Reasons For Use Research Articles

Artificial Intelligence in studies—use of ChatGPT and AI-based tools among students in Germany

AI-based tools such as ChatGPT and GPT-4 are currently changing the university landscape and in many places, the consequences for future forms of teaching and examination are already being discussed. In order to create an empirical basis for this, a nationwide survey of students was carried out in order to analyse the use and possible characteristics of AI-based tools that are important to students. The aim of the quantitative study is to be able to draw conclusions about how students use such AI tools. A total of more than 6300 students across Germany took part in the anonymous survey. The results of this quantitative analysis make it clear that almost two-thirds of the students surveyed use or have used AI-based tools as part of their studies. In this context, almost half of the students explicitly mention ChatGPT or GPT-4 as a tool they use. Students of engineering sciences, mathematics and natural sciences use AI-based tools most frequently. A differentiated examination of the usage behaviour makes it clear that students use AI-based tools in a variety of ways. Clarifying questions of understanding and explaining subject-specific concepts are the most relevant reasons for use in this context.

PSVIII-11 Antinutritional Factors Are Largely Mitigated By Extrusion and Did Not Negatively Impact Digestibility of Canine Grain-Free and Grain-Inclusive Foods

Abstract Ingredients commonly used in companion animal foods, such as whole grains and legumes, naturally contain antinutritional factors (ANF). Some ANF are known contributors to reduced nutrient digestibility and bioavailability, potentially resulting in defective protein synthesis, which is one hypothesis of potential root cause(s) for dilated cardiomyopathy. Yet some ANF, such as trypsin inhibitor (TI) and isoflavones, may act as beneficial bioactives at lower inclusion levels. While various processing methods can impact the presence or activity of ANF, the purpose of this investigation was to assess the presence of ANF in ingredients commonly used in canine foods, the effect of extrusion on ANF, and the subsequent digestibility of foods formulated using different ingredient strategies. Four test foods were formulated to meet requirements for adult dogs at maintenance: 1) grain-inclusive without peas or potatoes, 2) grain-inclusive with peas and pea fiber, 3) grain-free with peas and potatoes, and 4) grain-free with potatoes (Table 1). Grains, legumes, plant proteins, and finished test foods were analyzed for 41 ANF. Percent destruction of ANF was calculated from the inclusion levels of ingredients in the formulations and the tested levels in finished foods. Digestibility studies were then conducted to assess macronutrient digestibility of the test foods. Cereal grains and soybean meal were the primary sources of ANF in raw ingredients. Phytic acid, TI, and isoflavones (daidzin and genistin) were the most common ANF measured in ingredients. Lectin was not detectable in any ingredients or test foods; tannins were detected only in soybean meal. Except for phytic acid and TI, ANF were effectively (>99%) destroyed by this extrusion process. Trypsin inhibitor was detectable at levels slightly above the detection limit (1000 TIU/g) in all finished test foods (Table 2; 1,200 to 1,700 TIU/g). Phytic acid was detectable (0.49 to 0.76%) in all finished test foods except for the grain-free with potatoes formulation. This was unsurprising as both are known to be resistant to inactivation by heat, pressure and steam. Despite their presence in finished test foods, apparent DM, carbohydrate (NFE), and energy digestibility were high (>80%) for all foods; apparent fat and true protein digestibility were >90% (Figure 1). These data demonstrate the effectiveness of this specific extrusion process to minimize or mitigate the majority of ANF in canine foods when formulated with a variety of common ingredients. Despite the presence of these ANF, test foods remained highly digestible, demonstrating the importance and effectiveness of balanced nutritional formulation in mitigating their effects. We assert that the presence or absence of ANF in ingredients should not, by itself, be the reason for use or avoidance of an ingredient. Additional factors such as the quality of the raw ingredient, processing methods, and overall nutritional design must be considered.

Alternative Lymphodepletion Strategies Lead to Similar Response Rates and Toxicities in Standard-of-Care BCMA-Directed CAR-T Therapy in Relapsed Refractory Multiple Myeloma

