Comparison of surveys and use records for quantifying medically important antimicrobial use in 18 U.S. Beef Feedyards

The objective of this study was to evaluate agreement between medically important antimicrobial use metrics derived from in-person surveys of feedyard management as opposed to metrics derived from production unit-level antimicrobial use records. Survey respondents were asked to estimate values which would allow calculation of the metrics of regimens per animal year (Reg/AY) and milligrams of antimicrobial per kilogram of liveweight sold (mg/kg-LW). At the study level, values were calculated by antimicrobial class within the use categories of in-feed use, control of bovine respiratory disease (BRD) and individual animal treatment. At the feedyard level, values were calculated by total overall use and total use within use category. Feedyard level correlation coefficients between survey and record values for total use were 0.76 (p = .0004) and 0.73 (p = .0009) for Reg/AY and mg/kg-LW, respectively. Correlation coefficients for use category within metric ranged from 0.25 (p = .3224) to 0.65 (p = .0061). Comparing feedyard level survey and record values for total Reg/AY and mg/kg-LW using a Wilcoxon signed-rank test resulted in p-values (95% CI) of 0.3247 (-1.06, 0.25) and 0.7019 (-14.49, 10.387), respectively. Evaluation of comparative rankings as total use by metric indicated that for Reg/AY, only two of the five top-ranked feedyards were consistent between the two data sources. The relationship for mg/kg-LW demonstrated the lowest two and highest three values were consistent between sources; however, the ranking similarities appear to markedly decline in the middle ranks. This report demonstrates that survey-based antimicrobial use data may closely reflect summary values determined from records across multiple beef feedyards. However, individual feedyard relationships between their record and survey values vary widely and ranking by survey may lead to different conclusions as to highest and lowest use than ranking by data collected from use records.

Spatial Language of Young Children During Block Play in Kindergartens in Urban China

Spatial language is an important predictor of spatial skills and might be inspired by peer interaction and goal-oriented building behaviors during block play. The present study investigated the frequency, type and level of children’s spatial language during block play and their associations with the level of block play by observing 228 young children in classrooms equipped with unit blocks and allowing free play on a daily basis. The findings showed that during block play, young children used more words about spatial locations, deictic terms, dimensions, and shapes and fewer words about spatial features or properties and spatial orientations or transformations. Spatial locations were used most frequently, and young children tended to use vertical location words to represent the corresponding location. Most young children used gestures in conjunction with spatial deictic terms. Among shape words, tetragon words were frequently used, and the representation of spatial shapes showed alternatives, collective tendencies and gender differences. The use of spatial language during the play process had a significant positive correlation with age, the construction structure, and form of block building.

Convalescent plasma and hyperimmune globulin therapy in COVID-19

Introduction: Severe acute respiratory syndrome causing coronavirus SARS-CoV-2 (coronavirus disease 2019 (COVID-19)) has recently resulted in the recent global pandemic. As convalescent plasma (CP) therapy has been used with success in several viral infections before, it has become a treatment of choice. Medical literature is reviewed for randomized controlled studies using convalescent plasma therapy.Areas covered: More than one type of neutralizing antibody against a specific microorganism may be found in both CP and hyperimmune globulins. To give a standard titer of a specific neutralizing antibody to a patient, a reliable antibody titration assay should be developed. It is challenging to test the efficacy of the CP and HIG therapies with double-blind studies. There is a difficulty in the standardization of the CP and HIG study groups, as patients use various additional therapies. Different amounts and titers of CP and HIG and different titers of CP are used in patients. This review discusses the current knowledge on CP and HIG therapies used in COVID-19 disease.Expert opinion: The immune response to COVID-19 have diverse characteristics. The antibody produced after COVID-19 disease and vaccination is short-lived. Thus, CP should be an alternative especially in patients with lymphopenia and primary/secondary antibody deficiency.

Health Care Students' Knowledge of and Attitudes, Beliefs, and Practices Toward the French COVID-19 App: Cross-sectional Questionnaire Study

BACKGROUND

Many countries worldwide have developed mobile phone apps capable of supporting instantaneous contact tracing to control the COVID-19 pandemic. In France, a few people have downloaded and are using the StopCovid contact tracing app. Students in the health domain are of particular concern in terms of app uptake. Exploring their use and opinions about the app can inform improvements and diffusion of StopCovid among young people.

OBJECTIVE

The aim of this study is to investigate health care students' knowledge of and attitudes, beliefs, and practices (KABP) toward the StopCovid app.

METHODS

A field survey was conducted among 318 students at the health sciences campus of the University of Bordeaux, France, between September 25 and October 16, 2020. A quota sampling method was used, and descriptive statistics and univariate analyses were performed.

