Past Users Research Articles

The Right to be an Exception to Predictions: a Moral Defense of Diversity in Recommendation Systems

Recommendation systems (RSs) predict what the user likes and recommend it to them. While at the onset of RSs, the latter was designed to maximize the recommendation accuracy (i.e., accuracy was their only goal), nowadays many RSs models include diversity in recommendations (which thus is a further goal of RSs). In the computer science community, the introduction of diversity in RSs is justified mainly through economic reasons: diversity increases user satisfaction and, in niche markets, profits.I contend that, first, the economic justification of diversity in RSs risks reducing it to an empirical matter of preference; second, diversity is ethically relevant as it supports two autonomy rights of the user: the right to an open present and the right to be treated as an individual. So far, diversity in RSs has been morally defended only in the case of RSs of news and scholarly content: diversity is held to have a depolarizing effect in a democratic society and the scientific community and make the users more autonomous in their news choices. I provide a justification of diversity in RSs that embraces all kinds of RSs (i.e., a holistic moral defense) and is based on a normative principle founded on the agency of the user, which I call the right to be an exception to predictions. Such a right holds that the proper treatment of a RS user qua agent forbids providing them with recommendations based only on their past or similar users’ choices.

Ocular Symptoms in Adolescents and Young Adults With Electronic Cigarette, Cigarette, and Dual Use

Despite increasing use of cigarettes and electronic cigarettes (e-cigarettes) and related health effects among youth, few studies have reported their effects on eyes. To examine the frequency and severity of ocular symptoms (ocular discomfort, pain, burning, itching, redness, dryness, glare, blurriness, strain, and headaches) in young e-cigarette and cigarette users. In an observational cross-sectional study, a survey conducted in May 6 to 14, 2020, asked participants about use (ever, past 30 days, and past 7 days) of e-cigarettes and cigarettes. The participants included US individuals aged 13 to 24 years. Associations between vision-related outcomes (general vision, severity/frequency of ocular symptoms) and tobacco use were analyzed using weighted multivariable logistic regressions, adjusting for sociodemographic factors, contact lens use, and other combustible use. There were 2168 never users, 2183 ever users, 1092 past 30-day users, and 919 past 7-day users of e-cigarettes; 55.9% of e-cigarette ever users also used cigarettes (dual users). Of the 4351 respondents, 63.8% identified as female, and mean (SD) age was 19.1 (2.9) years. Between 1.1% and 3.9% of ever dual users reported severe to very severe ocular symptoms; between 0.9% and 4.3% reported daily symptoms, which was higher than the proportion of symptoms in e-cigarette- or cigarette-only users. Past 7-day dual users had more severe itching (adjusted odds ratio [AOR], 2.37; 95% CI, 1.36-4.13; P = .002), redness (AOR, 2.58; 95% CI, 1.50-4.46; P = .001), dryness (AOR, 2.89; 95% CI, 1.64-5.08; P < .001), glare (AOR, 2.56; 95% CI, 1.50-4.35; P = .001), blurriness (AOR, 2.47; 95% CI, 1.36-4.50; P = .003), headaches (AOR, 2.31; 95% CI, 1.34-4.00; P = .003); and more frequent pain (AOR, 3.45; 95% CI, 2.09-5.68; P < .001), burning (AOR, 3.08; 95% CI, 1.86-5.09; P < .001), and redness (AOR, 2.72; 95% CI, 1.69-4.36; P < .001) than all other participants. Past 30-day dual users had more severe dryness (AOR, 2.65; 95% CI, 1.61-4.36; P < .001) and more frequent pain (AOR, 3.33; 95% CI, 2.12-5.21; P < .001) than all other participants. Ever dual users experienced more severe dryness (AOR, 1.60; 95% CI, 1.05-2.43; P = .03) and blurriness (AOR, 1.79; 95% CI, 1.21-2.64; P = .003) and more frequent pain (AOR, 1.69; 95% CI, 1.13-2.53; P = .01) and blurriness (AOR, 1.63; 95% CI, 1.13-2.36; P = .009) than never users. In this cross-sectional US study, adolescents and young adult users of both e-cigarettes and cigarettes had a higher likelihood of experiencing severe and frequent ocular symptoms, with past 7-day users reporting more symptoms than past 30-day users or ever users. These findings provide additional reasons for users of e-cigarettes and cigarettes to reduce their tobacco use to possibly prevent or minimize ocular symptoms.

Prospective study of e-cigarette use and respiratory symptoms in adolescents and young adults

RationaleElectronic cigarette (e-cigarette) aerosol contains volatile aldehydes, including flavourings and oxidant metals with known pulmonary toxicity.ObjectivesTo evaluate the associations of e-cigarette use with symptoms of wheeze, bronchitic symptoms and shortness...

