One-time Users Research Articles

Myasthenia Gravis: utilising cross-platform quantitative content analysis to uncover and validate unmet needs.

Recent years have seen a rapid growth in the number of online health communities targeted at patients with long-term conditions. Myasthenia Gravis (MG) is a rare neurological disease for which such communities have not been analysed before. The aim of this study was to better understand the needs of the MG population through the collation and categorisation of questions that users of MG social media were asking fellow users on these platforms. Systematic observation of four MG Facebook groups was conducted over a 2-month period. Groups were selected for analysis based on the following systematic criteria: Language (English), Membership (≥ 5,000 members), group activity (≥ 2 posts per week), target audience (general MG population) and researcher engagement with group administrators. The study protocol was reviewed by the institutional review board of the Charité-Universitätsmedizin Berlin (EA2/106/22). During the observation period, data were extracted from individual posts featuring questions made across each group using a systematic and objective coding scheme. All data points were coded directly from the source and collated into an SPSS database (IBM SPSS V.27, SPSS). Absolute and relative frequencies were calculated for categorical variables and proportions were compared across groups to validate the credibility and relevance of different requests. Of the 2,062 posts observed (N = 2,062), 1,392 featured questions (n = 1,392). Questions were asked by 787 unique users: 531 were identified as one-time users (67%) and 256 were identified as repeat users (33%). Six hundred and fifty six users were classified as presumed diagnosed (83%), 61 as seeking diagnosis (8%), 69 as family and/or friends (9%) and as other (<0%). Eight unique categories of questions were observed including MG treatment (31%), Symptoms (19%), Living with MG (12%), Diagnosis (10%), non-MG medication (11%), Tests (8%), Location (4%) and Other (4%). Members of the MG population make active use of online health communities to seek and discuss practical information concerning various aspects of the disease, its diagnosis and care. The openness and willingness of the sample population to share sensitive medical information shows a high need for information not entirely catered to by the medical profession.

Tracking and Profiling Repeated Users Over Time in Text-Based Counseling: Longitudinal Observational Study With Hierarchical Clustering.

Due to their accessibility and anonymity, web-based counseling services are expanding at an unprecedented rate. One of the most prominent challenges such services face is repeated users, who represent a small fraction of total users but consume significant resources by continually returning to the system and reiterating the same narrative and issues. A deeper understanding of repeated users and tailoring interventions may help improve service efficiency and effectiveness. Previous studies on repeated users were mainly on telephone counseling, and the classification of repeated users tended to be arbitrary and failed to capture the heterogeneity in this group of users. In this study, we aimed to develop a systematic method to profile repeated users and to understand what drives their use of the service. By doing so, we aimed to provide insight and practical implications that can inform the provision of service catering to different types of users and improve service effectiveness. We extracted session data from 29,400 users from a free 24/7 web-based counseling service from 2018 to 2021. To systematically investigate the heterogeneity of repeated users, hierarchical clustering was used to classify the users based on 3 indicators of service use behaviors, including the duration of their user journey, use frequency, and intensity. We then compared the psychological profile of the identified subgroups including their suicide risks and primary concerns to gain insights into the factors driving their patterns of service use. Three clusters of repeated users with clear psychological profiles were detected: episodic, intermittent, and persistent-intensive users. Generally, compared with one-time users, repeated users showed higher suicide risks and more complicated backgrounds, including more severe presenting issues such as suicide or self-harm, bullying, and addictive behaviors. Higher frequency and intensity of service use were also associated with elevated suicide risk levels and a higher proportion of users citing mental disorders as their primary concerns. This study presents a systematic method of identifying and classifying repeated users in web-based counseling services. The proposed bottom-up clustering method identified 3 subgroups of repeated users with distinct service behaviors and psychological profiles. The findings can facilitate frontline personnel in delivering more efficient interventions and the proposed method can also be meaningful to a wider range of services in improving service provision, resource allocation, and service effectiveness.

