Number Of Visits Research Articles

Primary care seeking among adults with chronic neck and low back pain in Norway: A prospective study from the HUNT study linked to Norwegian primary healthcare registry.

To describe the frequency of primary care seeking for neck or back-related conditions among people with chronic neck and low back pain and to develop prediction models of primary care seeking and frequent visits. We included participants of the Trøndelag Health Study (HUNT4, 2017-19) in Norway who self-reported chronic neck and/or low back pain in the preceding year, and extracted data of primary care visits from the Norwegian primary healthcare registry. We investigated a total of 23 potential predictors and used multivariable logistic regression models to predict primary care seeking for neck or back-related conditions and frequent visits by healthcare provider (i.e., the highest quartile of number of visits). Among the 15,352 HUNT4 participants with chronic neck and/or low back pain, 6231 participants (40.6%) sought primary care for neck or back-related conditions (median = 5 visits, IQR 2-15) within 2 years after the study. Participants who consulted physical therapists sought care the most frequently (median = 10 visits, IQR 3-26). Discrimination of the best-fit prediction model of primary care seeking and frequent visits by healthcare provider, assessed by C-statistic, ranged from 0.66-0.76. Participants who made frequent primary care visits in the preceding year were highly likely to continue frequent care seeking in the following 2 years. Around 40% of people seek primary care for chronic neck and low back pain, and frequent care seeking may continue for years. Future studies should investigate strategies to reduce recurrent primary care visits, especially seeking physical therapist care, and promote self-management of chronic pain. People with chronic neck and low back pain who seek physical therapist care had the highest frequency of care seeking, underscoring the significant burden on healthcare systems. The high frequency of visits and associated healthcare expenditures highlight the critical need for effective and valuable primary care for chronic pain management. To mitigate recurrent visits and reduce costs, it is essential to provide patients with evidence-based treatments and self-management interventions.

Mathematical Modeling and Enhancing the Carrying Capacity of National Parks in the United States

A rapid growth in the number of visitors has been observed for many national parks in the United States, examples include Yellowstone National Park, Yosemite National Park, Rocky Mountain National Park and Arches National Park. As a result, public transit and parking resources have been stretched closer and closer to their capacities in these parks. In response, some National Park Services (NPS) have started to implement crowd control measurements, such as the timed entry reservation systems, where visitors have to reserve their slots to visit the park during certain time periods of the year. However, such policy does not touch on the fundamental issue of the subject, that is, the carrying capacity of the park. In this paper, we demonstrate that there will be even greater growth in the number of visitors in the near future, which means that a capacity boost is inevitable. Fortunately, we also observe that if we can fix some key bottlenecks, then we can dramatically increase the capacity of the park without destroying more natural land.

Chat-Bot Based Ticketing System Using Dialogflow and Llama LLM

MyMuseum represents an innovative solution designed to revolutionize the ticket booking process for museums across India, with the primary goal of enhancing engagement and increasing visitor numbers. At its core, the system incorporates a sophisticated conversational AI chatbot that streamlines the ticket booking process, eliminating the hassles traditionally associated with museum visits. This chatbot is complemented by an additional AI-powered feature that interactively presents exhibit information, creating a comprehensive and engaging user experience. The platform boasts a user-friendly interface accessible around the clock, significantly simplifying ticket booking procedures while offering real-time navigation support and comprehensive guides for all participating museums. Key features of MyMuseum include automated event management, a system for notifications and alerts, virtual tour capabilities, and interactive content delivery, collectively forming a holistic solution for museum visitors. This report provides an in-depth examination of the underlying technology stack, which encompasses the ticket-booking chatbot, a Large Language Model (LLM) for disseminating information about museums, their artifacts, and exhibits, integrated payment gateways, and robust backend services. It highlights the myriad benefits of the system, including enhanced automation, scalability, and the generation of data-driven insights. Beyond improving convenience for visitors, MyMuseum is projected to drive increased museum attendance, boost revenue through strategic upselling opportunities, and play a crucial role in enhancing cultural awareness and education. Furthermore, it promises to alleviate operational burdens on museum staff by providing real-time analytics and improving overall efficiency and sustainability in museum operations

Regional disparities and socio-demographic factors associated with eight or more antenatal care visits in Ghana