Introduction: Lymphodepletion (LD) chemotherapy is critical for the efficacy of CAR-T therapy by eradicating immunosuppressive cells, inducing costimulatory molecules, and promoting expansion and persistence of CAR-T cells. It also can contribute to an increased risk of infections, cytopenia, and other toxicities. We evaluated the utilization of varying LD regimens used in standard-of-care (SOC) autologous B-cell maturation antigen-directed (BCMA) CAR-T therapy with ide-cel or cilta-cel for relapsed/refractory multiple myeloma (RRMM) and the effect on outcomes and toxicity. Methods: Data were retrospectively collected from patients with RRMM who underwent LD and CAR-T cell infusion by December 31, 2022, from 13 US academic institutions with SOC ide-cel or cilta-cel. Response rates and other categorical variables, specifically LD regimen, were tested for association using Wilcoxon rank-sum (or Kruskal-Wallis for three or more groups) or Fisher's exact tests, respectively. Results: A total of 523 patients were infused at the time of data cut-off with 489 patients evaluable for safety and survival analyses; 368 (75%) were infused with ide-cel and 121 (25%) with cilta-cel. The median age was 65 years old (range 30-90) with 206 females (42%) and 283 males (58%), and 13% with ECOG performance status ≥ 2 at time of LD. Fludarabine and cyclophosphamide (Flu/Cy) LD was used in 422 patients while 67 patients received other LD regimens including bendamustine-based (n = 35, 52%), cladribine-based (n = 25, 37%) or cyclophosphamide alone (n = 7, 10%). The primary reason for use of Flu/Cy LD was institutional guidance or SOC in 378 patients (90%), while the primary reason for use of other LD regimens was due to the fludarabine shortage in 65 patients (97%) with 3% citing physician's choice or institutional guidance. No significant difference was identified among response outcomes, with those receiving Flu/Cy LD achieving an ORR of 84% compared to 81% with other LD regimens (p = 0.59) and no difference observed in rates of ≥ VGPR (66% Flu/Cy LD vs 60% other LD; p = 0.48). Of those evaluable for MRD at 1 and 3 months, the MRD negative rate at 10 -6 for those with Flu/Cy LD was 77% (n= 137) and 77% (n=113) and with other LD regimens was 66% (n=35) and 79% (n=28), respectively. At a median follow-up of 9.7 months, no statistically significant difference was noted in median progression free survival (mPFS) with Flu/Cy vs other LD regimens (9.3 mos vs NR) or overall survival (OS) (19.4 mos vs NR). When stratified by type of CAR-T therapy, treatment with bendamustine-based LD was associated with an inferior mPFS compared to those receiving Flu/Cy LD in patients treated with ide-cel (3.8 vs 8.5 mos; p=0.0056), though not by multivariate analysis. Univariate analysis of patients treated with ide-cel between Flu/Cy and bendamustine LD did not reveal any significant differences in age, gender, ECOG, R-ISS stage, extramedullary disease, high-risk cytogenetics or renal dysfunction (Cr < 45 ml/min). LD regimen was not a predictor for PFS on multivariable analyses amongst patients treated with ide-cel, while ECOG ≥ 3 (hazard ratio [HR]= 4.44, 95% confidence interval [CI]= 1.40, 14.08) and t(4,14) (HR= 2.02, 95% CI=1.14, 3.59) were associated with worse PFS. No difference in mPFS by LD regimen was observed in patients receiving cilta-cel, which was a smaller cohort (mPFS: Flu/Cy 11.7 mos, bendamustine-based NR, cladribine-based NR, cyclophosphamide NR). Rates of all grade CRS (81% vs 70%), Grade ≥ 3 CRS (3% vs 3%), all grade ICANS (19% vs 12%, and Grade ≥ 3 ICANS (4% vs 2%) were similar among those receiving Flu/Cy or other LD regimens, respectively. Patients receiving Flu/Cy LD were less likely to have any grade cytopenia at 1 month (33% vs 55%, p < 0.001) and 3 months (52% vs 69%, p < 0.001), with no observed difference in infection rate. Conclusions: The fludarabine shortage experienced in the US in late 2022 necessitated the use of alternative LD regimens with BCMA-directed CAR-T therapy with most centers relying on bendamustine- or cladribine-based regimens. Use of bendamustine-based LD was associated with inferior PFS in patients receiving ide-cel on univariate analysis, but not on multivariate analysis after adjusting for other prognostic factors. In summary, there is no clear difference in efficacy or safety between Flu/Cy and non-Flu/Cy LD in patients receiving BCMA-directed CAR-T therapy. *Authors contributed equally

Peranan Sekuent Cartigram Pada Pemeriksaan MRI Knee Joint Dengan Kasus Anterior Cruciate Ligament DI Instalasi Radiologi RSUD Sidoarjo