Knowledge and Attitude of the General Population in Saudi Arabia Toward Weight Management Medications (WMMs): A Cross-Sectional Study.

Over the past decades, the global prevalence of obesity has tripled, with the Kingdom of Saudi Arabia experiencing a notably higher rate of increase. While lifestyle modifications remain the first line of treatment, pharmacological interventions are often employed when dietary and exercise interventions prove insufficient. However, safety concerns, misuse, and limited knowledge about weight management medications (WMMs) pose serious challenges. The objectives of this study were to determine the level of knowledge and examine attitudes towards WMMs among the general population, and to explore the factors associated with these knowledge levels and attitude patterns. A cross-sectional study was conducted among adults from the general population in Saudi Arabia from January 2023 to May 2023. Participants completed a validated, self-administered electronic questionnaire in Arabic language. The questionnaire captured sociodemographic, lifestyle and health data, knowledge about WMMs, and attitudes toward them. The outcome measures included knowledge and attitudes scores. Factors associated with knowledge and attitudes were analyzed using chi-square tests. Statistical significance was determined at a p-value of <0.05. Around 716 respondents were included in the final analysis. Most of the participants acknowledged diet 565 (78.9%) and exercise 621 (86.7%) as effective strategies to lose weight. Only 222 (31.0%) participants recognized pharmaceutical medications as a weight management strategy. Knowledge about specific weight loss medications varied, with the highest recognition for semaglutide (Ozempic®, Novo Nordisk, Bagsværd, Denmark) 236 (33.0%) and liraglutide (Saxenda®, Novo Nordisk, Bagsværd, Denmark) 228 (31.8%), while the other WMMs were not commonly known between participants. Regarding attitudes, the majority disagreed with statements that WMMs are more effective than diet/exercise 413 (57.7%), are safe 405 (56.6%), and are more convenient to use 408 (57.0%). Notably, about three-quarters [534 (74.6%)] of participants agreed that these medications require specialist's counseling. No correlation was observed between knowledge score and attitude score (Pearson's correlation coefficient r=0.03; p=0.330). Respondents' knowledge about WMMs was significantly influenced by age, monthly income, educational level, psychiatric history, and previous use of WMMs (p<0.05). Adequate knowledge was more prevalent among participants aged 26-35, earning more than 20K SAR monthly, postgraduates, those with a psychiatric history, and past users of WMMs. Attitudes toward WMMs, however, showed no significant association with sociodemographic or health-related factors (p>0.05). However, prior use of WMMs significantly correlated with attitudes (p=0.007), with past users demonstrating more favorable attitudes. This study reveals a limited knowledge and cautious attitude regarding WMMs in the Saudi population, despite the high prevalence of obesity. With prior use of WMMs correlating with better knowledge and more favorable attitudes, these findings emphasize the need for targeted interventions to enhance public awareness and safe usage of these medications.

MPOWER Measures and Its Effect on Tobacco Control: A Cross-sectional Comparison of Global Adult Tobacco Surveys, India.

To study the MPOWER measures over time (GATS-1 vs GATS-2) and their effects on tobacco control indicators in India. The study used a cross-sectional design to compare the common questions identified from GATS-1 and GATS-2. Odds ratios for various MPOWER measures were estimated using a multivariate logistic regression model. Compared with GATS-1, the current any tobacco use was reduced by 32% in females and 17% in males in GATS-2 (M-measures). The P-measures have reduced across the survey periods. Under O-measures, compared with mixed users, only the male smokeless tobacco (SLT) users reported receiving more advice from a doctor to quit and reported trying more to stop SLT use. Compared with never users (W-measures), the health warnings were noticed on SLT products more by past users, smokers (males), and SLT users, while it was noticed on cigarette packages more by male past users and smokers. Promotion (E-measures) of cigarette and bidi was reported more by smokers (including mixed users), and promotion of SLT product was reported more by smokers (including mixed users) and male SLT users than by never users. Overall, MPOWER measures have shown improvement, with most changes highly reported by the never users and past users than by the current tobacco users. Stringent methods for the enforcement of MPOWER measures to reach all forms of tobacco users and integration of the National Tobacco Control Programme with other national health programs are imperative for highest achievements. Also, specific targeted strategies for the effective control of SLT use are highly recommended to be included in the MPOWER package.

Impact of long-acting buprenorphine injection on methamphetamine use: A retrospective cohort study.

