Total Duration Of Use Research Articles

The duration of lithium use and biological ageing: telomere length, frailty, metabolomic age and all-cause mortality

Lithium is an established first-line treatment for bipolar disorder. Beyond its therapeutic effect as a mood stabiliser, lithium exhibits potential anti-ageing effects. This study aimed to examine the relationship between the duration of lithium use, biological ageing and mortality. The UK Biobank is an observational study of middle-aged and older adults. We tested associations between the duration of lithium use (number of prescriptions, total duration of use and duration of the first prescription period) and telomere length, frailty, metabolomic age (MileAge) delta, pulse rate and all-cause mortality. Five hundred ninety-one individuals (mean age = 57.49 years; 55% females) had been prescribed lithium. There was no evidence that the number of prescriptions (β = − 0.022, 95% CI − 0.081 to 0.037, p = 0.47), the total duration of use (β = − 0.005, 95% CI − 0.023 to 0.013, p = 0.57) or the duration of the first prescription period (β = − 0.018, 95% CI − 0.051 to 0.015, p = 0.29) correlated with telomere length. There was also no evidence that the duration of lithium use correlated with frailty or MileAge delta. However, a higher prescription count and a longer duration of use was associated with a lower pulse rate. The duration of lithium use did not predict all-cause mortality. We observed no evidence of associations between the duration of lithium use and biological ageing markers, including telomere length. Our findings suggest that the potential anti-ageing effects of lithium do not differ by the duration of use.

Peculiarities of pharmacotherapy of patients with rheumatoid arthritis associated with interstitial lung disease

Objective: a comparative study of the peculiarities of pharmacotherapy of rheumatoid arthritis (RA) in presence and in absence of interstitial lung disease (ILD).Material and methods. The study included 1034 patients with active RA who met the 2010 ACR/EULAR criteria. Patients were divided into two groups: with ILD according to high-resolution computed tomography of the lungs (n=82) and without ILD or other types of chronic obstructive pulmonary diseases, including bronchial asthma (52 patients excluded; n=900). Based on medical documentation, archived medical records and medical history, a “drug card” was created for all stages of pharmacotherapy of patients with active RA. The Cumulative Illness Index Score (CIRS) was used to assess the profile and severity of comorbidities.Results and discussion. The main indicators of RA activity in the patients of the two groups were comparable, but a greater number of comorbidities (p˂0.0001) and a higher value of the CIRS multimorbidity index (p˂0.0001) were found in the group with ILD. The presence of ILD had no influence on the frequency of prescription, the total duration of use and the maximum dose of glucocorticoids (GC) (p˂0.05). The average dose of GC was statistically significantly higher in the group with ILD (p=0.008). These patients were taking disease-modifying antirheumatic drugs (DMARDs): methotrexate (p=0.04), leflunomide (p=0.02) and sulfasalazine (p=0.03), less frequently, but they took hydroxychloroquine significantly more frequently (p=0.02) with a comparable total duration of use of each medication. RA patients with ILD and without ILD received biologic DMARDs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) in 62.2 and 59.6% of cases, respectively (p˂0.05). At the same time, patients without ILD had experience of taking a greater number of different bDMARDs/tsDMARDs (p=0.03). In the group with ILD, patients more frequently received anti-B-cell therapy (p˂0.0001) and significantly less frequently drugs of other classes: tumour necrosis factor α inhibitors (p˂0.0001) and interleukin 6 inhibitors (p=0.01), T-cell costimulation blocker (p=0.04) and Janus kinase inhibitors (p=0.001). Patients with ILD were statistically significantly older at the start of bDMARD/tsDMARD therapy (p˂0.0001), and the period from the onset of RA to the start of bDMARD/tsDMARD therapy was comparable in both groups (p˂0.05).Conclusion. The observed peculiarities of pharmacotherapy in the group with ILD (frequency of use, choice and dose of GC, DMARDs, biologics and tsDMARDs) are probably related to the presence of ILD on the one hand and to the characteristics of concomitant pathology and older age on the other, as the activity of RA was comparable in our patients with and without ILD.

Compliance to Topical Minoxidil and Reasons for Discontinuation among Patients with Androgenetic Alopecia.

This study assessed the levels of compliance to topical minoxidil (TM) among male and female patients with androgenetic alopecia (AGA) and analyzed the factors associated with minoxidil discontinuation. A retrospective study was conducted among 400 consecutive patients with AGA who presented to a dermatology clinic and who were prescribed minoxidil 2% or 5% in the past 5years. Demographic factors, other previous treatments, and minoxidil parameters including the dose (2% or 5%), total duration of use, treatment results, and side effects were collected. The mean age of the patients was 32.41years [standard deviation (SD) 8.18], and 66.5% were female. The majority of patients (82.5%) did not receive any previous treatment for AGA. Of the total patients, 345 (86.3%) have discontinued minoxidil. Discontinuation rate showed no association with sex (p = 0.271), age category (p = 0.069), or previous treatment (p = 0.530). Furthermore, the likelihood of minoxidil discontinuation decreased with the increase in treatment duration (p < 0.001) and was significantly lower among patients who reported improvement (69.3%) or stabilization of hair shedding (64.1%) compared with those who reported baby hair (88.9%) or no efficacy (95.3%) (p < 0.001). Furthermore, having experienced an adverse effect of minoxidil was associated with 93.6% discontinuation rate compared with 75.8% in the case of no side effects (p < 0.001). Adjusted analysis showed that minoxidil discontinuation was independently association with longer duration of use [> 1year; odds ratio (OR) 0.22; p < 0.001], perceived improvement (OR 0.17; p < 0.001) or stabilization (OR 0.14; p < 0.001), and the occurrence of side effects (OR 3.06; p = 0.002). The clinical use of TM in AGA is limited by a substantially low compliance even in absence of adverse effects. We emphasize the importance of educating patients regarding the treatment's side effects and the need to use minoxidil for a minimum of 12months to assess treatment efficacy.