Background: The MRI knee joint examination procedure for clinical ACL rupture in the Radiology Installation of Sidoarjo Regional Hospital often adds a T2 Mapping MR Cartigram sequence. T2 mapping MR Cartigram is a special sequence for detecting damage to the collagen component of the cartilage matrix using a quantitative approach method by producing a color map. The aim of this research is to determine the procedure, reasons for use, and diagnostic information resulting from the T2 mapping MR Cartigram sequence. Method: This type of research is qualitative research with a case study approach. The research was conducted in March-June 2022 at the Radiology Installation of Sidoarjo Regional Hospital. Research subjects included three patients, three radiographers, one radiologist, and one sending doctor. Data was collected by means of observation, interviews and documentation and then analyzed using an interactive model system method which would be processed in the form of transcripts, then identified, reduced and categorized the data and made open coding so that conclusions could be drawn. Results: The results of the study show that the clinical MRI knee joint examination procedure for ACL rupture at Sidoarjo District Hospital includes patient preparation, equipment preparation, examination techniques and routine sequences used such as PD Fatsat, T2, T1, STIR, T2*GRE, PD 3D Cube, and additional T2 Mapping MR Cartiram sequence. The use of the T2 mapping MR Cartigram sequence aims to determine the effect of ACL rupture on cartilage damage quantitatively and objectively by placing an ROI in the cartilage area so that it can provide diagnostic information including early detection of cartilage damage, increased water content, and cartilage degenerative processes. The results of the interpretation of the analysis carried out by the Sidoarjo Regional Hospital Radiologist were only subjective, namely looking at the resulting color map to see whether it looked even and homogeneous. Conclusion: Basically, existing saturation measurements are not always the same, they will depend on the patient's diagnosis for which the action will be taken. This saturation measurement uses the AVOXimeter 1000E. no less important in the continuity of actions in the cath lab room.

Challenges and achievements in the utilization of the health system among adolescents in a region of Burkina Faso particularly affected by poverty

ObjectiveHealthcare for adolescents receives little attention in low-income countries globally despite their large population share in these settings, the importance of disease prevention at these ages for later life outcomes and adolescent health needs differing from those of other ages. We therefore examined healthcare need and use among adolescents in rural Burkina Faso to identify reasons for use and gaps in provision and uptake.MethodsWe interviewed 1,644 adolescents aged 12-20 living in rural northwestern Burkina Faso in 2017. Topics included healthcare need and satisfaction with care provided. We calculated response-weighted prevalence of perceived healthcare need and utilization, then conducted multivariable regression to look at predictors of need, realized access and successful utilization based on the Andersen and Aday model.Results43.7 [41.2 - 46.0] % of participants perceived need for healthcare at least once in the preceding 12 months - 52.0 [48.1 - 56.0] % of females and 35.6 [32.5 - 39.0] % of males. Of those with perceived need, 92.6 [90.0 - 94.3] % were able to access care and 79.0 [75.6 - 82.0] % obtained successful utilization. Need was most strongly predicted by gender, education and urbanicity, while predictors of successful use included household wealth and female guardian’s educational attainment.ConclusionHealthcare utilization among adolescents is low in rural Burkina Faso, but mostly thought of as sufficient with very few individuals reporting need that was not linked to care. Future objective assessment of healthcare need could help identify whether our results reflect a well-functioning system for these adolescents, or one where barriers lead to low awareness of needs or low expectations for service provision.

Prevalence of antibiotic misuse in cases of pneumonia and diarrhea in Saudi Arabia.

Antibiotic misuse is a major public health issue with long-term repercussions. The purpose of this investigation was to evaluate the effects of pneumonia and diarrhea, with an emphasis on antibiotic misuse. This study included 410 participants (217 fathers and 193 mothers), of whom 239 purchased antibiotics for their children without a prescription, whereas 171 had a prescription or were unsure if one was required. Antibiotics were used incorrectly by 58.1% of respondents. About 51.2% of participants said they were taking two antibiotics at the same time. Around 30% of people admitted to using antibiotics inefficiently. The most prevalent reason for use was "viral and bacterial," followed by "viral," and then "bacterial," with 35%, 21%, and 20%, respectively. In addition, 22.4% of patients have used antibiotics for an unknown reason. Saudi parents of children with pneumonia and diarrhea abuse antibiotics. Saudi legislation banning medications without a prescription has helped reduce antibiotic abuse, but more community-based education and awareness are needed.

Covid-19 Pandemic, Communicable Diseases and Consumption of Dietary and Herbal Supplements in Sub-Sahara African Setting – Nigeria

Introduction: The Covid-19 pandemic brought about changes in the livelihood of most people around the globe, including variations in intake of dietary and herbal supplements (DHS) during the pandemic. Objectives: To evaluate the dynamics of dietary and herbal supplements intake by persons already diagnosed with Tuberculosis (TB), Human Immuno-deficient Virus (HIV) and Hepatitis (Hep) during the pandemic in Nigeria. Design: Cross-sectional questionnaire survey. Setting: Within the geographical location and boundary of the country only. Participants: Adolescents, and adults residing in Nigeria. Respondents with TB, HIV and Hepatitis (n = 243) from a larger study (n=645) were recruited from different geo-political zones and various ethnic groups. Primary and Secondary Outcomes: Prevalence and determinants for the use of different DHS during Covid-19 pandemic in Nigeria, sources of information and reasons for use of these DHS. Results: HIV was the most prevalent communicable disease (95%) in the study. Most of the respondents increased their intake of supplements during the pandemic. Female respondents with HIV were slightly more likely to increase their consumption of supplements more than their male counterparts (χ²=0.09, P-value=0.77, OR=1.12, 95% CI=0.52, 2.45). Vitamin C was the most-consumed supplement by respondents with HIV (64.5%) and TB (60%) but the least by respondents with Hep (14.3%). Calcium (30, 13%) and zinc (16, 7%) were taken only by respondents with HIV. Maintenance of good health was the main reason for increased consumption of DHS and health-care providers were the major source of information on the use of DHS during the pandemic. Conclusions: HIV was most prevalent among the respondents. There was increased consumption of DHS and Vitamin C was the most consumed supplement during Covid-19 pandemic in Nigeria, The use of DHS by Nigerians with communicable diseases should be explored further to ascertain their usefulness or otherwise during illness or a future pandemic.

