prior to first ATS use, most negative life events were associated with periods of ATS usage. A detailed analysis of the specific life domains reveals that dominantly, the social environment was affected by negative life events.ConclusionsFor non-dependent, frequent and non-frequent ATS users, negative life events from the period of ATS use do not become obvious in our analysed data. Besides preventing a pathway into ATS dependency, the aim of an intervention should be to reduce the harm by for example drug testing which offers also the opportunity for interventions to prevent developing a substance use dependency.For the group of dependent ATS users, our study suggests holistic, tailored interventions and specialist treatment services are needed, as a single, simple intervention is unlikely to cover all the life domains affected.

Modeling traveler recovery time following man-made incidents: the case of the Athens metro

Man-man, life-threating incidents such as terrorist attacks, can have a significant impact in travel behavior and public transport ridership. Based on data collected from an extensive personal interview survey undertaken in Athens (Greece), factors affecting post-incident recovery time of metro users (i.e. the time till travelers will start re-using the metro system) are investigated and modeled. A preliminary statistical analysis reveals that most survey participants would return in the metro system within a week, while almost 16% of them exhibits a persistent change in traveler behavior as they would avoid using the metro system for more than 6 months. A clustering methodology and a discrete duration model are applied to further analyze and model metro user recovery time. Results show that women, less educated travelers, non-frequent users and travelers with higher risk perception, are less likely to use the metro system after a man-made incident.

Supervised injection facility use and all-cause mortality among people who inject drugs in Vancouver, Canada: A cohort study.

BackgroundPeople who inject drugs (PWID) experience elevated rates of premature mortality. Although previous studies have demonstrated the role of supervised injection facilities (SIFs) in reducing various harms associated with injection drug use, including accidental overdose death, the possible impact of SIF use on all-cause mortality is unknown. Therefore, we examined the relationship between frequent SIF use and all-cause mortality among PWID in Vancouver, Canada.Methods and findingsData were derived from 2 prospective cohort studies of PWID in Vancouver, Canada, between December 2006 and June 2017. Every 6 months, participants completed questionnaires that elicited information regarding sociodemographic characteristics, substance use patterns, social-structural exposures, and use of health services including SIFs. These data were confidentially linked to the provincial vital statistics database to ascertain mortality rates and causes of death. We used multivariable extended Cox regression analyses to estimate the independent association between frequent (i.e., at least weekly) SIF use and all-cause mortality. Of 811 participants, 278 (34.3%) were women, and the median age was 39 years (IQR 33–46) at baseline. In total, 432 (53.3%) participants reported frequent SIF use at baseline, and 379 (46.7%) did not. At baseline, frequent SIF users were on average younger than nonfrequent users, and a higher proportion of frequent SIF users than nonfrequent users were unstably housed, resided in the Downtown Eastside neighbourhood, injected in public, had a recent non-fatal overdose, used prescription opioids at least daily, injected heroin at least daily, injected cocaine at least daily, and injected crystal methamphetamine at least daily. A lower proportion of frequent SIF users than nonfrequent users were HIV positive and enrolled in addiction treatment at baseline. The median duration of follow-up among study participants was 72 months (IQR 24–123). In total, 112 participants (13.8%) died during the study period, yielding a crude mortality rate of 22.7 (95% CI 18.7–27.4) deaths per 1,000 person-years. The median years of potential life lost per death was 34 (IQR 27–42) years. In a time-updated multivariable model, frequent SIF use was inversely associated with risk of all-cause mortality after adjusting for potential confounders, including age, sex, HIV seropositivity, unstable housing, at least daily cocaine injection, public injection, incarceration, enrolment in addiction treatment, and calendar year of interview (adjusted hazard ratio 0.46, 95% CI 0.26–0.80, p = 0.006). The main study limitations are the limited generalizability of findings due to non-random sampling, the potential for reporting biases due to reliance on some self-reported information, and the possibility that residual confounding influenced findings.ConclusionsWe observed a high burden of premature mortality among a community-recruited cohort of PWID. Frequent SIF use was associated with a lower risk of death, independent of relevant confounders. These findings support efforts to enhance access to SIFs as a strategy to reduce mortality among PWID. Further analyses of individual-level data are needed to determine estimates of, and potential causal pathways underlying, associations between SIF use and specific causes of death.

Frequent Emergency Department Users: Focusing Solely On Medical Utilization Misses The Whole Person.