Dissecting shared e-scooters usage patterns and its impact on other transportation modes: A case study of Portland city

The study analyzed the survey data from the 2018 Portland E-scooter Pilot Program and aims to determine (i) who uses shared e-scooters and why they use them, and (ii) whether there is any association between e-scooter usage and the usage of other modes of transportation. To accomplish the first objective, the study identifies the users of shared e-scooters based on their travel behavior using an unsupervised machine learning approach, latent class analysis (LCA). The LCA model grouped e-scooter users into three distinct classes: Class 1 (Recreational Enthusiasts) −occasional and frequent users for recreation, Class 2 (Commute Riders) −frequent users for work, and Class 3 (Intermittent Joyriders) −occasional and one-time users for recreation. Furthermore, a set of ordered logit models is employed to determine the second objective based on the identified classes of e-scooter users, their socio-demographic characteristics, and the built environment variables. The results of ordered logit models revealed that compared to Commute Riders, both Recreational Enthusiasts and Intermittent Joyriders exhibit less interest in increasing the usage of available transportation modes after adopting e-scooters. Notably, low-income e-scooter users show a higher probability of increasing their usage across various transportation modes, including public transportation, driving, shared mobility services, personal bikes, shared bikes, and walking. The study offers valuable insights to guide city planners and policymakers in developing effective strategies for the deployment of e-scooters, targeting each group of users.

Trends in cannabis consumption: psychotic and anxiety symptoms among users

IntroductionDuring cannabis use, some individuals may experience psychotic symptoms, such as unusual perceptions or irrational thoughts, including mild hallucinations or temporary paranoia. Anxiety is also common, characterized by excessive worry or intense fear. The occurrence of these symptoms varies based on cannabis quantity, individual sensitivity, and surroundings. Although not all users experience these effects, the link between cannabis and psychotic or anxiety symptoms highlights the need for a thorough risk assessment.ObjectivesOur goal is to analyze trends in cannabis use, as well as the psychotic and anxiety symptoms experienced by users, and to examine whether cannabis use is associated with other substances consumption.MethodsWe collected demographic and substance consumption data from two groups: 29 individuals aged 18 to 28 who had tried cannabis at least once and 19 regular consumers through a structured questionnaire.ResultsRegular cannabis consumers had a higher proportion of males than those who had tried it once (X²(1)=4.81; p=0.028). There were no significant differences in age, alcohol or tobacco consumption between the groups. Notably, regular cannabis consumers had a history of using other illegal drugs, both in the past and within the last month (X²(1)=8.53; p=0.003). Regarding cannabis effects, regular users more frequently reported sensations like euphoria, relaxation, altered time perception, tachycardia, motor coordination difficulties, and impaired clear thinking compared to one-time users (X²(1)=10.12; p=0.001). Regarding anxiety symptoms during cannabis consumption, both groups experienced a similar frequency. Finally, regular cannabis consumers reported strange ideas or perceptions more often than one-time users (X²(1)=0.743; p=0.019). However, the associated discomfort level was similar in both groups.ConclusionsThis study highlights that regular cannabis use is associated with a greater likelihood of using other substances and experiencing more pronounced effects, including psychotic symptoms. However, it doesn’t necessarily lead to increased anxiety symptoms compared to one-time users. It’s important to acknowledge that the relationship between cannabis and psychosis is intricate and influenced by factors like consumption quantity and individual sensitivity. These findings stress the importance of understanding cannabis’s impact on mental health and its connection to the use of other substances.Disclosure of InterestNone Declared

Dockless bike use as a last-mile solution: Evidence from Reno and Sparks, Nevada

Dockless bike-sharing schemes have become more prevalent in cities around the world. While interest grows in studying their usage in larger cities with well-established transit systems, their role in expanding mid-sized cities that are more automobile-dependent remains understudied. This paper evaluates how dockless bike-sharing can provide a last-mile solution by connecting existing bus stops with destinations through an analysis of data collected from 111,155 unique trips over a five-month trial period of a dockless bike sharing scheme in Reno-Sparks, Nevada, USA in the summer of 2018. We classify trips by frequency of use and adjacency to bus stops into four categories and apply multivariate models to determine the link between trip occurrence and the immediate environment. Results indicate that repeat users’ trips that begin or end near the same bus stop are more strongly linked with proximity to bicycle lanes, but tend to be farther from parks and casino resorts. Repeat users typically start trips in denser areas of the city with higher shares of renter-occupied units and higher shares of households without a vehicle, and ended them in less dense areas with higher percentages of white, non-Hispanic residents compared to one-time users. We find differences in association of travel with food service, education, health services, and casino resorts. This suggests that some benefits may be realized by deploying bike sharing in mid-sized cities, but must be weighed against findings that show repeat usage in areas that align with common early transportation technology and service adopter profiles.