Initiation Patterns and Transitions Among Adults Using Stimulant Drugs: Latent Transition Analysis.

The fourth wave of the drug overdose epidemic in the United States includes increasing rates of stimulant-involved overdose. Recent studies of transitions leading to stimulant misuse have shown complex patterns that are not universally applicable because they have isolated individual populations or individual behaviors. A comprehensive analysis of transitions between behaviors and the associations with present-day problematic drug use has not been conducted. This study aims to determine whether adults from the general population who use stimulants initiate use through a heterogeneous combination of behaviors and quantify the association between these typologies with present-day problematic drug use. Individuals who have reported use of any stimulant in their lifetime were recruited from the 2021 Survey of Nonmedical Use of Prescription Drugs Program, a nationally representative web-based survey on drug use, to participate in a rapid follow-up survey about their past stimulant use. Individuals were asked which stimulants they used, the reasons for use, the routes of administration, and the sources of the stimulant. For each stimulant-related behavior, they were asked at what age, between 6 and 30 years, they initiated each behavior in a 6-year time window. A latent transition analysis was used to characterize heterogeneity in initiation typologies. Mutually exclusive pathways of initiation were identified manually by the researchers. The association of these pathways with present-day problematic drug use was calculated using logistic regression adjusted by the current age of the respondent. From a total of 1329 participants, 740 (55.7%) reported lifetime prescription stimulant use and 1077 (81%) reported lifetime illicit stimulant use. Three typologies were identified. The first typology was characterized by illicit stimulant initiation to get high, usually via oral or snorting routes and acquisition from friends or family or a dealer (illicit experimentation). The second typology was characterized by low, but approximately equal probabilities of initiating 1-2 new behaviors in a time window, but no singular set of behaviors characterized the typology (conservative initiation). The third was characterized by a high probability of initiating many diverse combinations of behaviors (nondiscriminatory experimentation). The choice of drug initiated was not a strong differentiator. Categorization of pathways showed those who were only in an illicit experimentation status (reference) had the lowest odds of having severe present-day problematic drug use. Odds were higher for a conservative initiation-only status (odds ratio [OR] 1.84, 95% CI 1.14-2.94), which is higher still for those moving from illicit experimentation to conservative initiation (OR 3.50, 95% CI 2.13-5.74), and highest for a nondiscriminatory experimentation status (OR 5.45, 95% CI 3.39-8.77). Initiation of stimulant-related use behaviors occurred across many time windows, indicating that multiple intervention opportunities are presented. Screening should be continued throughout adulthood to address unhealthy drug use before developing into full substance use disorders.

Effect of feeding dairy calves with milk fermented with selected probiotic strains on occurrence of diarrhoea, carriage of pathogenic and zoonotic microorganisms and growth performance

Calf-diarrhoea is a major health problem in dairy calves and a primary reason for use of antimicrobials. We aimed to investigate the effect of feeding milk fermented with a combination of four probiotic bacterial strains to young-calves on; occurrence of diarrhoea and associated-pathogens (bacteria, virus and parasites), shedding of Salmonella Dublin and Campylobacter, occurrence of virulence genes linked to Clostridium perfringens, Enterotoxigenic Escherichia coli and shiga-toxin producing E. coli (STEC), as well as growth performance. For this, 143 new-born calves from three Danish dairy-farms were allocated into Treatment- (fed the fermented milk for the first 8-weeks-of-life) and Control-groups (fed regular farm-milk). Diarrhoea was observed in 18.6 % (Farm 1), 22.4 % (Farm 2) and 15.7 % (Farm 3) of the total registrations mainly within the first 3-weeks-of-life. C. perfringens was the most frequently detected pathogen. The treatment did not affect the occurrence of virulence genes linked to STEC and C. perfringens and, overall, their detection levels were very low/undetected. The statistical model applied found no significant effect of the treatment on prevalence of early-diarrhoea (≤ 3 weeks), late-diarrhoea (>3 weeks), occurrence of C. perfringens and Cryptosporidium parvum or levels of Campylobacter spp. Limited detection of the other pathogens and associated virulence-genes under study, did not allow for assessment of the impact of the treatment on their occurrence. Notably, the feeding-approach showed a significant detrimental effect on daily-weight-gain. The inefficacy of the treatment may be associated with the complexity of influencing factors under field conditions including management practices.