The aim is to assess the impact of long-acting buprenorphine (LAI-BNP) on frequency of methamphetamine (MA) use. We undertook an observational, descriptive, retrospective cohort study of patients of a public, tertiary, community-based Alcohol and Other Drug Service (AODS) with opioid use disorder (OUD) treated with LAI-BNP who are current or past users of MA. We assessed the changes of frequency of use in their MA use at start (baseline), 3 and 6months of LAI-BNP. Study included 59 participants. Based on their MA use at the commencement of LAI-BNP, the sample was further sub-grouped as active users (n = 30) and past users (n = 29). At 6months of LAI-BNP, all the past users remained abstinent from MA use. 70% (n = 21) of participants with active MA use had reduced or ceased their MA use while 17% (n = 5) increased their MA use at 6months. The results favour the use of LAI-BNP as a potential treatment for MA use.

“Empowering Us”: A community-led survey of real-world perspectives of adults with type 1 diabetes using insulin pumps and continuous glucose monitoring to manage their glucose levels

ObjectiveTo conduct an Australian community-led survey of adults with type 1 diabetes (T1D), identifying priorities for, and barriers to, optimal use of advanced glucose management technologies. Research design and methodsA 30-question online survey of current or past users of insulin pump therapy (IPT), real-time continuous glucose monitoring (RT-CGM), or intermittently scanned CGM (isCGM) explored perceptions regarding device design, access, education, outcomes, and support. ResultsBetween November 2021 and January 2022, surveys were completed by 3,380 participants (age [mean ± SD] 45 ± 16 years; 62% female; 20 ± 14 years diabetes), with 55%, 82%, and 55% reporting experience with IPT, RT-CGM, and isCGM, respectively. Overall, most considered diabetes technology ‘(extremely) important’ for maintaining target glucose levels (98%) and reducing hypoglycaemia severity and frequency (93%). For most, technology contributed positively to emotional well-being (IPT 89%; RT-CGM 91%; isCGM 87%), which was associated with device effectiveness in maintaining glucose in range, comfort, and convenience. Barriers included affordability (IPT 68%; RT-CGM 81%; isCGM 69%) and insufficient information for informed choices about device suitability (IPT 39%; RT-CGM 41%; isCGM 36%). ConclusionsTechnology is perceived by adults with T1D as important for managing glycaemia and emotional well-being. Modifiable barriers to use include affordability, and information regarding device suitability.

ATI 302

Abstract ATI 302 (UNS S30200) is a variation of the 18Cr-8Ni austenitic alloy, the most familiar and most frequently used stainless steel. This alloy may be considered for a wide variety of applications where one or more of the following properties are important: resistance to corrosion, prevention of product contamination, ease of fabrication, attractive surface, ease of cleaning, or good strength and oughness at cryogenic temperatures. Past users of ATI 302 are generally now using ATI 304 because argon oxygen decarburizationtechnology has made lower carbon levels more easily attainable and economical. ATI 302 may be preferred over ATI 304 for temper rolled products or in other instances where its higher carbon content enables it to meet certain yield strength and tensile strength requirements while maintaining a higher level of ductility (elongation) versus that of the lower carbon ATI 304. This datasheet provides information on composition, physical properties, elasticity, and tensile properties as well as fatigue. It also includes information on high temperature performance and corrosion resistance as well as heat treating and joining. Filing Code: SS-1360. Producer or source: ATI.

O-081 A 10-year follow-up of reproductive outcomes in women returning after elective oocyte cryopreservation