Clinical and Safety Outcomes With GLP-1 Receptor Agonists and SGLT2 Inhibitors in Type 1 Diabetes: A Real-World Study.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) are used off-label in the management of type 1 diabetes mellitus (T1DM) in real-world practice as adjuvant therapies to insulin. There are few real-world data regarding efficacy and safety of this practice. This work aimed to determine the efficacy and safety of GLP-1RAs and sodium-glucose SGLT2is in the management of T1DM in real-world practice. A retrospective chart review was performed of all instances of GLP-1RA and/or SGLT2i use greater than 90 days in adult patients with T1DM at a single academic center. We report the clinical and safety outcomes over the duration of use. We identified 104 patients with T1DM who ever used a GLP-1RA (76 patients) or SGLT2i (39 patients) for more than 90 days. After 1 year of therapy, GLP-1RA users had statistically significant reductions in weight (90.5 kg to 85.4 kg; P < .001), glycated hemoglobin A1c (HbA1c) (7.7% to 7.3%; P = .007), and total daily dose of insulin (61.8 units to 41.9 units; P < .001). SGLT2i users had statistically significant reductions in HbA1c (7.9% to 7.3%; P < .001) and basal insulin (31.3 units to 25.6 units; P = .003). GLP-1RA users compared to SGLT2i users had greater reduction in weight (P = .027) while HbA1c reduction was comparable between the groups. Over a mean total duration of use of 29.5 months/patient for both groups, more SGLT2i users experienced diabetic ketoacidosis (DKA) (12.8% vs 3.9%). Therapy was discontinued because of adverse events 26.9% of the time for GLP-1RA users vs 27.7% for SGLT2i users. GLP-1RA and SGLT2i use in T1DM is associated with clinically relevant benefits. DKA remains a clinical concern with SGLT2i use, requiring careful patient selection and monitoring, with the risk to benefit ratio of treatment evaluated at an individual level.

The Effect of High Humidity Environments on Very Low Birth Weight Preterm Infants: A Systematic Review

The scholarly evidence on the timing and practice of interventional care administered to preterm infants in high-humidity environments is unclear. This makes evaluating the prognosis of preterm infants with comorbidities difficult and means that clinical medical staff lack clear guidelines for care. This systematic review was designed to explore the prognostic effects of interventions for comorbidities performed on very low birthweight preterm infants in high humidity environments to provide an empirical basis for developing related clinical-care guidelines. An electronic database was searched for all relevant documents published between 1930 and September 2021. The keywords used were "premature infants" OR "very low weight premature infants" OR "very low weight premature infants" AND "humidity", and the target groups were premature infants weighing ≤ 1,500 grams or delivered at ≤ 34 weeks of gestation. The timing and practice of interventions in high humidity environments and the occurrence and prognosis of related comorbidities were explored. The main findings cover the issues of body weight, total water intake, electrolytes, urine output, insensitivity water loss, infection, common complications, and mortality in preterm infants. After reviewing the methods, quality, and efficacy of the research in the identified studies, 9 articles were selected for integrated synthesis. Recommendations for the use of high humidity with infants delivered at ≤ 30 weeks of gestation or at birth weights ≤ 1,000 grams were integrated. An environment with a relative humidity of 70%-80% should be used during the first postpartum week and 50%-60% during the second postpartum week. The recommended total duration of use of a high-humidity environment is two weeks to avoid delaying the development of the stratum corneum. Physiological indicators shown to exhibit significant improvement under this regimen include reduced total water intake, increased urine output, and a lower incidence of hypernatremia. The appropriate timing and practice of high humidity intervention were integrated in this study. It is hoped that this review provides an evidence-based clinical practice guideline for preterm infant care.

Awake prone positioning in nonintubated spontaneous breathing ICU patients with acute hypoxemic respiratory failure (PRONELIFE)\u2014protocol for a randomized clinical trial