BackgroundAntenatal care is vital for maternal health and wellbeing, with the World Health Organization recommending a minimum of eight visits during pregnancy. In this study, we examined the regional disparities and factors associated with eight or more antenatal care visits in Ghana.MethodsWe performed a cross-sectional analysis of data from the 2022 Ghana Demographic and Health Survey. Our study comprised 3,893 women of reproductive age with birth history in the last two years before the survey. Regional disparities in the proportion of eight or more antenatal care visits were visualised using a spatial map. A mixed-effect multilevel binary logistic regression analysis was conducted to determine the factors associated with eight or more antenatal care visits using a four-modeled approach. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).ResultsThe prevalence of eight or more antenatal care visits in Ghana was 38.4% [95% CI = 36.0–41.0]. The regions with the highest prevalence were Eastern, Greater Accra, Western, and Volta. Those with the lowest prevalence were Northern, North East, Savannah, and Oti. The odds of eight or more antenatal care visits were lower among women aged 40–49 [aOR = 0.42, 95% CI = 0.18–0.96], women with four or more children [aOR = 0.57, 95% CI = 0.36–0.93], women who wanted pregnancy later [aOR = 0.63, 95% CI = 0.46–0.85], and women in five regions: Western North [aOR = 0.43, 95% CI = 0.19–0.94], Bono [aOR = 0.33, 95% CI = 0.14–0.76], Northern [aOR = 0.29, 95% CI = 0.13–0.66], Savannah [aOR = 0.30, 95% CI = 0.14–0.65] and North East [aOR = 0.33, 95% CI = 0.14–0.75]. Women in the richer [aOR = 1.99, 95% CI = 1.19–3.33] and richest [aOR = 4.82, 95% CI = 2.45–9.51] wealth index showed a higher likelihood of completing eight or more antenatal care visits relative to women in the poorest wealth index.ConclusionA significant proportion of women in Ghana fall short of the recommended eight or more antenatal care visits. Age, parity, desired pregnancy timing, wealth status, and region of residence are associated with the number of antenatal care visits. Women in five regions (Bono, Northern, North East, Savannah, and Western North) are significantly less likely to have eight or more antenatal care visits than those in the Western region. The government and policymakers should design programs to address the needs of older women, those with high parity, and women who want to delay pregnancy. Increased healthcare resources, educational campaigns, and addressing regional barriers to antenatal care access are crucial. Promoting public health initiatives to emphasise the importance of completing the recommended number of antenatal care visits for a healthy pregnancy is essential.

Machine-learning based prediction for high health care utilizers using a multi-institution registry

Abstract Background Rising healthcare costs worldwide have spurred interest in using machine learning to pinpoint major healthcare utilizers for population health efforts. Previous studies have focused on individuals who impose the highest financial burden, such as targeting high-need high-cost utilizers, a small group with limited potential for cost reduction. Therefore, we developed models to predict future healthcare utilization across various thresholds. Methods We leveraged data from a multi-institutional diabetes database to develop binary classification models capable of predicting healthcare utilization in the following year. The models predicted six different outcomes: patients with an annual total length of stay of ≥ 7, ≥14, and ≥30 days, and emergency department (ED) attendance of ≥ 3, ≥5, and ≥10 visits. To mitigate class imbalance, we applied random and synthetic minority oversampling techniques and compared against models trained without oversampling. Models were trained with 2019 data and tested on unseen data from 2020 and 2021. Results Models trained with random oversampling, including logistic regression, multivariate adaptive regression splines, boosted trees, and multilayer perceptron, consistently demonstrated high AUC (>0.80) and sensitivity (>0.60) across both training-validation and test datasets. Addressing class imbalance was found to be crucial, as models without oversampling displayed satisfactory AUC (>0.80) but significantly lower sensitivity (<0.10). Key predictors identified included age, number of ED visits in the present year, chronic kidney disease stage, inpatient bed days in the present year, and mean HbA1c levels. Conclusions Our machine learning models successfully predict high service level utilization with strong performance, offering valuable tools for policymakers and health planners to develop targeted health initiatives based on patient utilization patterns. Key messages • Machine learning models can be leveraged to predict future healthcare utilization and facilitate interventional program development. • Annual total length of stay and total emergency department visits are useful service level indicators.