Abstract Study question What are the reproductive treatment outcomes in women who underwent elective oocyte cryopreservation (EOC) returning to our clinic with a desire for a child? Summary answer Whether to warm oocytes or to first use fresh oocytes for ART depends on age upon returning, but both strategies resulted in favourable reproductive outcomes. What is known already Most affluent countries have observed a trend towards postponement of childbearing, and EOC is increasingly used in an attempt to extend the reproductive lifespan and mitigate age-related fertility decline. Although most follow-up studies after EOC have focused on women who requested oocyte warming, a substantial proportion of women who do not conceive naturally eventually embark for a fertility treatment without using their cryopreserved oocytes. Reports on reproductive outcomes in past EOC users are scarce, and the lack of reproductive treatment algorithms in this group of women hampers efficiency of clinical practice. Study design, size, duration This retrospective observational single-center study includes 843 women who had elective oocyte vitrification for non-medical reasons between 2009 and 2019, and describes the outcomes of the diverse reproductive treatment strategies that were performed in these women when they returned to the same clinic because of a desire for pregnancy until May 2022. Participants/materials, setting, methods Patient characteristics and data of ovarian stimulation of EOC cycles were analyzed, as well as data related to ovarian stimulation and laboratory data of ART in women who pursued fertility treatment with and/or without using their cryopreserved oocytes. The primary outcome was the live birth rate (LBR) per patient after oocyte warming and after ART using fresh oocytes. Secondary outcomes were laboratory outcomes and LBR per embryo transfer. Main results and the role of chance A total of 1353 EOC cycles (1.6 ± 0.9 per patient) were performed. Mean age was 36.5 ± 2.8 years. At the time of EOC 174 (20,6%) women had a partner. On average, 13.7 ± 9.2 mature oocytes were cryopreserved. After 39.9 ± 23.4 months, 231 (27.4%) women returned to the clinic. Upon returning, mean age was 40.4 ± 3.1 years, mean AMH 2.3 ± 2.0 ng/mL, and 150/231 (64,9%) patients had a partner. As a primary approach, 110/231 (47.6 %) past EOC women embarked on oocyte warming, 50/231 (21.6%) had intrauterine insemination, and 71/231 (30.7%) had ART using fresh oocytes. Cumulative LBR (CLBR) was 45.9 % (106/231) and miscarriage rate (MR) was 30.7% (51/166) in the entire cohort. A subset of 90/231 (39.0%) patients exclusively had oocyte warming, at 41.6 ± 3.0 years, with 10.0 ± 5.2 oocytes warmed per patient. 52/231 (22.5%) patients exclusively had ART using fresh oocytes, at a mean age of 39.0 ± 2.8 years, with 9.9 ± 7.4 mature oocytes retrieved per patient. CLBR was 37/90 (41.1%) in the oocyte warming-only group and 25/52 (48.1%) in the OS-only group. MR/transfer was 25.0% and 29.3% in the oocyte warming-only group and the OS-only group, respectively. Limitations, reasons for caution Both the small sample size and the retrospective design are limitations of this study. The decision to embark on a specific reproductive treatment strategy was based on patient preference, after counseling of treatment options. This precludes direct comparison of the efficacy of reproductive treatment options in past EOC users. Wider implications of the findings Reporting of clinical outcomes of women who underwent EOC and returned to the clinic to embark on divergent reproductive treatment strategies is mandatory to establish guidelines for best clinical practice in this growing patient population. Trial registration number Not applicable

Validating Wave 1 (2014) Urinary Cotinine and TNE-2 Cut-points for Differentiating Wave 4 (2017) Cigarette Use from Non-use in the United States Using Data from the PATH Study.

Sex and racial/ethnic identity-specific cut-points for validating tobacco use using Wave 1 (W1) of the Population Assessment of Tobacco and Health (PATH) Study were published in 2020. The current study establishes predictive validity of the W1 (2014) urinary cotinine and total nicotine equivalents-2 (TNE-2) cut-points on estimating Wave 4 (W4; 2017) tobacco use. For exclusive and polytobacco cigarette use, weighted prevalence estimates based on W4 self-report alone and with exceeding the W1 cut-point were calculated to identify the percentage missed without biochemical verification. Sensitivity and specificity of W1 cut-points on W4 self-reported tobacco use status were examined. ROC curves were used to determine the optimal W4 cut-points to distinguish past 30-day users from non-users, and evaluate whether the cut-points significantly differed from W1. Agreement between W4 self-reported use and exceeding the W1 cut-points was high overall and when stratified by demographic subgroups (0.7%-4.4% of use was missed if relying on self-report alone). The predictive validity of using the W1 cut-points to classify exclusive cigarette and polytobacco cigarette use at W4 was high (>90% sensitivity and specificity, except among polytobacco Hispanic smokers). Cut-points derived using W4 data did not significantly differ from the W1-derived cut-points [e.g., W1 exclusive = 40.5 ng/mL cotinine (95% confidence interval, CI: 26.1-62.8), W4 exclusive = 29.9 ng/mL cotinine (95% CI: 13.5-66.4)], among most demographic subgroups. The W1 cut-points remain valid for biochemical verification of self-reported tobacco use in W4. Findings from can be used in clinical and epidemiologic studies to reduce misclassification of cigarette smoking status.