BackgroundIt is uncertain whether awake prone positioning can prevent intubation for invasive ventilation in spontaneous breathing critically ill patients with acute hypoxemic respiratory failure. Awake prone positioning could benefit these patients for various reasons, including a reduction in direct harm to lung tissue, and prevention of tracheal intubation-related complications.Design and methodsThe PRONELIFE study is an investigator-initiated, international, multicenter, randomized clinical trial in patients who may need invasive ventilation because of acute hypoxemic respiratory failure. Consecutive patients admitted to participating ICUs are randomly assigned to standard care with awake prone positioning, versus standard care without awake prone positioning. The primary endpoint is a composite of tracheal intubation and all-cause mortality in the first 14 days after enrolment. Secondary endpoints include time to tracheal intubation and effects of awake prone positioning on oxygenation parameters, dyspnea sensation, and complications. Other endpoints are the number of days free from ventilation and alive at 28 days, total duration of use of noninvasive respiratory support, total duration of invasive ventilation, length of stay in ICU and hospital, and mortality in ICU and hospital, and at 28, 60, and 90 days. We will also collect data regarding the tolerance of prone positioning.DiscussionThe PRONELIFE study is among the first randomized clinical trials investigating the effect of awake prone positioning on intubation rate in ICU patients with acute hypoxemic failure from any cause. The PRONELIFE study is sufficiently sized to determine the effect of awake prone positioning on intubation for invasive ventilation—patients are eligible in case of acute hypoxemic respiratory failure without restrictions regarding etiology. The PRONELIFE study is a pragmatic trial in which blinding is impossible—however, as around 35 ICUs worldwide will participate in this study, its findings will be highly generalizable. The findings of the PRONELIFE study have the potential to change clinical management of patients who may need invasive ventilation because of acute hypoxemic respiratory failure.Trial registrationISRCTN ISRCTN11536318. Registered on 17 September 2021. The PRONELIFE study is registered at clinicaltrials.gov with reference number NCT04142736 (October, 2019).

Optimizing Engagement in an mHealth Intervention for Diabetes Support During Pregnancy: the Role of Baseline Patient Health and Behavioral Characteristics.

Mobile health (mHealth) technology that addresses diabetes mellitus in pregnancy has the potential to improve maternal and child health while diminishing socioeconomic and racial disparities. Little is known about health literacy, electronic health literacy, or patient characteristics that contribute to increased mHealth use. In this pilot study, we aimed to examine patient factors associated with user engagement with a novel app for diabetes support during pregnancy. Low-income pregnant individuals with gestational or type 2 diabetes mellitus were recruited for a 2-week usability assessment of a novel mHealth smartphone application, "SweetMama," designed to improve diabetes care. This analysis of user characteristics was a pilot assessment of data from the usability study phase. Participants completed assessments of patient health literacy, electronic health literacy, diabetes self-efficacy, and activation. User metrics (eg, sessions and total duration of use) were evaluated by participant characteristics. Descriptive analyses were conducted to assess outcomes with respect to patient's clinical history, health literacy, electronic health literacy, diabetes self-efficacy, and activation. Twenty-two diverse, low-income pregnant patients with either gestational or type 2 diabetes engaged with SweetMama for 14 days. Participants with gestational diabetes had greater mean minutes of use per session and mean total duration of use than those with type 2 diabetes. Participants with greater electronic health literacy, lower patient activation, and greater self-efficacy demonstrated greater total duration of use. No user metrics differed significantly by participant general health literacy. Findings of this pilot study suggest engagement with a novel mHealth app for diabetes support during pregnancy varied by baseline behavioral and clinical characteristics. Results could indicate that digital health literacy better differentiates engagement patterns than general health literacy.

1076 Optimizing engagement in health behavior interventions: the role of patient activation and health literacy

Improving health for pregnant patients with gestational or type 2 diabetes mellitus (DM) requires health education and behavior change support. The use of mobile health (“mHealth”) tools, such as behavior support “apps,” is a novel strategy to accomplish these needs. DM apps can deliver educational and motivational content, but little is known about how to optimize patient utilization of such interventions. We aimed to examine patient factors associated with user engagement with a novel app for DM support during pregnancy. In this secondary analysis of a usability trial, low-income pregnant women with DM used a novel mHealth app for 14 days. SweetMama was designed to provide women with educational, motivational, and goal-setting content on diet, exercise, medication management, glucose monitoring, and other health behaviors to support DM management during pregnancy. Upon enrollment, participants completed the Patient Activation Measure-13 (PAM) and the Newest Vital Sign (NVS) to assess patient activation and health literacy, respectively. User metrics (application episodes [log-ins], mean use time per episode, number of days of use, and total duration of use) were evaluated by DM type, PAM level, and NVS score. Pregnant patients (N=22) with DM accessed SweetMama frequently over this 14 day trial. Women with GDM had greater mean usage per episode (4.0 ± 2.9 vs 2.5 ± 0.9 minutes) and mean total duration of use (28.1 ± 17.0 vs. 18.2 ± 12.3 minutes) than women with T2DM (Table). Women with low-level patient activation had more frequent log-ins (median 11 [IQR 3-11] vs. 8 [IQR 6-9]) and greater number of days of use (median 13.2 [IQR 12.9-14.0] vs. 12.0 [IQR 9.9-13.0]). In contrast, no user metrics differed significantly by participant health literacy level. Early-phase usability findings suggest that use of a novel mHealth app for DM support during pregnancy was associated with patient activation and DM type. Next steps include understanding how to customize mHealth support and leverage patient engagement to optimize outcomes for pregnant women with DM.