Early Survivorship, Clinical and Radiographic Outcomes Following Primary and Revision Total Ankle Arthroplasty using a Modular Augmented Revision (INVISION) Implant

Category: Ankle Arthritis; Ankle Introduction/Purpose: As the number of total ankle replacements (TAR) performed annually increases, there is an increased demand for implants that can be used in revision scenarios when primary TARs fail. As indications for TAR expand, there is increased reliance on modular systems to treat challenging conditions including bone loss, avascular necrosis, and instability. The INVISION Total Ankle Arthroplasty System (Wright Medical Technology/Stryker, Memphis, TN), released in 2018, includes modular augmented tibial trays and talar plates of varied heights to compensate for bone loss. There is limited data on early survivorship and clinical outcomes of the INVISION. This novel study aims to determine the early implant survivorship, complications, patient-reported outcomes (PROMIS), and radiographic outcomes of the INVISION implant used in both the primary and revision arthroplasty setting. Methods: This study is a single-institution retrospective review of adult patients who underwent primary or revision TAR with the INVISION implant with minimum 2-year follow-up. Demographics, reason for use of INVISION, surgical data, complications, pre- operative and 2 year post-operative radiographic data, and pre-operative and 2-year post-operative patient-reported outcome scores were collected. The primary outcome was survivorship (retention of both tibial/talar components at final follow-up). Secondary outcomes were reoperation (return to OR with retention of both tibial and talar components), radiographic complications (peri-implant lucency, cysts, or subsidence), and patient-reported outcomes (PROMIS pre-operative and 2-year post-operative). PROMIS scores were collected across the following domains: physical function, pain interference, pain intensity, global mental health, and depression score. Results: Twenty-six patients (primary=7; revision=19) underwent INVISION TAR (mean age 62 years, weight 81.kg, BMI 29.3 kg/m2, 15/26 male) with mean follow-up 3.5 years. Reason for INVISION primary TAR included tibial (n=1) or talar (n=5) bone loss, and take-down fusion (n=1); INVISION revision TAR was used for tibial (n=6) or talar (n=7) component subsidence, recurrent tibiotalar malalignment (valgus=1, varus=3), and post-infection bone loss (n=2). Two-year implant survivorship was 100%. There were 2 reoperations (7.7%): 1 gutter debridement and 1 irrigation, debridement and polyethylene exchange for infection. Two-year follow-up PROMIS domains improved significantly (p < 0.05) from pre-operative in both the primary (pain interference, pain intensity) and revision cohorts (pain interference, pain intensity, global physical function). Two-year radiographic follow-up yielded 1 tibial peri-implant lucency and 1 tibial cyst. Conclusion: In this single-institution series, there was excellent short-term survivorship of the INVISION TAR implant with no failures in primary or revision cases. There were significant improvements in patient-reported outcomes scores. There were low rates of peri-implant lucencies and cysts. The results of this study support the use of the INVISION implant in both the complex primary and revision TAR setting. INVISION may offer an alternate surgical solution to fusion, custom printed cage implants, and total talus replacement in this complex patient population. Further research and follow-up data are warranted to report the longer-term outcomes and survivorship of this implant.

Cannabis Use Patterns among Patients with Early-Stage Breast Cancer in a Large Multicenter Cohort from a State with Legalized Adult Non-Medical Cannabis

Cannabis use among patients with cancer is an area of great interest given its widespread acceptance despite the lack of supporting clinical data. The absence of data limits the understanding of potential clinical benefits of cannabis and the ability of providers to deliver evidence-based recommendations for patient care. We explored cannabis use patterns in patients with early-stage breast cancer in a large multicenter cohort in a state with legalized adult non-medical cannabis. Initial questions about cannabis use history and frequency were introduced in Michigan Radiation Oncology Quality Consortium (MROQC) breast cancer patient surveys on 2/1/2020 for female patients receiving radiation after lumpectomy for non-metastatic breast cancer. Expanded questions were introduced on 6/28/2022 to assess mode of administration, active ingredient, and reason for use. Summary statistics were generated. A multivariable model using logistic regression identified patient characteristics associated with cannabis use. Among 3948 eligible patients, 2738 (69.35%) completed survey questions, and 2462/2738 (89.9%) completed the initial question on cannabis use. Among those, 364/2462 (14.8%) noted cannabis use in the last 30 days, 588 (23.9%) noted remote use (>30 days ago), 1462 (59.4%) reported never having used cannabis, 44 (1.8%) preferred not to answer cannabis use questions, and 4 (0.4%) did not provide use history. Younger age [age <50 vs 60-70, OR 2.5 (95% CI 1.65, 3.79) p<0.001)], Hispanic ethnicity [OR 2.20 (95% CI 1.06, 4.56) p = 0.03], history of smoking [OR 2.56 (95% CI 1.88, 3.48) p<0.001], current smoking [OR 4.70 (95% CI 3.22, 6.86) p<0.001)], and prior chemotherapy [OR 1.40 (95% CI 1.00, 1.96) p = 0.05] predicted recent cannabis use in a multivariable model. Of the 364 patients endorsing cannabis use in the last 30 days, 89 (24.5%), 72 (19.8%), 29 (8.0%), 66 (18.1%), 30 (8.2%), and 78 (21.4%) reported using cannabis 1-2 days, 3-5 days, 6-9 days, 10-19 days, 20-29 days, and all 30 days, respectively. The most common modes of administration among 76 individuals who responded to the expanded questionnaire to date were oral (39.4%), smoking (30.3%), and topical (10.5%). The products used contained tetrahydrocannabinol (THC; 26.3%), cannabidiol (CBD; 19.7%), balanced levels of THC and CBD (19.7%), or active ingredients that were unknown to the patient (34.2%). Patients frequently endorsed cannabis use for insomnia, anxiety, and pain. Many patients with early-stage breast cancer are using cannabis. Younger age, Hispanic ethnicity, smoking, and chemotherapy history are predictors of cannabis use. Patients are often unaware of the active ingredients in the products that they use, suggesting an important role for patient education and a need to equip providers to advise patients in their care.