The Demographic Representativeness and Health Outcomes of Digital Health Station Users: Longitudinal Study.

BackgroundDigital health stations offer an affordable and accessible platform for people to monitor their health; however, there is limited information regarding the demographic profile of users and the health benefits of this technology.ObjectiveThis study aimed to assess the demographic representativeness of health station users, identify the factors associated with repeat utilization of stations, and determine if the health status of repeat users changed between baseline and final health check.MethodsData from 180,442 health station users in Australia, including 8441 repeat users, were compared with 2014-2015 Australian National Health Survey (NHS) participants on key demographic and health characteristics. Binary logistic regression analyses were used to compare demographic and health characteristics of repeat and one-time users. Baseline and final health checks of repeat users were compared using McNemar tests and Wilcoxon signed rank tests. The relationship between the number of checks and final health scores was investigated using generalized linear models.ResultsThe demographic profile of SiSU health station users differs from that of the general population. A larger proportion of SiSU users were female (100,814/180,442, 55.87% vs 7807/15,393, 50.72%), younger (86,387/180,442, 47.88% vs 5309/15,393, 34.49% aged less than 35 years), and socioeconomically advantaged (64,388/180,442, 35.68% vs 3117/15,393, 20.25%). Compared with NHS participants, a smaller proportion of SiSU health station users were overweight or obese, were smokers, had high blood pressure (BP), or had diabetes. When data were weighted for demographic differences, only rates of high BP were found to be lower for SiSU users compared with the NHS participants (odds ratio [OR] 1.26; P<.001). Repeat users were more likely to be female (OR 1.37; P<.001), younger (OR 0.99; P<.001), and from high socioeconomic status areas—those residing in socioeconomic index for areas quintiles 4 and 5 were significantly more likely to be repeat users compared with those residing in quintile 1 (OR 1.243; P<.001 and OR 1.151; P<.001, respectively). Repeat users were more likely to have a higher BMI (OR 1.02; P<.001), high BP (OR 1.15; P<.001), and less likely to be smokers (OR 0.77; P<.001). Significant improvements in health status were observed for repeat users. Mean BMI decreased by 0.97 kg/m2 from baseline to final check (z=−14.24; P<.001), whereas the proportion of people with high BP decreased from 15.77% (1080/6848) to 12.90% (885/6860; χ21=38.2; P<.001). The proportion of smokers decreased from 11.91% (1005/8438) to 10.13% (853/8421; χ21=48.4; P<.001). Number of repeat health checks was significantly associated with smoking status (OR 0.96; P<.048) but not with higher BP (P=.14) or BMI (P=.23).ConclusionsThese findings provide valuable insight into the benefits of health stations for self-monitoring and partially support previous research regarding the effect of demographics and health status on self-management of health.

Repeated ambulance use is associated with chronic diseases - a population-based historic cohort study of patients\u2019 symptoms and diagnoses

BackgroundThere is a growing demand for emergency medical services (EMS) and patients are repeatedly transported by ambulance services. For many patients, especially those with chronic disease, there may be better ways of delivering care. We examined the symptom at time of emergency call and the hospital diagnosis for those ambulance users who repeatedly received an ambulance.MethodsPopulation-based historic cohort study of patients receiving an ambulance after an emergency call between 2011 and 2014: one-time users (i.e. one ambulance run in any 12 month period) were compared to two-time users (two runs in any 12 month period) and frequent users (>two runs). The presenting symptom according to the Danish Index for Emergency Care from the EMS calls and the hospital ICD-10 discharge diagnoses were obtained from patient records.ResultsWe included 52 533 patients (65 932 emergency ambulance runs). Repeated users constituted 16% of the patients (two-time users 11% and frequent users 5%) and one third of all ambulance runs. The symptoms showing the largest increase in frequency with increasing ambulance use were breathing difficulty (N = 3 905–15% were frequent users); seizure (N = 2 437–10% were frequent users), chest pain (N = 7 616–17% were frequent users), and alcohol intoxication (N = 1 998–5% were frequent users). The hospital diagnoses with a corresponding increase were respiratory diseases (N = 4 381) - 13% were frequent users), mental disorders (predominately abuse of alcohol) (N = 3 087–10% were frequent users) and neurological diseases (predominately epilepsy) (N = 2 207–6% were frequent users). 5% of one-time users, 12% of two-time users and 16% of frequent users had a Charlson Comorbidity Index > = 3.ConclusionRepeated use of ambulance services was common and associated with chronic health problems such as chronic respiratory diseases, epilepsy, mental disorders with alcohol abuse and comorbidity. Alternative methods of caring for many of these patients should be considered.Trial registrationNone.