The impact of a dedicated heart failure clinic on patients with heart failure with reduced ejection fraction

Abstract Introduction Heart failure (HF) is not a diagnosis but rather a syndrome with a variety of potential causes and once a patient has been diagnosed as having HF, the underlying etiology should be sought and treated. Thus, patients with HF should be engaged in a disease management program that includes a dedicated wider healthcare team which is critical for delivering the best care for patients. A dedicated HF clinic is one of the cornerstones of this ultimate management program. This clinic is specifically made to make sure of the proper management and follow-up of those patients. There is a scarce evidence of weather a dedicated HF clinic can alter the long-term outcomes of HF patients or not. Thus, the aim of this study is to search for the impact of a dedicated HF clinic on patients with HF with reduced ejection fraction (HFrEF) regarding the symptoms, management received according to latest guidelines, the patients’ quality of life and impact on health care resources. Patients and Methods This is a single center retrospective study that included patients presented to a dedicated heart failure clinic at a secondary care hospital through a one-year period. The study group included patients with diagnosis of HFrEF only who had one or more visit to the HF clinic. These patients served as their own control. Hospital admissions and emergency room visits in the 12-month period preceding enrollment was compared to the number in the following year after enrollment. Patients with incomplete data and those with ejection fraction >40% were excluded. Results The study included 48 patients with a mean age of 65 years, 70.8% of them were males. Most of the patients were hypertensive (77.1%), diabetic (75%) and with history of coronary artery disease (60.4%). Symptoms improved significantly in all patients, left ventricular volumes and ejection fraction improved (31±8.1% vs 40.7±10.5%) (P<0.0001). NT-ProBNP level improved significantly (5927 ng/L vs 3135 ng/L) (P = 0.03). The guideline directed medical therapy was used properly before and after the clinic. There was a significant improvement in the quality of life where the KCCQ-12 score improved from 71.25±13.2 to 83.3±13.3 (P<0.0001), six-minute walk test also improved significantly from 362±184 meters to 479±211 meters (P = 0.005). Regarding the economic impact, there was no significant difference in the number of unplanned visits (20.8% vs 10.4%) (P = 0.16) but there was a significant reduction in the number of HF hospitalizations within one year (20.8% vs 6.25%) (P = 0.038) Conclusion Dedicated HF clinics are very important now for the proper management of HF patients where it is proved that it can improve HF symptoms, improve the quality of life measurements, maintain the proper guideline directed therapy and reduce the economic burden of HF through reducing the number of HF hospitalizations.Clinical dataOutcomes

Workplace health promotion measures and use of medical services in the German Federal Armed Forces

Abstract Introduction Workplace health promotion measures (WHPM) are among recommended options for maintaining employees health, important for the German Federal Armed Forces as an employer. In order to detect associations between WHPM and health care utilization, we recorded the number of outpatient visits and hospital stays, differentiated according to gender, military or civilian activity. Methods Prospective longitudinal observational substudy with cross sectional analysis of items regarding use of medical services at T0 (6-9/2022). Analysis for T1 (2023) and T2 (2024) follow. Data were obtained with a web-based employee survey to record self-reported endpoints. A total of about 224.000 employees by the German Armed Forces were addressed. Results Survey participation rate was 10.5% (n = 23.568) of all employees in T0, 29.1% were women and 0.3% reported being diverse, 43.2% of the participants were <40 years of age. Independently of taking part in WHPM, we did not detect differences in the proportion of male soldiers receiving treatment in hospitals of the German Federal Armed Forces. Among female soldiers without WHPM, 37.5% stayed in hospitals and with WHPM 30.5%. Higher % of women (84%) than men (78%) presented to the military - or family physician (w: 81%, m: 73%), independent of participation in WHPM and assignment for civil or military. In last 4 weeks, more women (81.3%) than men (65.6%) were prescribed medication. Female employees in civilian w.p.(84.8%) took more medications than those in military w.p (77.7%). Oral contraception was used by 20% of women in both civilian and military w.p. Conclusions There are no gender differences nor difference for civilian or military employees concerning the number of days staying in hospital. More women than men recieved regular outpatient medical care and more women than men take medication regularly. *Ludwig S and Roy R share last authorship Key messages • There are no gender differences nor difference for civilian or military employees concerning the number of days staying in hospital. • More women than men recieved regular outpatient medical care and more women than men take medication regularly.