Contraceptive Behavior in Appalachia: Exploring Use, Nonuse, and Contraceptive Attitudes.

Very little is known about contraceptive behavior in Appalachia, a large geographic region in the eastern United States where even basic prevalence estimates of contraceptive use/nonuse are lacking. This study characterizes contraceptive behavior among Appalachians, including contraceptive use, reasons for use, and methods used; contraceptive nonuse and reasons for nonuse; and attitudes about contraception, including acceptability. This is a secondary analysis of a subsample of survey data collected on sexual and reproductive health attitudes, behaviors, and needs among reproductive-age women (18-49 years) living in the Appalachian region (n = 332). Results identify rates of contraceptive use (66.6%) and nonuse (33.1%) among Appalachian residents. Methods used most frequently included those that did not require prescription (i.e., external condoms and natural family planning methods) though many reported the use of intrauterine devices (IUDs). Among nonusers, fear of side effects from contraception and ambivalence towards pregnancy were most commonly selected as the most important reason for not using contraception. Contraception was considered acceptable by this sample overall, and these acceptability attitudes were significantly associated with contraceptive behavior.

Evaluating age-related disparities in cannabis-related problems among LGBT+ versus non-LGBT+ adults

LGBT+ adults demonstrate greater cannabis-related problems (e.g., Cannabis Use Disorder [CUD]) compared to non-LGBT+ counterparts. No study has explored age-related disparities in cannabis problems across the adult lifespan, nor have studies identified specific CUD criteria that contribute to elevated CUD among LGBT+ adults. The purpose of this study was to examine associations between LGBT+ identity and age with endorsement of CUD criteria in a sample of regular cannabis consumers. An online sample of N = 4334 (25.1% LGBT+) adults aged 18–64 residing in the U.S. completed an online survey about cannabis use behaviors and CUD diagnostic criteria. Bivariate contrasts revealed significantly greater CUD criteria endorsement among LGBT+ respondents, largely driven by differences at younger ages. However, this effect disappeared in the majority of adjusted logistic regression models. LGBT+ identity was associated with greater probability of use in larger amounts (adjOR = 2.10, 95% CI: 1.22–3.60) and use despite physical/mental health problems (adjOR = 2.51, 95% CI:1.23–5.03). No age*LGBT+ identity interactions were detected. Plotted trends depict more pronounced disparities in outcomes among LGBT+ adults under 35 years. Several potential risk and protective factors including employment, education, and reasons for use were identified. There were age-related differences in these characteristics among LGBT+ and non-LGBT+ respondents. Initial findings highlight the need for LGBT+ research examining trends in health outcomes and sociodemographic and cannabis characteristics across the lifespan. The study also provides a substantive contribution regarding specific cannabis-related problems that young LGBT+ cannabis consumers may be more likely to endorse than their non-LGBT+ counterparts.

Trends in coping reasons for marijuana use among U.S. adolescents from 2016 to 2022

ObjectiveThis study examines historical trends in coping reasons for marijuana use among adolescents (1976–2022) and explores sociodemographic variations in recent years (2016–2022). MethodData from U.S. national samples of 12th grade adolescents in the Monitoring the Future (MTF) study were used to examine long-term trends (1976–2022, N = 43,237) and recent differences by sociodemographic characteristics (2016–2022, N = 3,816). Measures included marijuana use, coping reasons for use, and sociodemographic characteristics. ResultsThe most prevalent coping reason across time was “relax,” endorsed by 52.9% of past 12-month users. Coping reasons mostly exhibited significant increases over time. Sociodemographic factors were associated with coping reasons. Females had higher odds of using marijuana to escape problems and get through the day (vs. males). Black respondents were more likely to use marijuana to get through the day, and Hispanic respondents were more likely to use to relax (vs. White respondents). Those with lower (vs. higher) parental education were more likely to use due to anger/frustration and to escape problems. Adolescents who used marijuana frequently (vs. less often) had higher odds of endorsing all coping reasons. There was no robust evidence of interactions between sociodemographic characteristics and year. ConclusionsResults indicate a consistent increase in coping reasons for adolescent marijuana use over time, with variations based on sociodemographic characteristics. The findings highlight the importance of understanding subpopulations of adolescents who have higher risk of coping-related marijuana use.