Frequent emergency department (ED) users often have complex behavioral health and social needs. However, policy makers often focus on this population's medical system use without examining its use of behavioral health and social services systems. To illuminate the wide-ranging needs of frequent ED users, we compared medical, mental health, substance use, and social services use among nonelderly nonfrequent, frequent, and superfrequent ED users in San Francisco County, California. We linked administrative data for fiscal years 2013-15 for beneficiaries of the county's Medicaid managed care plan to a county-level integrated data system. Compared to nonfrequent users, frequent users were disproportionately female, white or African American/black, and homeless. They had more comorbidities and annual outpatient mental health visits (11.93 versus 4.16), psychiatric admissions (0.73 versus 0.07), and sobering center visits (0.17 versus <0.01), as well as disproportionate use of housing and jail health services. Our findings point to the need for shared knowledge across domains, at the patient and population levels. Integrated data can serve as a systems improvement tool and help identify patients who might benefit from coordinated care management. To deliver whole-person care, policy makers should prioritize improvements in data sharing and the development of integrated medical, behavioral, and social care systems.

Frequent emergency department use and mortality in patients with substance and opioid use in Alberta: A population-based retrospective cohort study.

In the current opioid epidemic, identifying high-risk patients among those with substance and opioid use may prevent deaths. The objective of this study was to determine whether frequent emergency department (ED) use and degree of frequent use are associated with mortality among ED patients with substance and opioid use. This cohort study used linked population-based ED (National Ambulatory Care Reporting System) and mortality data from Alberta. All adults ≥ 18 years with substance or opioid use-related visits based on diagnostic codes from April 1, 2012, to March 31, 2013, were included (n = 16,389). Frequent use was defined by ≥ 5 visits in the previous year. Outcomes were unadjusted and adjusted (for age, sex, income) mortality within 90 days (primary), and 30 days, 365 days, and 2 years (secondary). To examine degree, frequent use was subcategorized into 5-10, 11-15, 16-20, and &gt; 20 visits. Frequent users were older, lower income, and made lower acuity visits than non-frequent users. Frequent users with substance use had higher mortality at 365 days (hazard ratio [HR] 1.36 [1.04, 1.77]) and 2 years (HR 1.32 [1.04, 1.67]), but not at 90 or 30 days. Mortality did not differ for frequent users with opioid use overall. By degree, patients with substance use and &gt; 20 visits/year and with opioid use and 16-20 visits/year demonstrated a higher 365-day and 2-year mortality. Among patients with substance use, frequent ED use and extremely frequent use (&gt; 20 visits/year) were associated with long-term but not short-term mortality. These findings suggest a role for targeted screening and preventive intervention.

Women's perceptions of medication use during pregnancy and breastfeeding-A Swedish cross-sectional questionnaire study.

Use of medication for different kinds of symptoms and diseases during pregnancy is common. When counseling the pregnant woman, an understanding of her perceptions concerning the use of medication as well as possible associated anxiety and obstacles is important to ensure high adherence to the treatment regimen. A questionnaire was developed regarding the use of medication, perceptions on use of medication, as well as perceptions about pregnancy outcomes in association with medication use during pregnancy. In total, 850 pregnant women in gestational weeks 25-29 participated in the study. The response rate was 92.7% (n=832/898). About 19.4% of the respondents (n=160/824) were frequent users (medication use daily to several times a week) and 28.4% (n=234/824) were non-frequent users (medication use once a week to once a month). The majority perceived medication use during early pregnancy (61.4%, n=501/816), late pregnancy (55.6%, n=455/819) and breastfeeding (57.7%, n=474/821) as probably harmful or harmful. These findings were more common in non-users (medication used rarely or never) than frequent users (P-value <0.001, <0.001 and 0.007). The pregnant women had great confidence in advice from a physician (83.8%, n=666/795) or a midwife (77.0%, n=620/805) concerning medication during pregnancy. The majority of pregnant women in Sweden consider the use of medication during pregnancy either 'probably harmful' or 'harmful' and this perception is associated with non-use of medication. The pregnant women in our study had high confidence in healthcare professionals when seeking advice; thus, actively asking about perceptions could lead to better counseling.

Social Determinants of Health-Related Quality of Life: A Recreation Setting Analysis.

Objective. To determine if significant differences between park users and non-park users are associated with scores on a composite health-related quality of life (HRQoL) index. Methods. Data for this study were collected based on random intercept of a cross section of eligible Monroe County, Indiana, residents at four selected public recreational parks, as well as nonpark locations from July to December 2017. Based on data collected using validated survey items, we created a composite HRQoL index. Statistical analysis included independent-samples t test, chi-square cross-tabulation, bivariate regression, and multivariate regression. Results. Frequent park users were significantly different from nonfrequent park users in various respects. The most leisure-time physical activity (LTPA) experiences of frequent park users occurred at a park location. Body mass index and park-based LTPA were significantly positively associated with HRQoL scores in a linear regression model. Conclusion. Frequent park use was shown to be positively associated with increased park-based LTPA and HRQoL. It is therefore possible that increasing park visitation will result in more members of a community who report experiencing their LTPA at a park location. Study outcomes lend support to the validity of a composite HRQoL index for population health assessments.