Starting the pill during adolescence: The influence of age of onset and duration of use on fear-related grey matter brain volumes

Oral contraceptives (OC) have been shown to modulate the brain regions involved in fear conditioning and extinction. OC use is often initiated during adolescence, a sensitive period for brain development. During this period, certain brain regions involved in fear circuitry are still undergoing important reorganization, such as the amygdala-prefrontal cortex (PFC) pathway. It remains unknown whether OC use during adolescence may induce long-lasting changes in the fear circuitry. To explore this question, we collected MRI data in 98 healthy women aged 23 to 35 (61 current users, 37 past users) and extracted region of interest-based grey matter volumes (GMV) for the amygdala, hippocampus, insula, dorsal anterior cingulate cortex (dACC), and ventromedial PFC. Controlling for total intracranial volume, age, and education, linear regressions revealed an interaction effect between the age of OC onset and duration of use for the left amygdala (p=.010), where a positive association with duration of use was obtained only when OC intake was initiated at an early age (β=0.323, p=.023). Although an interaction effect was found for the dACC (p=.043), we observed a non-significant negative association between duration of use and GMV at an early age of onset. Moreover, age of onset alone predicted right posterior hippocampus volume (β=0.378, p=.010). Our results suggest that OC use during adolescence may induce lasting effects on structural correlates of fear learning and its regulation. These findings support the further investigation into the timing of OC use to better comprehend whether OC disrupt normal brain development processes.

Patient and clinician perspectives about cannabis use while receiving cancer treatment at a comprehensive cancer center (CCC).

e24169 Background: Cannabis is gaining popularity worldwide including in the United States with 37 states legalizing access to cannabis. Limited data exist regarding why patients are using cannabis while receiving anticancer treatments. Methods: Patients with cancer who received treatment at a National Cancer Institute (NCI) designated CCC were approached from August of 2021 to August of 2022 to participate in a cross-sectional survey as part of a national NCI-funded effort. Consenting patients completed a survey during a medical visit asking about cannabis use (past and present), reason for use (including if cancer-related), type of cannabis, and frequency of use. A follow-up phone call occurred within 30 days to confirm medications used, and to collect further details about cannabis use, if reported. A healthcare provider survey was also conducted to explore perspectives regarding patients’ use of cannabis during active treatment. Results: A total of 315 cancer patients completed the survey (43% response rate) with a median age of 60.7 (±12.8), 58% female, and a variety of cancer types (hematologic 21.3%, breast 17%, gastrointestinal 11.7%, lung 10.2%). The respondents were of a diverse racial/ethnic backgrounds (White 61.6%, Black 22.5%, Other 7.3%), education (high school 27%, college 42.5%, post-graduate 14.9%), and employment status (retired 35.2%, employed 25.7%, unemployed or disabled 21.9%). Among respondents, nearly half (48.4%) had used cannabis before, one-third (32.1%) had used cannabis since their cancer diagnosis, and almost one in five (18.5%) were currently using cannabis. Among current or past users of cannabis the forms used were smoked (31%), gummy (29%), liquid (19%), edible (7%), and pill (6%). The most common reported reasons for use by respondents were insomnia (79%), pain (72%), mood (68%), poor appetite (68%), and gastrointestinal symptoms (51%). For the clinician survey, a total of 165 completed surveys (25% response rate) were received. Approximately half of respondents were nurses (54% nurses, 22% advance practice providers, and 21% physicians) and of White race (73%) with a mean age of 46 years. Approximately one-fourth (24%) reported discussing the topic of cannabis and about half of these conversations (45%) were initiated by the respondent. The healthcare providers estimated 10% of patients with cancer overall were using cannabis and that one in four patients (23%) were using cannabis during cancer treatment. Four in ten (39%) clinicians felt comfortable in providing guidance to patients about cannabis use, and only one in eight (13%) felt knowledgeable about the topic of cannabis. Conclusions: Approximately one-fifth of patients with cancer receiving treatment are actively using cannabis, despite limited data regarding the efficacy of cannabis. Management of cancer symptoms were among key reasons that cancer patients used cannabis.

(358) Responder Analysis from a Multicentered Survey of Men’s Perception who underwent Low Intensity Extracorpeal Shock Wave Therapy (LIESWT), as a Novel and Experimental Intervention for the Treatment of Erectile Dysfunction (ED)