Mode of use by mobile phone and change of time of simple audio-motor reaction for users of mobile communication. Age related features of ipsilateral and contralateral effects

By analysing the time of a simple auditory-motor reaction with mono-presentation of an audio signal, the effect of the electromagnetic radiation of a mobile phone on the human auditory system is evaluated. Regularities in the frequency of occurrence of ipsi and contralateral effects in mobile users of different age groups are obtained. This study has no analogues in either Russian or foreign publications and is currently exclusive. The purpose was to study age-related features of the severity of ipsi and contralateral effects, depending on the mode of use of the mobile phone. To record the ipsi- and contralateral effects, we used the differences in the average values of a simple auditory-motor reaction between the left and right ears with mono-presentation of the sound signal of 573 respondents of different age groups. The obtained values were compared with the control group data for each age group (491 respondents). If the difference was greater than in the control group, the ipsilateral or contralateral effect was recorded. The severity of the effect was evaluated taking into account the lateral preferences of each participant in the experiments (to which ear the mobile phone is most often held) and the mode of use of the mobile phone. Statistical processing of the results was carried out using the non-parametric Mann-Whitney test and the method of descriptive statistics: prevalence indicator (Pr) (relative frequency of manifestation of a particular attribute in the sample). The comparison of the severity of ipsi and contralateral effects for different age groups allowed us to establish the following patterns. It was found that, in general, the manifestation of the contralateral effect decreases with age, and the ipsilateral effect increases. However, this change is not linear. It is shown that the features of the manifestation of the contralateral and ipsilateral effect for each age group depend both on the time of daily use of a mobile phone and on the total duration of use of a mobile phone. We believe that when studying multidimensional input data, an individual approach is necessary. The presented results confirm the negative effect of the radiation of mobile phones on the auditory system, primarily of our younger generation. Given the special vulnerability of children to physical environmental factors and the depth of penetration of EMR MT into the brain of a child, we believe that from a radiobiological point of view, there is already a need to develop a special SanPiN (sanitary rules and norms) for all available modern low-intensity sources of electromagnetic radiation, including Wi-Fi.

Assessment of Data Usage of Cancer e-Interventions (ADUCI) Framework for Health App Use of Cancer Patients and Their Caregivers: Framework Development Study.

BackgroundMultimedia interventions can provide a cost-effective solution to public health needs; however, user engagement is low. Multimedia use within specific populations such as those affected by cancer differs from that of the general population. To our knowledge, there are no frameworks on how to accurately assess usage within this population to ensure that interventions are appropriate for the end users. Therefore, a framework was developed to improve the accuracy of determining data usage. Formative work included creating a data usage framework during target audience testing for smartphone app development and analysis in a pilot study.ObjectiveThe purpose of this study was to develop a framework for assessing smartphone app usage among people living with cancer and their caregivers.MethodsThe frequency and duration of use were compared based on manual data extraction from two previous studies and the newly developed Assessment of Data Usage of Cancer e-Interventions (ADUCI) Framework.ResultsManual extraction demonstrated that 279 logins occurred compared with 241 when the ADUCI Framework was applied. The frequency of use in each section of the app also decreased when the ADUCI Framework was used. The total duration of use was 91,256 seconds (25.3 hours) compared with 53,074 seconds (14.7 hours) when using the ADUCI Framework. The ADUCI Framework identified 38 logins with no navigation, and there were 15 discrepancies in the data where time on a specific page of the app exceeded the login time. Practice recommendations to improve user engagement and capturing usage data include tracking data use in external websites, having a login function on apps, creating a five-star page rating functionality, using the ADUCI Framework to thoroughly clean usage data, and validating the Framework between expected and observed use.ConclusionsApplying the ADUCI Framework may eliminate errors and allow for more accurate analysis of usage data in e-research projects. The Framework can also improve the process of capturing usage data by providing a guide for usage data analysis to facilitate evidence-based assessment of user engagement with apps.