Perception of the Health Surveillance Users on the Health Electronic Surveillance Network (HESN) of Saudi Ministry of Health

Background: Ministry of health in Saudi Arabia implemented a pioneer electronic health surveillance network in 2012. This advanced system is hoped to play an important role in the prevention and control for possible serious health events and facilitate other public health programs. Objective: To evaluate the perception of active HESN users on its performance as a surveillance system, identify its weaknesses and suggest practical recommendations for improvement. Methods: A complete list of 11324 HESN users was identified. Active user was defined as a user with minimum use of one single time for either immunization or investigation purposes and has a valid email contact. Out of 1535 active users, 700 participants were selected randomly, and a cross sectional study conducted. A pre-designed electronic questionnaire was sent via emails to all the participants. The response rate was (87%), of which the completed forms were 493 (81%). Results: Mean age was 36.89±9.11 (24-66 years), 57.8% were males, and 44.6% participants were Saudis. Riyadh and eastern province represented the highest two regions of participation; 93 (18.9%) and 70 (14.2%) respectively. about half of participants were nurses 251 (50.9%), whereas doctors composed nearly a quarter 123 (24.9%). There were (66.5%) who had experienced surveillance system and (23.9%) worked with electronic medical records. Majority (85.2%) underwent trainings and (92.2%) worked with outbreak investigation function of HESN. About (70.8%) were generally satisfied with HESN, and (41%) believed that HESN requires improvements. Those who use HESN several times a week are more satisfied (81.3%) than one-time users weekly (75.6%) (P=0.001). Internet speed has also a significant association with the general satisfaction level about HESN, (P<0.001). Users of Google chrome browser are happier (82.3%) than Firefox (78.7%) and Internet explorer users (72%). (P<0.001). There are (60.9%) of Arabs and (57.7%) Saudis who agree that HESN needs improvements, compared to only (42.9%) of non-Arabs (P<0.001). Conclusions: There is a general reasonable satisfaction level amongst HESN users. However, to ensure achieving the real awaited public health goals of HESN and increase the satisfaction level, there have to be certain and important improvements.

Patterns of intra-articular injection use after initiation of treatment in patients with knee osteoarthritis: data from the osteoarthritis initiative.

We sought to describe and evaluate longitudinal use of intra-articular injections after treatment initiation among adults with radiographically confirmed knee osteoarthritis (OA). Using data from the Osteoarthritis Initiative (OAI), we included participants with radiographically confirmed OA (Kellgren-Lawrence grade (K-L)≥2) in ≥1 knee at baseline. With 9 years of data, 412 participants newly initiating hyaluronic acid or corticosteroid injections with their index visit were identified. For each type of injection initiated, socio-demographic and clinical characteristics were described by patterns of treatments (one-time use, switched, or continued injections). Multinomial logistic models estimated the extent to which patient-reported symptoms (post-initial injection and changes over time) were associated with patterns of injection use. Of those initiating injections, ∼19% switched, ∼21% continued injection type, and ∼60% did not report any additional injections. For participants initiating corticosteroid injections, greater symptoms post-initial injection were associated with lower odds of continued use compared to one-time users (adjusted odds ratio (aOR) for Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain: 0.91; 95%, confidence interval (CI): 0.83 to 0.99; aORstiffness: 0.77; CI: 0.63 to 0.94; aORphysical function: 0.97; CI: 0.94 to 1.00). Symptom changes over time (e.g., worsened or improved) were not associated with patterns of injections use. After treatment initiation, the proportion of patients switching injection use and one-time users was substantial. Symptoms post-initial injection appear to be associated with patterns of injection use. The extent to which these patterns are an indication of lack of impact on patient-reported symptoms should be explored.