Chronic inflammation is associated with impaired cardiac structure and function in patients with inflammatory arthritis: the ARTCADIA Study

Abstract Background Inflammation as an underlying cause of cardiac dysfunction has been underscored in recent years. Patients with inflammatory arthritis (IA) are at risk of being exposed to a high degree of chronic and systemic inflammation. It is therefore important to investigate whether high inflammatory burden impacts cardiac structure and function in patients with IA. Purpose To examine the impact of long-term inflammation on measures of cardiac structure and function in individuals with rheumatoid arthritis (RA) and axial Spondyloarthritis (axSpA), collectively referred to as IA, in a large cohort. Methods In a prospective cohort study, outpatients with a diagnosis of IA were included over two years during their biannual rheumatological routine appointment. In total, 1,285 participants were included. Participants were evaluated at a cardiology research center where echocardiography was performed following a pre-defined protocol. To evaluate chronic inflammation, C-reactive protein (CRP) was averaged from clinical outpatient visits registered in a rheumatological database. Uni- and multivariable linear regressions were used to examine the relationship between echocardiographic measures and log-transformed CRP. Results Among the 1,285 participants, 903 (70%) were diagnosed with RA, 358 (28%) with axSpA, and 24 (2%) with other forms of IA. Mean age was 60 ± 13 years, 64% were female. The median number of outpatient visits was 30 (Interquartile range (IQR): 18 - 48), median disease duration was 12 (IQR: 6 - 20) years, and the median outpatient CRP was 5.7 (IQR: 3.7 – 9.8) mg/L. 519 (40%) patients had hypertension (HT), 113 (9%) diabetes mellitus (DM), 76 (5.9%) ischemic heart disease (IHD) and 35 (2.5%) heart failure (HF). Mean left ventricular (LV) ejection fraction was 54.6 ± 5.7%, mean numerical global longitudinal strain (GLS) was 17.8 ± 2.4%, mean LV mass index (LVMi) was 73 ± 18 g/m2 and mean tricuspid annular plane systolic excursion (TAPSE) was 2.5 ± 0.4 cm. In univariable analyses, higher levels of CRP were significantly associated with lower GLS, p < 0.001; higher E/e’, p = 0.001; higher LVMi, p < 0.001 and lower TAPSE, p = 0.005 (Figure). The associations remained significant after adjusting for clinical characteristics including disease duration, age, sex, blood pressure, body mass index, physical activity, pack-years of smoking, cholesterol, HT, DM, heart rate, atrial fibrillation, IHD and HF (p < 0.05 for all associations). We observed no significant interactions between the IA diagnosis and inflammation across the significant echocardiographic measures. Conclusion In a large cohort of patients with IA, increasing levels of chronic inflammation determined by outpatient CRP was associated with impaired measures of cardiac structure and function and remained significant after adjusting for clinical characteristics. The prognostic and clinical implication of these findings needs to be explored in future studies.Linear regression splines

Detecting Unrecognized Dementia Using Deep Learning Methods with Korean National Claims Data

Abstract Background Dementia is one of the leading causes of death in elderly people. In Korea, the government supports dementia screening for people aged 60 and older, but it is not a population-based organized screening program. It is difficult to achieve early diagnosis and early treatment. The objective of this study is to detect unrecognized dementia using Korean National Claims Data for early diagnosis. Methods This study used the National Health Insurance Claims data in Korea. The case group is the new dementia visit as an unrecognized group, while the control group was randomly selected from the general population without dementia. The predictors included health utilization, socioeconomic and demographic, procedure codes, diagnostic codes and health screenings data. The health utilization variables included length of stay, the number of outpatient visits, health expenditures and other encounter information. All medical utilization data was aggregated monthly. In the case group, 12 months of data from 6-month or 2-years before the onset of dementia were used. In the control group, 12 months of data from randomly selected time point were included. Transformer, embedding methods, and Time2Vec were used as the deep learning methods. This study included 453,306 incidents of dementia, representing almost all cases reported from 2010 to 2019 in Korea. The control group consisted of 669,873. Results After training the deep learning prediction model, the AUC for 6-month dementia prediction on the test dataset was 0.87, and for 2-year dementia prediction, it was 0.76. The most important variables were health utilization variables, especially health expenditures. The health utilization trajectories of the case group were significantly different from those of the control group. Conclusions Based on the claims data, we could detect unrecognized dementia case. We can extend the model to other chronic disease such as cancer and stroke, which are significant burden of disease. Key messages • Screening in healthcare facilities or using lab test results would be more accurate, but it would be difficult to apply to a large population due to the cost-effectiveness and timeliness constraints. • On the other hand, the detection model using the existing claims data would be helpful to to develop cost-effective mass screening program. It can cover the weakness of current screening program.