P1329STENTING VERSUS ISOLATED BALLOON ANGIOPLASTY FOR CENTRAL VEIN STENOSIS IN HEMODIALYSIS PATIENTS

Abstract Background and Aims comparative analysis of the results of isolated balloon angioplasty (BA) and BA with stenting of central veins stenosis in patients on hemodialysis. Method A retrospective study included 62 patients with confirmed stenosis of the central veins: subclavian, brachiocephalic veins, vena cava inferior, or multiple lesions. In 39 patients, stents are not used; isolated balloon angioplasty (BA) was performed. In 23 patients we used bare metal stents. Results Functional primary patency (the time interval between the start of AVF using and the first endovascular intervention) did not differ in the groups – fig. 1A; HR 1.142 [95% CI 0.6875; 1.897], p = 0.5994. The use of stents leads to increase primary patency (the time interval between the first and second endovascular interventions) – fig. 1B; HR 2.064 [95% CI 1.252; 3.404], p = 0.0017. The use of stents allows to increase the functional secondary patency (total duration of use of the AVF) – fig 1C; HR 2.099 [95% CI 1.272; 3.463], p = 0.0016. Secondary patency (the time interval between the first endovascular intervention and the complete cessation of the use of AVF) was higher after BA with stenting: HR 2.03 [95% CI 1.232; 3.347], p = 0.0021; fig 1D. The use of stents allows to increase functional primary assisted patency (non-occlusive period from the start of AVF use) – fig. 1E and primary assisted patency (non-occlusive period from the first surgical intervention) – fig 1F: HR 1.936 [95% CI 1.175; 3.188], p= 0.0053 and HR 2.0 [95% CI 1.213; 3.295], p = 0.0042. The need for open reconstructive interventions after the first BA or BA with stenting was the same 0.374 [95% CI 0.24; 0.556] and 0.45 [95% CI 0.291; 0.664] per 10 patient-months, incidence rate ratio (IRR)= 0.831 [95% CI 0.471; 1.464] р=0.521. The need for endovascular interventions did not differ between isolated BA and BA with stenting 1.137 [95% CI 0.8913; 1.43] and 0.827 [95% CI 0.606; 1.104] per 10 patient-months, IRR=1.374 [95% CI 0.952; 1.999] p=0.09. Total need for surgical interventions (open + endovascular) also did not differ: 1.511 [95% CI 1.225; 1.843] and 1.277 [95% CI 0.997; 1.611] per 10 patient-months, IRR 1.183 [95% CI 0.872; 1.612] p=0.2822. We found a strong negative correlation between functional primary patency and primary patency (r = -0.627; p &amp;lt;0.0001) – fig. 2, as well as a between functional primary patency and secondary patency in patients after isolated BA (= -0.53; p = 0.0005, respectively), but not after stenting (r = -0.351; p = 0.101 and r = -0.304; p = 0.159, respectively). In a case of isolated BA, the success of the first intervention largely determines the secondary patency, which is expressed in a strong, statistically significant positive correlation of primary patency and secondary patency. In a case of BA with stenting, the correlation between these estimates is also statistically significant, but significantly lower. Conclusion 1. The results of balloon angioplasty without stenting are significantly influenced by the duration of the period between the start of AVF use and the manifestation of central vein stenosis. 2. The use of stents can slightly improve the results of endovascular interventions in central vein stenosis, regardless the its time of development. 3. The use of stents leads to a moderate increase in the median patency of AVF and a significant increase in the proportion of patients with functional AVF in the late postoperative period. 4. The use of stents does not reduce the need for surgical interventions

681PD - Low-dose aspirin and risk of gastric and oesophageal cancer: A population-based study

BackgroundEvidence suggests that low-dose aspirin is associated with a 30–40% protective effect against colorectal cancer (CRC) yet its effect on other gastrointestinal cancers has been less studied. We aimed to quantify the association between use of low-dose aspirin and risk of gastric/ oesophageal cancer using a population-based primary care database in the United Kingdom – The Health Improvement Network. MethodsAmong persons aged 40–89 years from 2005–2015, ∼200,000 new users of low-dose aspirin (75–300mg/day) were each matched to a non-user by age, sex, time since study entry and number of primary care visits in the previous year. Individuals were followed (max. 18 years) to identify incident cases of gastric/oesophageal cancer. Nested case–control analyses were conducted using 5000 controls for both sets of cancer cases frequency matched by age, sex and calendar year. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for current vs. non-use of low-dose aspirin using logistic regression. Current use was when low-dose aspirin use lasted to 0–90 days before the index date (event date for cases, random date for controls) and total duration of use before the index date was >1 year; non-use was no use of low-dose aspirin ever before the index date or use that ended ≥1 year before the index date. ResultsWe identified 727 incident cases of gastric cancer and 1394 incident cases of oesophageal cancer. As shown in the table, compared with non-use, current use of low-dose aspirin was associated with a significant 54% reduced risk of gastric cancer and a significant 41% reduced risk of oesophageal cancer. Protective effects were seen for both cancers irrespective of total previous duration of low-dose aspirin use.Table681PD Odds ratios (95% confidence intervals) for the association between use of low-dose aspirin (current vs non-use) and gastric/oesophageal cancerTableGastric cancerOesophageal cancerCases N=727 n (%)Controls N=5000 n (%)Adjusted OR* (95% CI)Cases N=1394 n (%)Controls N=5000 n (%)Adjusted OR* (95% CI)Non-use of low-dose aspirin442 (60.8)2404 (48.1)1.0 (reference)829 (59.5)2555 (51.1)1.0 (reference)Current use of low-dose aspirin (with duration >1 year)146 (20.1)1407 (28.1)0.46 (0.38-0.57)331 (23.7)1397 (27.9)0.59 (0.51-0.69)Duration >1 to<3 years56 (7.7)693 (13.9)0.34 (0.25-0.46)145 (10.4)680 (13.6)0.51 (0.41-0.62)Duration>=3 years90 (12.4)714 (14.3)0.60 (0.47-0.77)186 (13.3)717 (14.3)0.68 (0.56-0.82)Remaining current users of low-dose aspirin (i.e. patients with duration <1 year)66 (9.1)730 (14.6)0.31 (0.23-0.42)103 (7.4)625 (12.5)0.33 (0.26-0.42)Past use of low-dose aspirin (use that ended >90 days before the index date)73 (10.0)459 (9.2)0.61 (0.46-0.80)131 (9.4)423 (8.5)0.65 (0.52-0.81)Duration <1 year34 (4.7)283 (5.7)0.42 (0.29-0.62)65 (4.7)268 (5.4)0.49 (0.37-0.67)Duration>=1 year39 (5.4)176 (3.5)0.92 (0.64-1.34)66 (4.7)155 (3.1)0.92 (0.67-1.26)*Adjusted by age, sex and primary care practitioner visits in the year before the index date. ConclusionsOur results indicate that use of low-dose aspirin is associated with a significantly reduced risk of gastric and oesophageal cancer as supported by mechanistic data. Editorial acknowledgementSusan Bromley, EpiMed Communications Ltd (Oxford, UK). Legal entity responsible for the studyLuis A Garcia Rodriguez. FundingBayer AG. DisclosureL. Garcia Rodriguez: Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Bayer AG. P. Vora: Full / Part-time employment: Bayer AG. M. Soriano-Gabarró: Full / Part-time employment: Bayer AG. L. Cea Soriano: Research grant / Funding (institution): Bayer AG.