Patterns of intra-articular injection use after initiation of treatment in patients with knee osteoarthritis: data from the osteoarthritis initiative

Purpose: Despite that the efficacy is lacking and recommendations from guidelines are conflicting, intra-articular injections such as hyaluronic acid and corticosteroid injections are increasingly used in patients with osteoarthritis (OA). Studies on patterns of injection use and factors associated with these patterns are scarce. The aim of this study was to describe and evaluate longitudinal use of intra-articular injections after treatment initiation among adults with radiographically confirmed knee OA. Methods: Using publicly available data from the Osteoarthritis Initiative, we used 9 years of data and included participants with at least one knee with radiographically confirmed OA (Kellgren-Lawrence grade (K-L) ≥2) at baseline. We identified 412 participants had newly initiated hyaluronic acid or corticosteroid injections. Among those, 96 initiated hyaluronic acid and 316 initiated corticosteroid injections. After treatment initiation, 79 participants switched the injection type, 90 participants continued the treatment use, and 243 participants did not receive any injections use during the follow-up. Switching and continued users were then matched to 243 one-time users by the frequency of distribution of follow-up times between the first initiation and switching/continued. According to types of injections initiated, sociodemographic and clinical characteristics were calculated by patterns of treatments use at the index visit. Average yearly changes in symptoms and clinical assessments between treatment initiation and switching/continued treatment use were also examined. Multinomial logistic regression models were used to identify factors associated with patterns of injection use including sociodemographics and clinical/functional factors. We estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for each group compared with a common reference group (one-time users) after adjusting for sociodemographics and clinical/functional factors. Results: Approximately 4 in 5 of those initiating injections users switched injection type or did not receive any injections after their index injection use. Among hyaluronic acid initiators, 24.0% switched to corticosteroid injections. Among corticosteroid initiators, 17.8% switched to hyaluronate injections. One-time users were common in both types of index injections (60.4%: hyaluronate; 58.5%: corticosteroid). Information to identify factors associated with patterns of injection use among participants initiating hyaluronic acid use were limited due to the small sample size. Among participants initiating corticosteroid injection use, switching and continued injection use was less likely to be associated with increasing age (aOR switching: 0.97 (95% CI: 0.93-0.1.02); aOR continued: 0.96 (95% CI: 0.92-0.99)). Greater comorbidity status (grade 1 versus 0) was associated with increased odds of switching injections use (aOR: 3.35; 95% CI: 1.30 to 8.60), continued users (aOR: 2.16; 95% CI: 0.94 to 4.97). Symptoms such as WOMAC pain and physical function at index visit was correlated with both switching and continued injections use: pain (aOR switching: 0.95 (95% CI: 0.86 to 1.06); aOR continued: 0.89 (95% CI: 0.81 to 0.97)); physical function (aOR switching: 0.96 (95% CI: 0.93 to 1.00); aOR continued: 0.96 (95% CI: 0.93 to 1.01)). SF-12 PCS was associated with decreased odds of both switching injections use (aOR: 0.97; 95% CI: 0.92 to 1.02) and continued users (aOR: 0.99; 95% CI: 0.94 to 1.05) compared to one-time users. Conclusions: Among individuals with radiographically confirmed OA initiating corticosteroid injection use, report of switching or continued treatment use is associated with indicators of greater comorbidity status and functional status. However, the proportion of switching injection use and one-time users after treatment initiation was substantial in both types of commonly used treatment agents. This may indicate that longer-term efficacy regarding symptom relief and/or slowing disease progression of these agents remains in question among patients with OA in the real-world setting.

Early testing of new sanitation technology for urban slums: The case of the Blue Diversion Toilet

The toilets used most in informal urban settlements have detrimental consequences for the environment and human health due to the lack of proper collection and treatment of toilet waste. Concepts for safe, sustainable and affordable sanitation systems exist, but their feasibility and acceptance have to be investigated at an early stage of development, which is difficult due to the high costs of building working models. In this paper, we present an approach to estimate acceptance in a valid and representative form with only one working model, and apply it to test an innovative zero-emission toilet with recycling of wash water. Four basic principles were specified for investigation and nine hypotheses formulated to test the feasibility and acceptance of these principles: source separation of urine and feces with subsequent collection for resource recovery; provision of wash water in a separate cycle with on-site recovery through a membrane bioreactor; a convenient and attractive overall design; and a financially sustainable business plan. In Kampala (Uganda), in 2013, data was collected from 22 regular users, 308 one-time users and a representative sample of 1538 participants. Qualitative data was collected from the users, who evaluated their likes, perceived benefits, social norms and expected ease of use based on verbal and visual information. Most of the hypotheses were confirmed, indicating the feasibility and acceptance of the basic principles. Source separation and on-site water recovery were found to be feasible and accepted, provided users can be convinced that the emptying service and water recovery process work reliably. In the survey, the toilet was evaluated favorably and 51% of the participants agreed to be placed on a bogus waiting list. However, some design challenges were revealed, such as the size of the toilet, hiding feces from view and improving the separation of urine and water.