General Practitioner Availability and Accessibility in Serbia Before and During the Pandemic

Abstract Background During the COVID-19 pandemic in Serbia, state-owned primary health centres’ general practitioners (GPs) served as the first point of care for adults (the population aged 19 years and older) and gatekeepers of the health system. The study highlights changes in the overall availability, accessibility, and workload of GPs during the pandemic. Methods We used routine health facility data at the national level to describe the changes in GPs over the past three years, before the pandemic (2017-2019) and during the pandemic (2020-2022). Specifically, we looked at the total number of GPs, the percentage of specialists, the average number of citizens per GP, the services used per capita, the average number of visits per GP, and the leading causes of morbidity. Results The study found a decrease in the total number of GPs in both periods (before: -10%, during: -9%) and in the number of specialists (before: -2%, during: -3%). During the pandemic, the average number of citizens per GP varied. In 2022, the average number of visits per GP decreased noticeably to 3557 GPs, of which 37% were specialists. In the same year, each GP received 6661 annual visits and served 1509 citizens on average. However, these figures exhibit considerable regional and geographical differences. Circulatory and respiratory diseases were the most common reasons for visiting a GP (about 14% and 13% of all visits, respectively). Up to 10% of all visits resulted in either a diagnosis of external factors that influence health status or in ill-defined symptoms, clinical and laboratory findings. Conclusions This study’s findings underscore the critical reductions in availability, accessibility, and workload of general practitioners in the Serbian public sector and emphasize the importance of strengthening the primary healthcare system to better respond to future challenges. Key messages • Public health officials should prioritize the development of effective strategies and policies that focus on improving the quality and accessibility of primary health care services in Serbia. • A greater investment in general practice is necessary to ensure it can effectively meet the population’s needs during health emergencies.

Investigation of usage of antenatal care services by Syrian immigrant pregnant women and the frequency of anaemia and hypertension during the pandemic.

During the pandemic period, the use of health services by disadvantaged groups such as immigrants has deteriorated. The study aims to evaluate the use of antenatal care services by Syrian pregnant women during the pandemic. It is a cross-sectional type of study. The population consisted of 495 pregnant women who applied to the Extended Migrant Health Center (EMHC) between August 2020 and December 2022. Demographic data and pregnancy-related health records were examined through the system records, without any contact with the pregnant women. The percentage of pregnant women who had timely follow-up for each antenatal visit were 11.5% (n=56), 17.2% (n=80), 20.0% (n=88), and 17.4% (n=73), respectively. Only 17.7% (n=87) of the pregnant women made the recommended number of visits during their pregnancy period. The recommended number of follow-ups was statistically significantly higher in women with high-risk pregnancies (p=0.045). Of the pregnant women, 27.4% had anaemia and 2.4% had hypertension. The use of antenatal care in immigrant pregnant women is very low. Interventions are needed in this regard. Increasing the utilization of antenatal care services by immigrant pregnant women is extremely important for both the health of the pregnant woman and the health of the baby.