Profiling Hormonal Contraceptive Use and Perceived Impact on Training and Performance in a Global Sample of Women Rugby Players.

The potential impact of hormonal contraceptives (HCs) on player health and performance in women's rugby union (rugby) is not well understood, despite rugby's growing popularity worldwide. This study investigated the prevalence of HC use and reported associations with training and performance in a global sample of women rugby players. A globally distributed online survey, seeking to explore experiences in women's rugby, was completed by 1596 current or former adult women 7s or 15s rugby players (mean age 27 [6]y; 7 [5]y playing experience) from 62 countries. The survey included a section of questions about reported HC use, including the type, reason for use, symptoms, and experiences relating to rugby training and performance. A total of 606 (38%) participants from 33 of the 62 (53%) countries reported using HCs, with the combined oral contraceptive pill reported as the most frequently used (44%). Almost half of participants using HCs (43%) tracked HC-related symptoms. Over 10% reported altered rugby performance due to HC-related symptoms, 22% required medication to manage symptoms, and 11% used HCs to control or stop their menstrual periods for rugby training and performance. The current study highlights the prevalence of HC use in women's rugby, identifying practices that may negatively affect performance, health, and well-being. Thus, there is an urgent need to better understand the motivations for such practices and knowledge of potential side effects among women rugby players across all levels and countries.

Cannabis use among recently treated cancer patients: perceptions and experiences.

To characterize cannabis use among cancer patients, we aimed to describe 1) patterns of cannabis use across multiple cancer sites; 2) perceived goals, benefits, harms of cannabis; and 3) communication about cannabis. Patients with 9 different cancers treated at Memorial Sloan Kettering Cancer Center between March and August 2021 completed an online or phone survey eliciting cannabis use, attitudes, and communication about cannabis. Multivariable logistic regression estimated the association of cancer type and cannabis use, adjusting for sociodemographic characteristics and prior cannabis use. Among 1258 respondents, 31% used cannabis after diagnosis, ranging from 25% for lung cancer to 59% for testicular cancer. Characteristics associated with cannabis use included younger age, lower education level, and cancer type. In multivariable analysis, compared to lung cancer patients, gastrointestinal cancer patients were more likely to use cannabis (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.25-5.43). Cannabis use in the year prior to diagnosis was strongly associated with cannabis use after diagnosis (OR 19.13, 95% CI 11.92-30.72). Among users, reasons for use included difficulty sleeping (48%); stress, anxiety, or depression (46%); and pain (42%). Among respondents who used cannabis to improve symptoms, 70-90% reported improvement; < 5% reported that any symptom worsened. Only 25% discussed cannabis with healthcare providers. Almost a third of cancer patients use cannabis, largely for symptom management. Oncologists may not know about their patients' cannabis use. To improve decision making about cannabis use during cancer care, research is needed to determine benefits and harms of cannabis use.

Prevalence of Cannabis Use Disorder and Reasons for Use Among Adults in a US State Where Recreational Cannabis Use Is Legal.

Medical and nonmedical cannabis use and cannabis use disorders (CUD) have increased with increasing cannabis legalization. However, the prevalence of CUD among primary care patients who use cannabis for medical or nonmedical reasons is unknown for patients in states with legal recreational use. To estimate the prevalence and severity of CUD among patients who report medical use only, nonmedical use only, and both reasons for cannabis use in a state with legal recreational use. This cross-sectional survey study took place at an integrated health system in Washington State. Among 108 950 adult patients who completed routine cannabis screening from March 2019 to September 2019, 5000 were selected for a confidential cannabis survey using stratified random sampling for frequency of past-year cannabis use and race and ethnicity. Among 1688 respondents, 1463 reporting past 30-day cannabis use were included in the study. Patient survey-reported reason for cannabis use in the past 30 days: medical use only, nonmedical use only, and both reasons. Patient responses to the Composite International Diagnostic Interview-Substance Abuse Module for CUD, corresponding to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition CUD severity (0-11 symptoms) were categorized as any CUD (≥2 symptoms) and moderate to severe CUD (≥4 symptoms). Adjusted analyses were weighted for survey stratification and nonresponse for primary care population estimates and compared prevalence of CUD across reasons for cannabis use. Of 1463 included primary care patients (weighted mean [SD] age, 47.4 [16.8] years; 748 [weighted proportion, 61.9%] female) who used cannabis, 42.4% (95% CI, 31.2%-54.3%) reported medical use only, 25.1% (95% CI, 17.8%-34.2%) nonmedical use only, and 32.5% (95% CI, 25.3%-40.8%) both reasons for use. The prevalence of CUD was 21.3% (95% CI, 15.4%-28.6%) and did not vary across groups. The prevalence of moderate to severe CUD was 6.5% (95% CI, 5.0%-8.6%) and differed across groups: 1.3% (95% CI, 0.0%-2.8%) for medical use, 7.2% (95% CI, 3.9%-10.4%) for nonmedical use, and 7.5% (95% CI, 5.7%-9.4%) for both reasons for use (P = .01). In this cross-sectional study of primary care patients in a state with legal recreational cannabis use, CUD was common among patients who used cannabis. Moderate to severe CUD was more prevalent among patients who reported any nonmedical use. These results underscore the importance of assessing patient cannabis use and CUD symptoms in medical settings.