Pediatric Use of Emergency Medical Services: The Role of Chronic Illnesses and Behavioral Health Problems

Objective: The increasing use of prehospital emergency medical services (EMS) and its contribution to rising emergency department use and healthcare costs point to the need for better understanding factors associated with EMS use to inform preventive interventions. Understanding patient factors associated with pediatric use of EMS will inform pediatric-specific intervention. We examined pediatric patient demographic and health factors associated with one-time and repeat use of EMS. Methods: We reviewed data from Baltimore City Fire Department EMS patient records over a 23-month period (2008–10) for patients under 21 years of age (n = 24,760). Repeat use was defined as involvement in more than one EMS incident during the observation period. Analyses compared demographics of EMS users to the city population and demographics and health problems of repeat and one-time EMS users. Health comparisons were conducted at the patient and incident levels of analysis. Results: Repeat users (n = 1,931) accounted for 9.0% of pediatric users and 20.8% of pediatric incidents, and were over-represented among the 18–20 year age group and among females. While trauma accounted for approximately one-quarter of incidents, repeat versus one-time users had a lower proportion of trauma-related incidents (7.2% vs. 26.7%) and higher proportion of medical-related incidents (92.6% vs. 71.4%), including higher proportions of incidents related to asthma, seizures, and obstetric/gynecologic issues. In patient-level analysis, based on provider or patient reports, greater proportions of repeat compared to one-time users had asthma, behavioral health problems (mental, conduct and substance use problems), seizures, and diabetes. Conclusions: Chronic somatic conditions and behavioral health problems appear to contribute to a large proportion of the repeat pediatric use of this EMS system. Interventions may be needed to engage repeat users in primary care and behavioral health services, to train EMS providers on the recognition and management of behavioral health emergencies, and to improve family care and self-management of pediatric asthma and other chronic conditions.

Supply- and Demand-Side Factors Influencing Utilization of Infant and Young Child Feeding Counselling Services in Viet Nam.

Adequate utilization of services is critical to maximize the impact of counselling on infant and young child feeding (IYCF), but little is known about factors affecting utilization. Our study examined supply- and demand-side factors associated with the utilization of IYCF counselling services in Viet Nam. We used survey data from mothers with children <2y (n = 1,008) and health staff (n = 60) from the evaluation of a program that embedded IYCF counseling into the existing government health system. The frequency of never users, one-time users, repeat users, and achievers of the recommended minimum number of visits at health facilities were 45.1%, 13.0%, 28.4% and 13.5%, respectively. Poisson regression showed that demand-generation strategies, especially invitation cards, were the key factors determining one-time use (Prevalence ratio, PR 3.0, 95% CI: 2.2–4.2), repeated use (PR 3.2, 95% CI: 2.4–4.2), and achievement of minimum visits (PR 5.5, 95% CI: 3.6–8.4). Higher maternal education was associated with higher utilization both for one-time and repeated use. Being a farmer, belonging to an ethnic minority, and having a wasted child were associated with greater likelihood of achieving the minimum recommended number of visits, whereas child stunting or illness were not. Distance to health center was a barrier to repeated visits. Among supply-side factors, good counselling skills (PR: 1.3–1.8) was the most important factor associated with any service use, whereas longer employment duration and greater work pressure of health center staff were associated with lower utilization. Population attributable risk estimations showed that an additional 25% of the population would have achieved the minimum number of visits if exposed to three demand-generation strategies, and further increased to 49% if the health staff had good counseling skills and low work pressure. Our study provides evidence that demand-generation strategies are essential to increase utilization of facility-based IYCF counselling services in Viet Nam, and may be relevant for increasing and sustaining use of nutrition services in similar contexts.