RESULTS

Of the 318 respondents, 77.3% (n=246) had heard about the app, but only 11.3% (n=36) had downloaded it, and 4.7% (n=15) were still using it at the time of the survey. Among the 210 participants who had heard about the app but did not download it, the main reasons for not using the app were a belief that it was not effective given its limited diffusion (n=37, 17.6%), a lack of interest (n=37, 17.6%), and distrust in the data security and fear of being geolocated (n=33, 15.7%). Among the 72 students who had not heard of the app and were given a brief description of its functioning and confidentiality policy, 52.7% (n=38) said they would use it. Participants reported that the main solution for increasing the use of the app would be better communication about it (227/318, 71.4%).

CONCLUSIONS

Even among health students, the contact tracing app was poorly used. The findings suggest that improved communication about its advantages and simplicity of use as well as clarifying false beliefs about it could help improve uptake.

Association between ICU interruptions and physicians trainees' electronic health records efficiency

The intensive care unit (ICU) is a stressful and complex environment in due to its dynamic nature and severity of admitted patients. EHR interface design can be cumbersome and lead to prolonged times to complete tasks. This paper investigated the relationship between a prominent EHR interface design and interruptions with physician's efficiency during patient chart review at ICU Pre-Rounds. We conducted a live observation of ICU physicians in a 30-bed MICU at a tertiary, southeastern medical center. Directly after the observation sessions, the physicians completed a modified System Usability Scale (SUS) survey. A total of 52 EHR patient chart reviews were observed at the MICU Pre-rounds. There was statistically significant positive correlation between time spent to review patient EHR with both number of scrolling(p-value<0.0001) across EHR interface; and with number of visited EHR  screens (p-value=0.0444). There was positive correlation between number of interruptions with time spent to review patient EHR during ICU prerounds. EHR design and the occurrence of interruptions lead to reduced physician-EHR efficiency levels. We report that the number of scrolling and visited screens executed by physicians to gather the required information was associated with increased screen time and consequently decreased physician efficiency.

The Role of Transparency, Trust, and Social Influence on Uncertainty Reduction in Times of Pandemics: Empirical Study on the Adoption of COVID-19 Tracing Apps

Background

Contact tracing apps are an essential component of an effective COVID-19 testing strategy to counteract the spread of the pandemic and thereby avoid overburdening the health care system. As the adoption rates in several regions are undesirable, governments must increase the acceptance of COVID-19 tracing apps in these times of uncertainty.

Objective

Building on the Uncertainty Reduction Theory (URT), this study aims to investigate how uncertainty reduction measures foster the adoption of COVID-19 tracing apps and how their use affects the perception of different risks.

Methods

Representative survey data were gathered at two measurement points (before and after the app’s release) and analyzed by performing covariance-based structural equation modeling (n=1003).

Results

We found that uncertainty reduction measures in the form of the transparency dimensions disclosure and accuracy, as well as social influence and trust in government, foster the adoption process. The use of the COVID-19 tracing app in turn reduced the perceived privacy and performance risks but did not reduce social risks and health-related COVID-19 concerns.

Conclusions

This study contributes to the mass adoption of health care technology and URT research by integrating interactive communication measures and transparency as a multidimensional concept to reduce different types of uncertainty over time. Furthermore, our results help to derive communication strategies to promote the mass adoption of COVID-19 tracing apps, thus detecting infection chains and allowing intelligent COVID-19 testing.

When Color Takes Shape: Young Children Use Object Information from Their Own Drawings to Solve a Task

In two studies, we examined whether and how 3- and 3½-year-old children were able to use object information from their own drawings to solve a task. The children had to produce drawings of simple objects and then use the shape and/or color of their pictures to identify replicas of the referents depicted. The results showed a relationship between graphic production and use. In Study 1, when shape was the single distinctive cue across objects, only the older group was able to produce and use drawings effectively. In Study 2, 3-year-olds used their drawings effectively when not only shape, but also color, were available as cues to identify the objects portrayed. Although most 3-year-olds' drawings did not reflect the shape of the referents, by incorporating color young children demonstrated to recognize the intention behind their own representations and used them to solve the task. Our findings are discussed in line with intentionality and Theory of Mind.