Young adult longitudinal patterns of marijuana use among US National samples of 12th grade frequent marijuana users: a repeated‐measures latent class analysis

Long-term frequent marijuana use is associated with significant negative outcomes, yet little is known about the longitudinal course of marijuana use among those who start frequent use during adolescence. Objectives are (a) to identify latent patterns of within-person marijuana use from ages 19-30years among 12th graders reporting frequent marijuana use, (b) to examine if membership in identified patterns has changed across historical time and (c) to examine if key covariates differentiate class membership. Longitudinal, national US panel data from 4423 individuals [53.4% of the eligible sample; 2744 (62%) males] who reported frequent marijuana use in 12th grade (modal age 18years; senior year cohorts 1976-2006) followed biennially from ages 19/20 to 29/30. Self-reported past 30-day marijuana use (frequent use defined as use on 20+ occasions), demographics, college graduation, marriage and parenthood. Repeated-measures latent class analysis (RMLCA) identified five latent classes of past 30-day marijuana use from ages 19/20 to 29/30: continued frequent users (estimated membership 23.4%); frequent to non-frequent users (15.5%); consistent non-frequent users (18.4%); non-frequent users to discontinuers (19.5%); and discontinuers (23.2%). In multivariable models, membership in the highest-risk latent class (continued frequent users) versus one or more of the lower-risk latent classes was more likely for recent cohorts (P=0.038 to <0.001), as well as those who did not marry (P=0.039 to <0.001) or become parents (P=0.001) by modal age 29/30. Nearly one in four 12th grade (modal age 18years) frequent marijuana users in the US continues to report high frequency use to age 30; the proportion continuing high frequency use across young adulthood has increased among more recent cohorts.

The Relationship Between Lifestyle, Health Promotion Lifestyle Profile II And High Blood Pressure In University Students.

BACKGROUND:Identifying and controlling systemic arterial blood pressure is important in young people, and it is possible to reduce the frequency of systemic arterial hypertension by improving the lifestyle.AIM:The aim of the study is to assess the relationship between healthy lifestyle behaviors and systemic blood pressure in university students.MATERIALS:The study sample consisted of 200 university students from a state university in Edirne. Lifestyles and habits were evaluated with Health Promotion Lifestyle Profile II. Students’ blood pressure was measured from both arms twice.RESULTS:The mean HPLP-II score of those who frequently feel good was significantly higher than those who rarely feel good. The mean score of those who frequently wake up between 06:00-09:00 in the morning was statistically significantly higher than those who wake up outside these hours. Those who perform social or artistic activities during their leisure times had a mean scale score higher than those who don’t perform. Although there wasn’t a statistically significant difference according to smoking status, the mean score of non-smokers was higher than smokers. The mean scale scores were higher in frequent salt users than non-frequent users; participants with low saturated fatty acid intake had higher scores than those with high intake, and rare fast food consumers had higher scores than frequent consumers. The statistically significant difference between blood pressure values of females and males was due to higher blood pressure in male students. Those working in a part-time job had higher blood pressure values than those who weren’t working. Among the students whose body mass indexes could be evaluated, there were differences in blood pressure values.CONCLUSION:It has been observed in our study that health-related responsibilities and lifestyle behaviours increase with better leisure time activities, improved eating habits and a positive outlook on life. Turning youngs’ tendencies towards healthy lifestyle behaviours to habits can make them healthier, more collective and more productive regarding physical, social and psychological well-being.

P135: Frequent emergency department use as an independent factor associated with mortality in substance and opioid misuse: a retrospective analysis of linked databases