Feasibility of mobile health game “Fume” in supporting tobacco-related health literacy among early adolescents: A three-armed cluster randomized design

ObjectiveNew interventions supporting health literacy and a tobacco-free lifestyle in adolescence are needed to narrow the widening gap in existing health inequalities. Health games offer potential and could be utilized for example in school healthcare, but more research is needed to increase the understanding of the effects of game elements in health interventions. The aim of this feasibility study is to determine the short-term effectiveness of the tobacco-related mobile health game Fume and a non-gamified website in comparison with a no-intervention control group, regarding tobacco-related health literacy among 10–13-year-old early adolescents. In addition, we compare the demand for and acceptability of Fume to that of the website. MethodsIn total, 151 early adolescents participated in this single-blinded, three-armed cluster randomized trial. The participants from three municipalities in southwest Finland were randomly allocated between a group with access to the health game Fume (n = 61), a group with access to the website (n = 47), and a group with no intervention (n = 43). The intervention groups first participated in a 20-min training session with Fume/the website, and then had two weeks to use Fume/the website based on their own interest. Short-term effectiveness was measured by primary (anti-smoking self-efficacy) and secondary (smoking outcome expectations, attitudes towards tobacco use, tobacco-use motives, motivation to decline tobacco use in the future, and knowledge about tobacco) outcomes derived from the theory-based determinants of tobacco-related health literacy and evaluated with self-assessment questionnaires at baseline and post-intervention (after a two-week follow-up). For evaluating the demand, the actual use of Fume/the website was tracked during the two-week period. Regarding acceptability, the raised interest towards Fume/the website and opinions about the interventions were evaluated post-intervention. Differences were tested with the McNemar, Fisher exact, and non-parametric tests. ResultsStatistically significant favorable changes during the study period were found for positive (P = 0.002) and negative (P = 0.02) smoking outcome expectations and attitudes towards cigarette smoking (P = 0.01) within the group using Fume. No statistically significant changes were detected within the website or control groups. Statistically significant differences were not found for the change in outcome variables among the three groups. The number of visits (P < 0.001), number of separate visit days (P < 0.001) and total duration of use (P < 0.001) were larger for the group using Fume than for that using the website. Fume sparked more interest in early adolescents than the website did (P < 0.001). There were no statistically significant differences in opinions about Fume and those regarding the website. ConclusionsThe intervention with embedded game elements, the health game Fume, was found to be more feasible as a tobacco-related health education intervention than the non-gamified website among early adolescents in light of demand and acceptability (raised interest). Even though no change in anti-smoking self-efficacy was found, the results of this feasibility study demonstrated favorable short-term changes with Fume in some other theory-based determinants of tobacco-related health literacy.

ON THE RELATIONSHIP BETWEEN THE INDICATORS OF STUDENTS WITH THE FATIGUE FACTORS OF THE LESSON AND THE SCHOOL SCHEDULE

Рresents the results of studying the variability of the parameters characterizing the fatigue of students in the learning process depending on the leading in the modern digital environment factors of a school lesson (total duration of use of e-learning and the density of academic work), as well as from the hygienic rationality of the school timetable based on the difficulty of school subjects. Obtained a statistically significant model the variability of pronounced fatigue of students in the dynamics of the school day, depending on lessons and schedules. Shows the degree of influence on the development of fatigue of the child in the learning process rationally structured schedule during the school day (from the standpoint of difficulty of subjects), increase the use of e-learning and teaching density lesson. These indicators are recommended for use as indicators of the fatigue of students during the school day at the hygienic assessment of the educational process in educational organizations.

Clinico-demographic profile among female with alcohol related problems in the eastern part of Nepal

Background: Alcohol can affect anyone. It is not prejudicial towards any race, colour, sex, religion or economic level. It affects individual’s life, personal relationship, health and occupational functioning.1 Alcohol is estimated to cause a net harm of 3.7% of all deaths and 4.4% of the global burden of disease.3 This study will provide baseline data and pave way for further studies and broaden the implication for the management and control of alcohol related problems in female.Objective: To provide baseline data about the clinico-demographic profile of the female with alcohol related problems.Method: A semi- structured proforma was designed to collect the data. A total of 51 female patients participated in the study after giving their written informed consent. Result: The maximum number of patients were in the age group of 41-50 (37.2%); followed by the age group 31-40 (31.3%). The mean age was 42.63 ± 11.11 years. The predominant caste was Rai 33.3% followed by Limbu 19.6%. All the cases were Hindus by religion. Most of the cases were married (82.3%) housewives, (56.8%) with nuclear family (68.6%) and illiterate (58.8%). The age of first alcohol intake was 17.45±9.45 years, total duration of use 24.86±14.7. Family custom (56.88%) was the most common reason for the first use of alcohol. Local distilled alcohol was preferred (58.8%) and 72.5% used to drink alone. The most common presenting complaint was auditory hallucination (12.36%).Conclusion: The most affected age group was at the peak of their economic and reproductive abilities. Most of the patients were illiterate and jobless. A comprehensive educational awareness program about alcohol use and its effects on the female as a whole, with special attention to pregnancy and lactation is to be undertaken at the community level, with maximum female participation. It is important to recognize and realize that women have unique aspects to their alcohol problems and to understand the complex interplay of roles they have to play in the form of daughter, mother, wife, in-law and manager of the household activities including taking care of children as well as elderly at home and plan accordingly.Health Renaissance 2015;13(2): 30-42