Abstract Introduction Low-intensity extracorporeal shock wave therapy (LI-ESWT) is an experimental, non-FDA approved yet novel treatment modality that has recently been developed for treating erectile dysfunction (ED). The basic science hypothesis concerning the mechanism of action is that LI-ESWT causes microtrauma at the cellular level which may stimulate the release of angiogenic factors, and cause neovascularization of the treated tissue. Completed research report improvement in erectile functioning, decreased reliance on phosphodiesterase inhibitor medication as well as the regained ability to attain and maintain natural or spontaneous erections. We report here a preliminary responder analysis of men who had LIESWT as part of their erectile dysfunction treatment paradigm. Objective We report here the preliminary responder analysis results of an internet based, random retrospective survey on past users of this novel technology for the treatment of ED. Methods A random survey was sent to a convenience sample from 10 national centers (Hawaii, Washington (2), Portland, Utah, Oklahoma (2), Arizona, California, Oregon) to men who had completed 6 sessions of LIESWT for the treatment of ED. The internet-based survey examined patient perception and experience of this intervention. We present the responders analysis ( n=47). All procedures were performed by sexual medicine health care professionals after a detailed and comprehensive history, physical examination, and laboratory/hormonal assessment. Results Surveys were completed anonymously over the course of a 2-week period by men who had undergone 6 sessions of LIESWT. 28% of participants were aged 50-59; whereas 63 percent were over the age of 60. Other adjunctive treatments included erectile dysfunction (ED) medication, testosterone replacement therapy (TRT), previous plasma rich protein injections and Intracavernosal injections. 83% of those who got the procedure noticed an improvement within the first 5 weeks. 89% of responders noticed an improvement in erection firmness whereas 81% noticed an improvement in quality of erections. 77% of responders noticed an improvement in their level of sexual satisfaction and 72% noticed an improvement in sexual pleasure. 60% noticed an improvement in the overall quality of the orgasm. Overall, the procedure was well tolerated with &amp;lt;0.5% (3/670 procedures) adverse events reported (1 pain in penis, 1 “knot in penis” and 1 pain in the head) reported. Overall, 65% of LIESWT users would recommend this procedure to a friend. Conclusions LIESWT is a novel and experimental intervention for the treatment of ED. While it shows excellent promise, most data contain some shortcomings, including: small numbers, limited follow-p, and various non-standardized protocols. Results from a double-blind, randomized, control trial confirm that LI-ESWT may result in significant clinical improvement of erectile function and a shift towards improvement in penile hemodynamics without any adverse effects. Our participant responder analysis demonstrates that LIESWT improves erectile function and other sexuality parameters. Further larger, randomized sham-controlled, and comparative clinical trials are warranted before LI-ESWT may be considered new standard of care for men with vasculogenic ED. Disclosure No

Marijuana use is inversely associated with liver steatosis detected by transient elastography in the general United States population in NHANES 2017-2018: A cross-sectional study.

The impact of marijuana on the general population is largely unknown. The present study aimed to assess the association between marijuana use and liver steatosis and fibrosis in the general United States population utilizing data from the National Health and Nutrition Examination Survey (NHANES). This cross-sectional study was performed with data from the 2017-2018 cycle of NHANES. The target population comprised adults in the NHANES database with reliable vibration controlled transient elastography (VCTE) results. The median values of the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were used to evaluate liver steatosis and fibrosis, respectively. After adjusting for relevant confounders, a logistic regression analysis was used to assess the association between marijuana use and liver steatosis and fibrosis. A total of 2622 participants were included in this study. The proportions of never marijuana users, past users, and current users were 45.9%, 35.0%, and 19.1%, respectively. Compared to never marijuana users, past and current users had a lower prevalence of liver steatosis (P = 0.184 and P = 0.048, respectively). In the alcohol intake-adjusted model, current marijuana use was an independent predictor of a low prevalence of liver steatosis in people with non-heavy alcohol intake. The association between marijuana use and liver fibrosis was not significant in univariate and multivariate regression. In this nationally representative sample, current marijuana use is inversely associated with steatosis. The pathophysiology is unclear and needs further study. No significant association was established between marijuana use and liver fibrosis, irrespective of past or current use.

Longitudinal transitions in e-cigarette and cigarette use among US adults: prospective cohort study

To support tobacco control efforts, this study sought to characterize longitudinal transitions in use of electronic nicotine delivery systems (ENDS) and cigarettes. Participants were nationally representative samples of 53,729 US adults from Waves 3-5 (2015-2019) of the Population Assessment of Tobacco and Health Study. We examined behavioral transitions (initiation, relapse, progression, and cessation) in ENDS and cigarette use across waves. Weighted generalized estimating equation models adjusted for sociodemographic variables. Of never ENDS users at baseline, an estimated 1.7% reported initiating ENDS use by follow-up. Of former ENDS users, an estimated 12.1% relapsed into ENDS use. Of periodic ENDS users at baseline, 13% progressed to established ENDS use. Of baseline current ENDS users, 46.3% discontinued ENDS use. The corresponding transitions for cigarette smoking were 1.6% (initiation), 4.8% (relapse), 21.1% (progression), and 14% (discontinuation). Adults aged 18-24 (vs. older age), Hispanics (vs. non-Hispanic white), and past 12-month cannabis users were more likely to initiate ENDS or cigarettes (all p<0.05). Having any internalizing mental health symptoms increased the odds of ENDS initiation, while externalizing symptoms increased the odds of cigarette initiation. Those who perceived nicotine as very harmful (vs. none/low harm) were more likely to discontinue ENDS. Current cigarette users (vs. non-users) at baseline were more likely to initiate, relapse, or discontinue ENDS (all p<0.05) and vice versa. We observed high changeability in ENDS and cigarette use among US adults over time. In absolute terms, ENDS use grew, while smoking fell. Tobacco control programs should focus on priority populations, including young adults and people with internalizing and externalizing mental health symptoms. National Institutes of Health, R01-CA246606-01A1, R01-DA048390.