Determinants of micronutrient supplementation during pregnancy among women in three sub-Saharan African countries: a multilevel logistic regression model

BackgroundPoor maternal nutrition during pregnancy is a common cause of poor maternal and infant outcomes. Micronutrient deficiencies are common among pregnant women in low- and middle-income countries, including sub-Saharan Africa. Pregnant women are recommended to take micronutrients like iron or folic acid and deworming medication during pregnancy. Therefore, this study was conducted to assess micronutrient intake and its associated factors among pregnant women in three countries using the most recent demographic and health survey.MethodsWe used data from the most recent demographic and health surveys, which were carried out between 2019 and 2022 in three sub-Saharan African countries. The study included a weighted sample of 13,568 reproductive-age women who had given birth within the five years prior to the survey. Utilizing multilevel logistic regression, the factors associated with the dependent variable were identified. Model comparison and fitness were assessed using the deviance (-2LLR), likelihood ratio test, median odds ratio, and intra-class correlation coefficient. Ultimately, factors were deemed statistically significant if they had a p-value less than 0.05.ResultsThe pooled prevalence of micronutrient intake among pregnant women during pregnancy of last birth was 77.56% (95% CI: 76.85%–78.25%). Factors like age [AOR = 1.78; 95% CI (1.14, 2.77)], educational status [AOR = 1.49; 95% CI (1.23, 1.79)], marital status [AOR = 0.66; 95% CI (0.58, 0.75)], working status [AOR = 1.17; 95% CI (1.01, 1.34)], media exposure [AOR = 1.20; 95% CI (1.05, 1.38)], preceding birth interval [AOR = 1.17; 95% CI (1.01, 1.34)], number of ANC visits [AOR = 1.65; 95% CI (1.29, 2.10)], and residence [AOR = 1.19; 95% CI (1.03, 1.37)] were significantly associated with micronutrient intake among pregnant women.ConclusionsMore than three-fourths of the study subjects were micronutrient supplemented during their pregnancy. Improving women's education, disseminating nutrition information through media, providing more attention to young pregnant women who live in rural areas, increasing the number of ANC visits, and women's empowerment are strongly recommended.

Participation in the Missouri Parents as Teachers Parent Education Program and third grade math and English language arts proficiency

The Missouri Parents as Teachers (PAT) Parent Education Program is a voluntary and universal home visiting program available to all Missouri families who are expecting a child or who have a child ages birth to kindergarten entry. Families participating in the Missouri PAT Parent Education Program receive a variety of family support services, including family personal visits with trained parent educators to develop parent practices and child school readiness. Research indicates that home visiting components of parent education programs support child academic outcomes. However, studies have not extensively examined how variation in participation, including the developmental period of exposure—the child's age upon entry and duration of participation—and number and frequency of home/family visits, is associated with child outcomes. In this study, we used linear probability regression to examine associations between variation in participation in the Missouri PAT Parent Education Program and child third grade proficiency in math and English language arts (ELA) (n = 9777), while controlling for relevant child, parent, family, and school-level factors. We also tested the potential moderating role of family low-income status at enrollment into the program. We found that the number of family personal visits was positively associated with third-grade math and ELA proficiency, whereas no significant findings emerged for developmental period of program exposure. Our findings indicate that increased exposure to the Missouri PAT Parent Education Program was positively associated with third-grade academic achievement for all children, including those from low-income families.

Impact of marginalization on characteristics and healthcare utilization among people with substance use disorder in Ontario, Canada, before and during the COVID-19 pandemic: A cross-sectional study.

To describe and compare the characteristics of people with SUD and their use of healthcare services in two ways: 1) across varying levels of marginalization and 2) before and during the pandemic. We conducted a population-based cross-sectional study using administrative data from Ontario, Canada. We included individuals age 16+ with a recorded diagnosis of SUD between June 2018-2019 (pre-pandemic) and June 2021-2022 (during-pandemic). Baseline sociodemographic and clinical characteristics and use of healthcare services were enumerated across the five quintiles of the Ontario Marginalization Index. 259,497 pre-pandemic and 276,459 during-pandemic people with SUD were identified. Over 40% belonged to the two highest marginalization quintiles (Q4/Q5). Most had an outpatient visit with similar percentages across quintiles, however the number of visits increased with increasing marginalization (pre-pandemic: mean 8.5 visits in Q1 vs 13.0 visits in Q5; during-pandemic: mean 9.5 in Q1 vs 13.4 in Q5). There was no consistent pattern in percent of people who sought alcohol-related outpatient care, however more marginalized people sought drug-related outpatient care (pre-pandemic: 19.1% in Q1 vs 31.7% in Q5; during-pandemic: 18.7% in Q1 vs 32.5% in Q5). Almost half of people with SUD had an emergency department (ED) visit, of which more belonged to higher marginalization quintiles (pre-pandemic: 43.5% in Q1 vs 49.8% in Q5; during-pandemic: 41.4% in Q1 vs 49.3% in Q5). SUD prevalence and most health service utilization remained similar from pre- to during-pandemic. Increasing marginalization was associated with increased use of healthcare among people with SUD. Future research should aim to further explore the complex relationship between marginalization and substance use.