Identifying and Characterizing One-Time and Never Users of Mammography Screening Services among Medicare Eligible Women

Background. Despite eligibility for a screening mammogram once every 2 years from 1991 to 1997, only a small percentage of Medicare women utilized this benefit. We examined mammography use among 388,707 North Carolina Medicare women from 1994 to 1997 to identify characteristics of one-time and never users of mammography.Methods. Data were obtained from North Carolina Medicare mammography claims and enrollment files from 1994 to 1997. Women ages 65+ as of 01/01/1994, continuously enrolled in Medicare from 1994 to 1997, and alive as of 12/31/1997 were included in the sample (n = 388,707). Mammogram use was categorized as never, once, or at least twice during 1994/1995 and 1996/1997. Women with at least one mammography claim during 1994/1995 and at least one mammography claim during 1996/1997 were called repeat users, women with one mammography claim during the 4 years were labeled one-time users, and women with zero mammography claims during the 4 years were termed never users. Multivariate logistic regression analyses were conducted to determine associations between characteristics and mammography frequency.Results. Biennial mammography claims data rates were 35.3% in 1994/1995 and 41.8% in 1996/1997. Compared with all other users, one-time users (n = 108,899) were more likely to be ages 65–74 (vs 75–84 and 85+), live in an urban versus rural county, and be eligible for Medicare only versus Medicare and Medicaid. Never users (n = 184,545) were more likely to be ages 85+, be non-Caucasian, live in a rural county, and be eligible for both Medicare and Medicaid versus Medicare.Conclusions. These results demonstrate different demographic characteristics for one-time and never mammography users. This approach of using multiple years of claims data to segment the targeted population provides the opportunity to tailor interventions to subgroups.

Factors related to emergency department use: Results from the Ontario health survey 1990

To assess factors related to emergency department use in the Ontario population. Population-based, cross-sectional study weighted to represent the entire noninstitutionalized population of the province. The 1990 Ontario Health Survey population sample of 60,972 individuals. Responses were given to survey questions on whether the ED had been visited in the past 12 months and, if so, how many times. Overall, 21.1% of all Ontario residents had had at least one visit to the ED in the preceding 12 months. Of these residents, 30.1% reported having two or more visits. Factors associated with increased ED use were described and tested with univariate and multivariate analysis, comparing the usage rates of ED users with those of nonusers and those of repeat users with those of one-time users. In all of the analyses, health needs (significant accidents, number of health problems, and self-reported health status) were the strongest determinants of ED use. However, even after adjusting for these health needs in the multivariate models, there still were significant variations in ED utilization among groups. Our study estimated that approximately one in five Ontario residents had reported one or more visits to the ED in the past 12 months. There were identifiable subgroups in the population with increased ED usage even after adjustment for health needs factors.

Skip and Scan Telephone Menus: User Performance as a Function of Experience

We present the results of a laboratory study comparing three styles of audio menus. One of these styles is the technique predominantly employed in interactive voice response (IVR) systems today. Two alternatives to this Standard technique were evaluated in this study. One of these alternatives was first proposed in Resnick and Virzi (1992), which they called Skip and Scan menus. This new style was hypothesized to be superior to Standard menus for intermediate users, but was expected to show limitations for one-time callers and expert users. The third menu alternative we evaluated combines elements of the Standard and Skip and Scan menus and was hypothesized to be superior in a broad range of usage conditions. Performance was measured over 36 tasks and two IVR applications. In all but the first few trials, the Skip and Scan menu style reported in Resnick and Virzi led to performance equal to or better than the other two menu styles. Standard menus showed a performance benefit for the first few trials of the first application only: this benefit was not present in the second application. There were no differences among the techniques in the trials simulating expert behavior.

Characteristics of Native American Users of Inhalants

The authors investigated a population of identified users of inhalants at a Native American boarding school and compared and contrasted the users to a control group of nonusers. The subjects included 62 adolescents of Native American descent (mean age of 16.6), classified into one nonuser control group (N = 20) and two user groups: onetime users (N = 21) and repeat users (N = 21). Measures of traditional Native American characteristics, desirable physical and psychological assets, academic achievement, grade point average, adherence to school policy, and self-concept were collected on each subject. A one-way analysis of variance was computed to determine the relationship that existed between the research variables and the membership of each subject in his or her respective groups. Findings are discussed, and similarities of the Native American inhalant users to inhalant users in the general adolescent population are noted.