Flavored Cannabis Use and Cannabis-Tobacco Co-use: Patterns In U.S. States With Legalized Nonmedical Adult Use

Little is known about inhaled flavored cannabis use. This study aimed to investigate the prevalence and patterns of flavored cannabis use and cannabis-tobacco co-use. This study surveyed adult past 30-day cannabis users in U.S. states and districts that have legalized cannabis for nonmedical/adult use (n=9) (November 2018; n=2,978). By product/behavior (any cannabis, cannabis extract vaporizers, mixed cannabis-nicotine vaporizers, blunts, chasing), the association between flavored (versus non-flavored) use and sociodemographic characteristics, cannabis use disorder symptoms, and tobacco use was estimated using weighted multivariable logistic regression in January 2022. Almost half of adult cannabis users reported using at least one flavored cannabis product (46.5%). Flavored cannabis use was more likely among respondents who were female (AOR=1.2, CI=1.0, 1.4), were Black (ref: White; AOR=2.2, CI=1.5, 3.1), were Hispanic/Latino/a/x (ref: White; AOR=1.6, CI=1.2, 1.9), had cannabis use disorder symptoms (AOR=2.0, CI=1.6, 2.4), or were currently using tobacco (AOR=2.4, CI=2.1, 2.9). Use was less likely among middle-aged/older adults (ref: ages 21-34 vs 35-49 years; AOR=0.6, CI=0.5, 0.7). Observed differences in flavored cannabis use are concerning if flavors raise appeal or dependence. Integrating flavored cannabis and tobacco research and practice is warranted.

Association of hormone preparations with bone mineral density, osteopenia, and osteoporosis in postmenopausal women: data from National Health and Nutrition Examination Survey 1999-2018.

This study aimed to evaluate the associations of hormone preparations with lumbar spine bone mineral density (BMD), osteopenia, and osteoporosis in postmenopausal women, and whether these impacts persisted after hormone preparations were discontinued. A total of 6,031 postmenopausal women were enrolled and divided into seven groups based on the types of hormone preparations. Among them, 1,996 participants were further divided into a current users (CU) group and a past users (PU) group. Multivariable linear regression models or logistic regression models were used to evaluate the associations of hormone preparation with lumbar spine BMD, osteopenia, and osteoporosis. Combined oral contraceptive pills, estrogen-only pills, estrogen/progestin combo pills, estrogen-only patches, or the use of more than two kinds of hormone preparations were positively associated with lumbar spine BMD (all P < 0.05). Except for estrogen-only patches, other hormone preparations also had a protective effect against osteopenia (all OR < 1, all P < 0.05), but none of them were associated with osteoporosis prevalence (all P > 0.05). The BMD increased by 0.10 and 0.04 g/cm 2 in the CU and PU groups, respectively, compared with the nonusers group (all P < 0.05). In both the CU and PU groups, the risk of osteopenia was reduced (OR, 0.34 and 0.57, respectively). Hormone preparations increase lumbar spine BMD in postmenopausal women and exert a protective effect against osteopenia. These impacts persisted after hormone preparations were discontinued. Hormone preparations, however, were not associated with osteoporosis prevalence.

Antipsychotic drugs and risk of acute pancreatitis: A nationwide case-control study.

Use of antipsychotic drugs, especially second-generation agents, has been suggested to cause acute pancreatitis in multiple case reports; however, such an association has not been corroborated by larger studies. This study examined the association of antipsychotic drugs with risk of acute pancreatitis. Nationwide case-control study, based on data from several Swedish registers and including all 52,006 cases of acute pancreatitis diagnosed in Sweden between 2006 and 2019 (with up to 10 controls per case; n = 518,081). Conditional logistic regression models were used to calculate odds ratios (ORs) in current and past users of first-generation and second-generation antipsychotic drugs (dispensed prescription <91 and ≥91 days of the index date, respectively) compared with never users of such drugs. In the crude model, first-generation and second-generation antipsychotic drugs were associated with increased risk of acute pancreatitis, with slightly higher ORs for past use (1.58 [95% confidence interval 1.48-1.69] and 1.39 [1.29-1.49], respectively) than for current use (1.34 [1.21-1.48] and 1.24 [1.15-1.34], respectively). The ORs were largely attenuated in the multivariable model-which included, among others, alcohol abuse and the Charlson comorbidity index-up to the point where only a statistically significant association remained for past use of first-generation agents (OR 1.18 [1.10-1.26]). There was no clear association between use of antipsychotic drugs and risk of acute pancreatitis in this very large case-control study, indicating that previous case report data are most likely explained by confounding.