Perception des systèmes électroniques de délivrance de la nicotine (SEDEN) chez les lycéens du Nord et du Pas-de-Calais

Electronic nicotine delivery systems (ENDS) have been gaining popularity for over a decade, particularly among young people. The aim was to understand how these devices were perceived, in general and according to different characteristics: gender, smoking status, experimentation or possession of SEDEN. A cross-sectional observational study was conducted by an online questionnaire to 15 high schools between 14 May and 23 October 2021. Perception was assessed by a constructed score. In total, 772 responses from 10 high schools were analysed; 44.7% had already experimented with ENDS. The main reason for use was pleasure (33.8%). Only 15% of smokers or former smokers reported using ENDS to stop smoking as their main reason. The majority of ENDS (72.8%) are perceived as harmful. This negative perception is more important among women, non-smokers, non-experimenters and non-owners of ENDS. More than 50% of the respondents consider ENDS as distinct from tobacco. ENDS are perceived as potentially harmful and their use is often motivated by pleasure. Their perception as a practice distinct from smoking, combined with unknown long-term consequences, justifies increased vigilance in the face of the emergence of these new uses.

Prevalence and Reasons for Use of Dietary Supplements and Energy Drinks Among Air Force Personnel

Prevalence and Reasons for Use of Dietary Supplements and Energy Drinks Among Air Force Personnel

Long-Term, Self-Dosing CBD Users: Indications, Dosage, and Self-Perceptions on General Health/Symptoms and Drug Use

Introduction: Self-dosing of off-the-shelf cannabidiol (CBD) for a myriad of health conditions is common in the USA. These CBD products are often mislabeled, suggesting that much less or much more CBD is being consumed than indicated on the label. This study examined the relationship between long-term self-dosing of CBD and (a) indications and, when a verified concentration of CBD is being consumed, (b) the daily CBD dosage, (c) the impact on general health and symptoms, and (d) over-the-counter (OTC) and prescription (Rx) drug usage. Methods: US adults 18–75 years of age who had used unverified CBD products for >1 month were recruited to participate in this decentralized, observational, IRB-approved study and provided a concentration-verified CBD product of their choice from 15 different vendors for 4 weeks. Prior to receiving product, they were queried on their primary reason for use (PRfU), primary symptom for use (PSfU), general health score (GHS), symptom score (SS), OTC and Rx drug use, and daily CBD dose. Individuals were queried daily on OTC and Rx drug use and CBD dose and weekly on SS and GHS prior to (pre-CBD) and after (post-CBD) ingestion of CBD on that day. Results: The PRfU included chronic pain, mental health, general health and wellness, sleep disorders, the central nervous system, digestive health, and others, while the PSfU included anxiety, back and/or joint pain, sleep, inflammation, and others. The mean daily dose was normally distributed, with a mean, median, and range of 53.1, 40.8, 8–390 mg/day, respectively. For both GHS and SS, the post-CBD was significantly higher than the pre-CBD score for each category of PRfU. The GHS scores did not change over the study, but pre- and post-CBD SS improved over time, with pre-improving more than post-CBD SS. The percentage of individuals decreasing or completely stopping OTC drugs or Rx drugs over the 4 weeks was 31.2% and 19.2%, respectively, with those taking CBD for chronic pain, decreasing drug use the most. OTC and Rx drug usage decreased when the CBD dose was changed and when GHS and SS improved. Conclusion: Pain, mental health (primarily anxiety/stress), and sleep are the most common reasons for CBD use. Self-administration of CBD reduced OTC and Rx drug usage at daily doses less than those reported in controlled studies. CBD self-administration significantly improves self-perception of general health and decreases symptom severity, and as these improve, fewer OTC and Rx drugs are used.