Age and sex differences in the association of dental visits with inadequate oral health and multimorbidity: Findings from the Canadian Longitudinal Study on Aging (CLSA)

BackgroundDental attendance is important for the prevention, diagnosis, and treatment of oral diseases. In this study, we aimed to assess the extent of the association between dental visits, inadequate oral health, and multimorbidity (MM), and whether this association differs by age and sex.MethodsWe conducted a cross-sectional analysis of the first follow-up wave (2018) of the Canadian Longitudinal Study on Aging (CLSA). Poor self-reported oral health (SROH), oral health problems, and edentulism were used to indicate inadequate oral health. MM was defined as having 2 or more chronic conditions out of cancer, cardiovascular diseases, chronic respiratory diseases, diabetes, and mental illnesses. Dental visiting was determined as the number of visits to a dental professional within the past 12 months. Covariates included socioeconomic, behavioural factors, and the availability of dental insurance. We constructed multivariable Poisson and logistic regression models with interactions terms and estimated the relative excess risk due to interaction prevalence ratio (RERIPR) to assess the effect measure modification of age and sex on the associations of interest. We conducted sensitivity analyses and estimated E-values for unmeasured confounding.ResultsIn this sample (n = 44,815), dental visiting was inversely associated with inadequate oral health and MM in adjusted models, reducing the odds/prevalence of poor SROH (OR 0.41, 95% CI 0.34, 0.51), oral health problems (PR 0.89, 95% CI 0.79, 0.94), edentulism (OR 0.10, 95% CI 0.06, 0.15), and MM (PR 0.86, 95% CI 0.79, 0.92). These associations were stronger in older age and females.ConclusionDental visiting may contribute to better oral health and reduced chronic diseases in the middle-aged and older population. Our findings suggest the need for age and sex-specific targeted interventions to optimize oral and overall health.

Store Advertising Strategy In Tuban In Increasing Product Appeal

Advertising strategy of Ceker Gobyozz Byozz Tuban Shop and its impact on business growth. Using the Diffusion of Innovation Theory by Everett M. Rogers, this study identifies how innovation in products and advertising strategies can be applied to small businesses. This shop utilizes the trend of spicy food that is popular among young people as the main innovation, accompanied by promotions through social media such as Instagram, Facebook, and WhatsApp, as well as print media in the local community. This strategy is implemented in stages, starting from word-of-mouth (WOM) promotion to the use of more modern media. The results of the study show that a well-integrated advertising strategy can significantly increase the number of visitors. This shop is able to attract around 50-70 visitors per branch per day, with a total turnover of 120 million rupiah per month. In addition, involvement in the local community accelerates the diffusion of innovation and helps the shop reach a wider market. Consumer adoption decisions are influenced by product quality and positive experiences at the shop, which creates customer loyalty. In conclusion, an innovative and targeted advertising strategy is the key to the success of Ceker Gobyozz Byozz Shop, providing important insights for small businesses in developing their businesses through effective promotions.

Efektivitas Instagram Sebagai Media Promosi Terhadap Minat Pengunjung Wisata Omah Sukuh, Jawa Tengah

Internship is one of the options for students of the Literature-1 program to complete their final project at the Faculty of Business and Economics, Islamic University of Indonesia. The final project of this Internship was completed by the author by studying Omah Sukuh in collaboration with Perum Perhutani. At the time of the internship, the author was placed in agrotourism in charge of inputting data on visitors who came every month, the number of visitors to Omah Suku was still small who came to tour Omah Sukuh. Regarding the problems faced by the tribe's house, the author wants to analyze how effective Instagram social media is to be a place to promote. The internship was carried out for 4 months from February 13, 2023 to May 14, 2023.The author took a qualitative method for the preparation of this internship final project, data collection was carried out by interviews with the company manager of Perum Perhutani and the person in charge of tourism Omah Sukuh. The author has gained a lot of knowledge and skills such as marketing using influencers on Instagram social media is very effective to be used as a place for promotion. The findings from this study can be used to optimize the use of Instagram as a promotional medium, especially in creating content on Instagram reels with interesting content, the use of hashtags and audio that are relevant and trending. Just like what has been done before, but still increased creativity, innovation, and consistency. This can increase visitors who come from viewing content on Instagram uploaded by influencer content.