P046 A multinomial approach to prediction of methotrexate treatment response and discontinuation due to adverse events in rheumatoid arthritis

Abstract Background/Aims As recommended by the NICE guidelines, methotrexate (MTX) is typically prescribed as the first line therapy for patients with rheumatoid arthritis (RA). However, around 40% of patients do not respond to MTX at 6 months and around 80% experience adverse events (AEs). Our previous systematic review identified that clinical prediction models of MTX outcomes suffered from methodological limitations, including a lack of validation, suboptimal handling of missing data, and no consideration of competing risks, such as patients discontinuing due to adverse events (AEs). These shortcomings resulted in high risk of bias and should be addressed to aid the implementation of outcome prediction in clinical practice. Therefore, this study aimed to (i) develop a multinomial prediction model for estimating an individual’s risks of not achieving low disease activity (LDA) and discontinuing due to AEs at 6 months after starting MTX, using information observable at the starting point of treatment, (ii) update prognosis at 3 months, and (iii) internally validate these models to assess performance. Methods Data came from the national multi-centre (n = 38) Rheumatoid Arthritis Medication Study (RAMS), which recruited patients with a diagnosis of RA or undifferentiated polyarthritis starting MTX for the first time. We conducted a Patient and Public Involvement focus group with past and current MTX users, which informed our outcome choice of LDA (DAS28 ≤3.2). A multinomial logistic regression (MLR) was used to develop a prediction model that estimated the probabilities of three outcomes: 1) not in LDA, 2) achieved LDA, and 3) discontinued due to AEs. The updated model at 3 months was conditional on patients not having achieved LDA. Missing data was handled using multiple imputation and models were internally validated through bootstrapping. Calibration, discrimination, and variance explained was assessed to quantify model performance. Results A total of 1632 patients were included in the analysis. At 6 months, 756 (46%) patients achieved LDA, 730 (45%) were not in LDA, and 146 (9%) discontinued due to AEs. The updated model at 3 months included 1179 (72%) patients as they had not achieved LDA. For the LDA outcome pair, the c-statistic was 0.73 (0.70, 0.75), while it was 0.54 (0.49, 0.59) for the AEs outcome. The calibration slope was 0.99 (0.85, 1.12) and 0.74 (0.23, 1.23), respectively. Predictive performance at 3 months was similar to baseline. Conclusion Our MLR models handled outcomes of disease activity and AEs simultaneously. We were able to predict outcomes of LDA more accurately than AEs and performance was better in terms of calibration, which is crucial for the clinical utility of a prediction model. This modelling approach could provide more clinically useful and realistic predictions of MTX outcomes, as competing risks such as AEs have previously been ignored. Disclosure C.K. Gehringer: None. G.P. Martin: None. K.L. Hyrich: Honoraria; Abbvie. Grants/research support; BMS and Pfizer. S.M.M. Verstappen: None. J.C. Sergeant: None.

User experiences of an online therapist-guided psychotherapy platform, OPTT: A cross-sectional study

IntroductionIn the last few years, online psychotherapy programs have burgeoned since they are a more accessible and scalable treatment option compared to in-person therapies. While these online programs are promising, understanding the user experience and perceptions of care is essential for program optimization. MethodsThis study investigated the experiences of end-users who had previously received online psychotherapy through a web-based platform. A 35-item multiple-choice survey was developed by the research team and distributed to past users to capture their perceptions of the program. ResultsThe survey yielded 163 responses, with a 90 % completion rate. Participants were predominantly white and female, with an average age of 42 years. While most participants preferred in-person therapy, they also reported the benefits of the online psychotherapy program. Participants had positive perceptions of the platform, the quality and interaction of their therapist, and the homework assignments and skills covered. Lack of motivation to complete weekly homework assignments was cited as a common struggle. DiscussionThe findings support online psychotherapy as a beneficial digital mental health tool and highlight some areas for improvement. Scalability and accessibility are key benefits of the platform. At the same time, improvements in participant engagement, including those from equity-seeking and equity-deserving groups, may enhance the efficacy of the programs offered.