Introduction: Substance and opioid misuse present significant illness burdens in Emergency Departments (EDs). Understanding risk factors for mortality in these patients is urgently needed to allow targeted prevention. This studys objective was to determine whether frequent ED use is independently associated with mortality among patients with substance and opioid misuse, and secondarily, whether degree of frequent use influences mortality risk. Methods: This is a retrospective cohort study in Alberta, Canada. National Ambulatory Care Reporting System ED data was linked to Vital Statistics mortality data using postal code, birthdate, and sex. All adults (18 years old at index visit, i.e. first visit made in the study year) with substance or opioid misuse (defined by ICD-10 codes) from April 1, 2012 to March 31, 2013 were included. Frequent use was defined by 5 ED visits in the 12 months prior to index visit. The primary outcome was mortality within 90 days, and secondarily, within 30 days, 365 days, and 2 years post-index visit. Mortality was compared using Kaplan-Meier curves and Cox regression adjusting for age, sex and income. Degree was examined by subcategorizing frequent use into 5-10, 11-15, 16-20, and &gt;20 visits. Results: Overall, 16,389 patients made 24,880 visits for substance misuse, and 1787 patients made 2241 visits for opioid misuse. Frequent vs. non-frequent substance misusers were older, more often female, lower income, more often of rural residence, and arrived more by ambulance for lower acuity visits that were hospitalized less often. Compared to frequent substance misusers, frequent opioid misusers were more often female, of non-rural residence, arrived less often by ambulance, and made higher acuity visits that were hospitalized more often. Among substance misuse patients, 97.1% (95% CI: 96.6, 97.7) of frequent users vs. 98.0% (95% CI: 97.7, 98.2) of non-frequent users were alive at 2 years. Frequent use was significantly associated with mortality at 365 days (HR 1.36 [95% CI: 1.04, 1.77]) and 2 years (HR 1.32 [95% CI: 1.04, 1.67]) but not at 90 or 30 days. Subcategorized by degree, frequent use was significantly associated with mortality only for patients with &gt;20 visits/year at 365 days (HR 1.88 [1.03, 3.44]) and 2 years (HR 1.89 [1.10, 3.22]). Among opioid misuse patients, there was no difference in mortality between frequent and non-frequent ED users at any time point. However, subcategorized by degree, a significant association was seen for those with 16-20 visits/year at 365 days (HR 3.62 [95% CI:1.13, 11.66]), and 2 years (HR 3.37 [95% CI: 1.05, 10.81]). Conclusion: In substance misuse patients, frequent ED use was significantly associated with long-term but not short-term mortality. Mortality risk for substance and opioid misuse patients was concentrated in extremely frequent users suggesting that the highest frequency presenters should be targeted for prevention.

Iodine Deficiency in a Study Population of Norwegian Pregnant Women-Results from the Little in Norway Study (LiN).

Iodine sufficiency is particularly important in pregnancy, where median urinary iodine concentration (UIC) in the range of 150–250 µg/L indicates adequate iodine status. The aims of this study were to determine UIC and assess if dietary and maternal characteristics influence the iodine status in pregnant Norwegian women. The study comprises a cross-sectional population-based prospective cohort of pregnant women (Little in Norway (LiN)). Median UIC in 954 urine samples was 85 µg/L and 78.4% of the samples (n = 748) were ≤150 µg/L. 23.2% (n = 221) of the samples were ≤50 µg/L and 5.2% (n = 50) were above the requirements of iodine intake (>250 µg/L). Frequent iodine-supplement users (n = 144) had significantly higher UIC (120 µg/L) than non-frequent users (75 µg/L). Frequent milk and dairy product consumers (4–9 portions/day) had significantly higher UIC (99 µg/L) than women consuming 0–1 portion/day (57 µg/L) or 2–3 portions/day (83 µg/L). Women living in mid-Norway (n = 255) had lowest UIC (72 µg/L). In conclusion, this study shows that the diet of the pregnant women did not necessarily secure a sufficient iodine intake. There is an urgent need for public health strategies to secure adequate iodine nutrition among pregnant women in Norway.

Emergency Department Frequent Users for Acute Alcohol Intoxication.

IntroductionA subset of frequent users of emergency services are those who use the emergency department (ED) for acute alcohol intoxication. This population and their ED encounters have not been previously described.MethodsThis was a retrospective, observational, cohort study of patients presenting to the ED for acute alcohol intoxication between 2012 and 2016. We collected all data from the electronic medical record. Frequent users for alcohol intoxication were defined as those with greater than 20 visits for acute intoxication without additional medical chief complaints in the previous 12 months. We used descriptive statistics to evaluate characteristics of frequent users for alcohol intoxication, as well as their ED encounters.ResultsWe identified 32,121 patient encounters. Of those, 325 patients were defined as frequent users for alcohol intoxication, comprising 11,370 of the encounters during the study period. The median maximum number of encounters per person for alcohol intoxication in a one-year period was 47 encounters (range 20 to 169). Frequent users were older (47 years vs. 39 years), and more commonly male (86% vs. 71%). Frequent users for alcohol intoxication had higher rates of medical and psychiatric comorbidities including liver disease, chronic kidney disease, ischemic vascular disease, dementia, chronic obstructive pulmonary disease, history of traumatic brain injury, schizophrenia, and bipolar disorder.ConclusionIn this study, we identified a group of ED frequent users who use the ED for acute alcohol intoxication. This population had higher rates of medical and psychiatric comorbidities compared to non-frequent users.