Usage and Dose Response of a Mobile Acceptance and Commitment Therapy App: Secondary Analysis of the Intervention Arm of a Randomized Controlled Trial.

BackgroundMobile phone apps offer a promising medium to deliver psychological interventions. A mobile app based on Acceptance and Commitment Therapy (ACT) was developed and studied in a randomized controlled trial (RCT).ObjectiveTo study usage metrics of a mobile ACT intervention and dose-response relationship between usage and improvement in psychological flexibility.MethodsAn RCT was conducted to investigate the effectiveness of different lifestyle interventions for overweight people with psychological stress. This paper presents a secondary analysis of the group that received an 8-week mobile ACT intervention. Most of the analyzed 74 participants were female (n=64, 86%). Their median age was 49.6 (interquartile range, IQR 45.4-55.3) years and their mean level of psychological flexibility, measured with the Acceptance and Action Questionnaire II, was 20.4 (95% confidence interval 18.3-22.5). Several usage metrics describing the intensity of use, usage of content, and ways of use were calculated. Linear regression analyses were performed to study the dose-response relationship between usage and the change in psychological flexibility and to identify the usage metrics with strongest association with improvement. Binary logistic regression analyses were further used to assess the role of usage metrics between those who showed improvement in psychological flexibility and those who did not. In addition, associations between usage and baseline participant characteristics were studied.ResultsThe median number of usage sessions was 21 (IQR 11.8-35), the number of usage days was 15 (IQR 9.0-24), and the number of usage weeks was 7.0 (IQR 4.0-8.0). The participants used the mobile app for a median duration of 4.7 (IQR 3.2-7.2) hours and performed a median of 63 (IQR 46-98) exercises. There was a dose-response relationship between usage and the change in psychological flexibility. The strongest associations with psychological flexibility (results adjusted with gender, age, and baseline psychological variables) were found for lower usage of Self as context related exercises (B=0.22, P=.001) and higher intensity of use, described by the number of usage sessions (B=−0.10, P=.01), usage days (B=−0.17, P=.008), and usage weeks (B=−0.73, P=.02), the number of exercises performed (B=−0.02, P=.03), and the total duration of use (B=−0.30, P=.04). Also, higher usage of Acceptance related exercises (B=−0.18, P=.04)was associated with improvement. Active usage was associated with female gender, older age, and not owning a smart mobile phone before the study.ConclusionsThe results indicated that active usage of a mobile ACT intervention was associated with improved psychological flexibility. Usage metrics describing intensity of use as well as two metrics related to the usage of content were found to be most strongly associated with improvement.Trial RegistrationClinicalTrials.gov NCT01738256; https://clinicaltrials.gov/ct2/show/NCT01738256 (Archived by WebCite at http://www.webcitation.org/6iTePjPLL)

Why perimenopausal women should consider to use a levonorgestrel intrauterine system

Objective: The use of a levonorgestrel intrauterine system (LNG-IUS) is useful in preventing pregnancy and for the treatment of menstrual disturbances. A smooth or symptom-free transition to and through menopause is possible when LNG-IUS is combined with estrogen therapy. Unfortunately the majority of physicians are generally unaware of this usefulness combined hormonal therapy in the pre-, peri- and postmenopausal women.Design and method: Based on long-term clinical experience with LNG-IUS in the form of Femilis®, 104 women where followed from the premenopause through the menopausal transition into the postmenopause. These perimenopausal women received supplemental 17 β-estradiol by gel or patch, or orally as estradiol valerate. Patients received one or two separate Femilis insertions at 5 year intervals. Main outcome measures included acceptability and continued use of the combined regimen for the treatment of climacteric symptoms and for prevention of cardiovascular disease, osteoporosis and other adverse effects caused by estrogen deprivation.Results: The average age at insertion was 48 years (range 28–58) and the total duration of use was 137 months (range 80–161). The Femilis LNG-IUS was well tolerated as the number of removals for LNG-IUS-related reasons was low. The LNG-IUS was well retained in the uterine cavity as no expulsions were observed. Seven women were lost to follow-up. Eighty-six women (82%) opted for replacement of an LNG-IUS at expiry after 5 years and continued with the estrogen therapy.Conclusion: Intrauterine progestogen delivery for endometrial suppression in combination with estrogen therapy in the symptomatic perimenopausal women is highly practical as it combines the benefits of prevention of endometrial proliferation and treatment of menorrhagia and hyperplasia, if present. In addition, the contraceptive effect of locally administered LNG is highly desirable as many perimenopausal women run considerable risk of unintended pregnancy. For these reasons, the author views this regimen as one of the most effective, safest and best accepted route resulting in high patient compliance. It is important to convey this message to general practitioners as well as women.