Tooth loss during long-term periodontal therapy in specialized practices – a retrospective cohort study from a periodontal practice-based research network (Perio-PBRN)

ObjectivesTo investigate tooth-specific, clinical tooth-, and patient-related factors associated with tooth loss (TL) in patients with mild to severe periodontitis treated in a periodontal practice-based research network (Perio-PBRN) over at least 5 years.Materials and methodsThe Perio-PBRN consists of five German periodontal practices where clinical data were collected regarding patient age, tooth type, bleeding on probing (BOP), pocket probing depth (PPD), furcation involvement (FI), number of attended appointments, and other variables of interest. The data were evaluated regarding factors influencing TL.ResultsData from 687 patients (aged 54.5 ± 11.1 years) with mild (N = 23, 3.35%), moderate (N = 247, 35.95%) or severe (N = 417, 60.70%) periodontitis and 15,931 teeth over a mean observation period of 6.83 ± 1.40 years per patient were gathered via the Perio-PBRN. In this period, a total of 657 teeth were lost (4.12%, overall TL: 0.14 ± 0.22 teeth/patient/y). The risk of TL was significantly increased for teeth with persistent PPD ≥ 6 mm (hazard ratio: 6.81 [95% confidence interval: 5.07–9.15] in comparison to PPD < 4 mm. Additionally, BOP (3.90 [2.46–6.19]), furcation involvement, jaw, age and tooth type showed a significant influence on TL, while number of visits were not significantly associated with TL.ConclusionsPeriodontal care of patients with moderate to severe disease in specialized practices was associated with a low rate of TL. Known tooth-related prognostic factors were confirmed. However, the results must be interpreted cautiously without knowledge of risk factors such as smoking and diabetes.Clinical relevancePBRNs can help gather large amounts of periodontal practice-level data.Trial registrationThe study was registered in the German Clinical Trials Register (DRKS 00011448).

Antibacterial Effectiveness Test of Liquid Soap from Seven-Blade Needle Leaf Extract (Pereskia Bleo) Against Staphylococcus aureus Bacteria, Faculty of Medicine, University of Prima Indonesia

This study aims to analyze the digital-based marketing strategy implemented by FranchiseGlobal.com in order to increase exposure, market penetration, and brand awareness in the franchise industry. Using qualitative descriptive methods and a case study approach, this study explores digital marketing strategies that utilize big data, digital platforms, and social media to reach potential franchisees. Data were obtained through interviews, documentation, and direct observation of FranchiseGlobal.com's marketing activities. The results of the study indicate that the digital marketing strategy implemented by FranchiseGlobal.com, both in the short, medium, and long term, has succeeded in increasing the number of website visitors and brand awareness, although there are still challenges in expanding penetration into international markets, especially ASEAN. This study concludes that digital-based marketing is a crucial component in developing a franchise business more widely and effectively, and provides recommendations for optimizing the use of big data and technological innovation in future marketing strategies.

Development of Digital-Based Marketing Strategies: A Case Study on Franchiseglobal.com

This study aims to analyze the digital-based marketing strategy implemented by FranchiseGlobal.com in order to increase exposure, market penetration, and brand awareness in the franchise industry. Using qualitative descriptive methods and a case study approach, this study explores digital marketing strategies that utilize big data, digital platforms, and social media to reach potential franchisees. Data were obtained through interviews, documentation, and direct observation of FranchiseGlobal.com's marketing activities. The results of the study indicate that the digital marketing strategy implemented by FranchiseGlobal.com, both in the short, medium, and long term, has succeeded in increasing the number of website visitors and brand awareness, although there are still challenges in expanding penetration into international markets, especially ASEAN. This study concludes that digital-based marketing is a crucial component in developing a franchise business more widely and effectively, and provides recommendations for optimizing the use of big data and technological innovation in future marketing strategies.