Total Ankle Arthroplasty and Ankle Arthrodesis Use: An American Board of Orthopaedic Surgery Part II Database Study

Total ankle arthroplasty (TAA) use has increased during the past 20 years, whereas ankle arthrodesis (AAD) use has remained constant. The purpose of this study was to examine trends in TAA and AAD use in American Board of Orthopedic Surgery Part II candidates while considering the influence of fellowship training status on treatment of end-stage ankle arthritis. The American Board of Orthopedic Surgery Part II database was queried to identify all candidates who performed ≥1 TAA or AAD from examination years 2009 through 2018. Candidates were categorized by examination year and by self-reported fellowship training status. Descriptive statistical methods were used to report procedure volumes. Trends in use of TAA and AAD were examined by using log-modified regression analyses. From 2009through 2018, there was no significant change in TAA or AAD use among all candidates (p = .92, p = .20). Candidates reporting a foot and ankle fellowship trended toward increased use of TAA relative to AAD compared with non-foot and ankle fellowship candidates, but this failed to reach statistical significance (p = .06). The use of arthroscopic AAD increased over time (p < .01) among all candidates. TAA and AAD use did not change over the study period. Volume of TAA and AAD performed by early-career surgeons remains low. The findings in this study should serve as an important reference for orthopedic trainees, early-career surgeons, and orthopedic educators interested in optimizing training curriculum for surgical management of end-stage ankle arthritis.

Multivariate Analysis of Attitudes, Knowledge and Use of ICT in Students Involved in Virtual Research Seedbeds

The incorporation of information and communication technologies (ICTs) in higher education has been carried out in a transversal manner within the curriculum, and the processes of formative research in both face-to-face and virtual programmes are not an exception to this process. In this context, it is recognised that students’ perceptions of the inclusion of technologies in the classroom can influence their teaching and learning process; however, they have not been widely addressed in multiple settings including research seedbeds. Thus, this paper aims to identify such perceptions represented in the attitudes, knowledge and uses of ICTs in students ascribed to the research seedbed in a virtual business administration programme of an Institution of Higher Education located in Colombia. For its fulfillment, the ACUTIC scale was applied to a sample of 65 students in order to identify these perceptions through a hierarchical cluster analysis, a single factor analysis of variance (ANOVA) test, a post hoc Tukey method and a factor analysis. The main result is that attitudes, knowledge and use of ICTs are varied and they can be represented in three clusters. In general, the attitude towards the incorporation of technologies in the research seedbed is positive; however, there is a gap in terms of knowledge and use, especially of those tools oriented to the disciplinary field and research.

Factors influencing e-Health service in regional Bangladesh

OBJECTIVES

This study probed the current status of e-health services use and associated factors that promote or hinder the people to get involved with e-health services.

METHODS

The quantitative data were collected using a structured interview schedule considering 381 randomly selected respondents covering rural and urban areas of Patuakhali, Jhalakathi, and Barishal district during February-April 2019. Only the adult (more than 18 years age) male, female, and transgender people living in the study area were included in the sample of the study. Descriptive statistics, Chi-square test, and binary logistic regression were used to analyze data.

RESULTS

Factors that significantly increased the likelihood of using e-health services included age (odds ratio [OR] = 1.05, 95% confidence interval [CI]: 1.02-1.08), males (OR = 3.75, 95% CI: 1.70-8.26), knowledge in e-health (OR = 1.19, 95% CI: 1.02-1.38), and skill in using cell phone (OR = 1.11, 95% CI: 1.02-1.21). On the contrary, factor that negatively influenced the use of e-health services was residence in the rural area (OR = 0.209, 95% CI: 0.08-0.53). Although, this research is one of the few regional researches in e-health service use, the study has limited geographical coverage, failed to explore causality of factors, and did not address factors mediating the relationship of criterion and predictor variables.

CONCLUSION

Regional e-health service providers in developing countries need to focus more on minimizing e-health service divide based on gender and place of residence. In addition, they should also emphasize digital literacy, particularly e-health knowledge and skill in device use. The findings of this study may provide an applied guideline to enhance the use of e-health services among regional communities in developing countries.

Public Health Interventions' Effect on Hospital Use in Patients With COVID-19: Comparative Study

BACKGROUND

Different states in the United States had different nonpharmaceutical public health interventions during the COVID-19 pandemic. The effects of those interventions on hospital use have not been systematically evaluated. The investigation could provide data-driven evidence to potentially improve the implementation of public health interventions in the future.

OBJECTIVE

We aim to study two representative areas in the United States and one area in China (New York State, Ohio State, and Hubei Province), and investigate the effects of their public health interventions by time periods according to key interventions.

METHODS

This observational study evaluated the numbers of infected, hospitalized, and death cases in New York and Ohio from March 16 through September 14, 2020, and Hubei from January 26 to March 31, 2020. We developed novel Bayesian generalized compartmental models. The clinical stages of COVID-19 were stratified in the models, and the effects of public health interventions were modeled through piecewise exponential functions. Time-dependent transmission rates and effective reproduction numbers were estimated. The associations of interventions and the numbers of required hospital and intensive care unit beds were studied.

RESULTS

The interventions of social distancing, home confinement, and wearing masks significantly decreased (in a Bayesian sense) the case incidence and reduced the demand for beds in all areas. Ohio's transmission rates declined before the state's "stay at home" order, which provided evidence that early intervention is important. Wearing masks was significantly associated with reducing the transmission rates after reopening, when comparing New York and Ohio. The centralized quarantine intervention in Hubei played a significant role in further preventing and controlling the disease in that area. The estimated rates that cured patients become susceptible in all areas were small (<0.0001), which indicates that they have little chance to get the infection again.