Nicotine absorption from electronic cigarette use: comparison between experienced consumers (vapers) and naïve users (smokers).

Electronic cigarettes (ECs) are nicotine delivery devices that are proposed as tobacco harm reduction products to smokers. Nicotine delivery from ECs is potentially important in their efficacy as smoking substitutes. Herein, nicotine delivery from using a new-generation EC device (variable-wattage, set at 9 W) was evaluated, comparing experienced (vapers) with naïve users (smokers). Twenty-four vapers and 23 smokers participated to the study. They were asked to obtain 10 puffs in 5 minutes and then use the EC ad lib for 60 more minutes (total duration of use: 65 minutes). An 18 mg/mL nicotine-containing liquid was used. Blood samples were obtained at baseline, 5-minutes and every 15 minutes thereafter, while number of puffs and average puff duration were recorded. Although at baseline both groups had similar plasma nicotine levels, smokers consistently exhibited lower levels at all time-periods; at 5-minutes the levels were lower by 46%, while during the subsequent period they were lower by 43% (at 65-minutes) to 54% (at 20-minutes). Both groups took similar number of puffs, but smokers had average puff duration of 2.3 s compared to 3.5 s in vapers. Even in vapers, plasma nicotine levels at 5 minutes were lower than those observed after smoking 1 tobacco cigarette.

Use of antihypertensive drugs and risk of skin cancer.

Several antihypertensive drugs are photosensitizing and may therefore act as cocarcinogens with ultraviolet radiation. To examine whether antihypertensive drug use is associated with squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and malignant melanoma (MM). We used population-based databases to conduct a case-control study including all first-time cases of SCC (n = 2282), BCC (n = 17,242), and MM (n = 3660) in northern Denmark, 1991-2010. We matched approximately 10 controls (n = 231,743) to each case by age, sex and county using risk-set sampling. We used conditional logistic regression to compute odds ratios (ORs) for skin cancer with 95% confidence intervals comparing ever users of antihypertensives (>2 previous prescriptions) with non-users (≤2 previous prescriptions). We adjusted for comorbidity and comedications. We further analysed use by duration (short term: <5 years; long term: ≥5 years) and intensity (low intensity or high intensity: <50% or ≥50% prescription coverage during total duration of use, respectively). Ever users of diuretics were at increased risk of SCC (OR 1.19; 1.06-1.33), driven by potassium-sparing agents alone (OR 1.40; 1.09-1.80) or with low-ceiling diuretics (OR 2.68; 2.24-3.21) and by long-term use (OR 1.41; 1.16-1.72 at low intensity; OR 1.44; 0.98-2.14 at high intensity). Ever users of sulphonamides (OR 1.49; 1.04-2.12) and non-aldosterone antagonist potassium-sparing agents (OR 2.26; 0.85-6.01) were at increased MM risk. The latter was also associated with BCC (OR 1.47; 1.00-2.17), as was low-ceiling diuretics combined with potassium-sparing agents (OR 1.23; 1.12-1.35). Long-term, low-intensity (OR 1.53; 1.05-2.23) and high-intensity (OR 1.44; 0.56-3.69) angiotensin receptor blocker use was associated with MM. Estimates for angiotensin-converting enzyme inhibitors, β-blockers, and calcium channel blockers were inconsistent or weak (<20% increased). Long-term angiotensin receptor blocker use was associated with risk of MM. Moreover, long-term diuretic use was associated with SCC risk, driven by potassium-sparing agents alone or in combination with low-ceiling diuretics.

Risk-benefit profiles of women using tamoxifen for chemoprevention.

Tamoxifen has been US Food and Drug Administration-approved for primary prevention of breast cancer since 1998 but has not been widely adopted, in part because of increased risk of serious side effects. Little is known about the risk-benefit profiles of women who use chemoprevention outside of a clinical trial. We examined characteristics associated with initiation and discontinuation of tamoxifen for primary prevention of breast cancer within a large cohort of women with a first-degree family history of breast cancer. This research was conducted within The Sister Study, a cohort of 50884 US and Puerto Rican women age 35 to 74 years enrolled from 2003 to 2009. Eligible women were breast cancer-free at enrollment and had a sister who had been diagnosed with breast cancer. Participants reported tamoxifen use, ages started and stopped taking tamoxifen, and total duration of use at enrollment. We identified 788 tamoxifen users and 3131 nonusers matched on age and year of enrollment who had no history of contraindicating factors (stroke, transient ischemic attack, cataract, endometrial or uterine cancer). Characteristics associated with tamoxifen initiation were evaluated with multivariable conditional logistic regression. All statistical tests were two-sided. Based on published risk-benefit indices, 20% of women who used tamoxifen had insufficient evidence that the benefits of tamoxifen outweigh the risk of serious side effects. After 4.5 years, 46% of women had discontinued tamoxifen. While the majority of women who used tamoxifen for primary prevention of breast cancer were likely to benefit, substantial discontinuation of tamoxifen before five years and use by women at risk of serious side effects may attenuate benefits for breast cancer prevention.