CONCLUSIONS

The series of public health interventions in three areas were temporally associated with the burden of COVID-19-attributed hospital use. Social distancing and the use of face masks should continue to prevent the next peak of the pandemic.

A comparative analysis of kratom exposure cases in Thailand and the United States from 2010-2017

Background: Interest in the Southeast Asian natural remedy kratom has increased in Western countries recently, along with increasing concern over its potential toxic effects.Objective: To describe and compare demographics, common co-exposure substances, clinical effects, treatments, and medical outcomes of kratom "abuse" exposures in the United States (US) and Thailand.Methods: This is a retrospective analysis of kratom "abuse" exposures, defined as use when attempting to gain a psychotropic effect, reported to the National Poison Data System (NPDS) in the US and the Ramathibodi Poison Center (RPC) in Thailand from 2010 to 2017. Multivariate analysis identified risk factors for severe medical outcomes, defined as both ICU admissions and death.Results: Nine-hundred-twenty-eight cases were included (760 from NPDS and 168 from RPC). A greater proportion of cases involved co-exposures in Thailand (64.8% versus 37.4%; odds ratio [OR] = 3.10, 95% confidence interval [CI] = 2.15-4.47, p < .01). Both countries had a similar prevalence of opioid and benzodiazepine co-ingestions, but the US had more co-ingestions with other sedatives (4.6% versus 0%, OR = 0, 95% CI = 0-0.47, p < .01). Common clinical effects included tachycardia (30.4%), agitation/irritability (26.2%), and drowsiness/lethargy (21.1%). Six deaths occurred, including one single-substance exposure in the US, three multiple-substance exposures in the US, and two multiple-substance exposures in Thailand. Severe medical outcomes were reported more frequently in the US (OR = 18.82, 95% CI = 5.85-60.56, p < .01).Conclusions: Despite lower frequencies of co-ingestants overall, US kratom abuse exposures yielded greater clinical severity. This disparity may be attributable to differences in the products labeled "kratom," greater sedative co-exposures in the US, and/or differences in population genetics or use patterns.

Effect of awareness of being monitored on wearing of orthopaedic footwear

OBJECTIVE

To investigate the effect of awareness of being monitored on wearing time and adherence to wearing orthopaedic footwear. Quantitative assessment of wearing time was made using direct measurement with temperature sensors during the first 3 months after provision of footwear.

DESIGN

Randomized controlled trial.

INTERVENTION

Awareness that the temperature sensor is used for measuring wearing time.

METHODS

All 55 participants had a temperature sensor built into the medial arch of the left insole of their orthopaedic footwear. Participants were assigned randomly to either an "awareness group" (n = 25, mean age 67 years) and knew they were being monitored for wearing time, or a "no awareness group" (n = 30, mean age 65 years) and only knew their shoe temperature was being measured. Differences were assessed with a linear mixed model.

RESULTS

Mean (standard deviation; SD) wearing time in the intervention group was 7.32 h/day (SD 4.2), and 6.11 h/day (SD 4.1) in the control group (p = 0.017). A significant interaction effect was found between awareness and pathology group on wearing time (p = 0.036). The difference was especially large (7.0 (SD 4.7) vs 2.4 (SD 2.2) h/day) in the subgroup of people with diabetes.

CONCLUSION

Awareness of being monitored increases wearing time and wearing of orthopaedic footwear.

Factors Related to the Behavior of People Who Have Never Used the Internet for Voluntary Reasons: Cross-Sectional Survey Study

BACKGROUND

If there are people who do not want to use the internet despite having the circumstances and conditions for using it, another policy consideration will be needed.

OBJECTIVE

The purpose of this study was to explore the factors related to the behavior of people who do not voluntarily use the internet.

METHODS

A cross-sectional survey was conducted in 2018. It used a proportional quota random sampling design to select a representative sample of Koreans. Accordingly, 6150 participants were included in the study. Multiple logistic regression methods were used to explore the predicting factors of the act of voluntarily not using the internet.

RESULTS

Age, education level, bonding and bridging social capitals, and daily life satisfaction for health status were found to be factors related to the behavior of not voluntarily using the internet. However, gender, household income, occupation, family size, and community type were not related to voluntary nonuse of the internet.

CONCLUSIONS

It was found that sociodemographic factors, such as age and education level, which are difficult to modify, along with psychosocial factors located deeper than the visible living conditions, such as social capital and life satisfaction, are involved in voluntary internet nonuse. These results also suggest that it is not desirable to proceed with policies related to information and communications technology on a separate track, but rather that they should be comprehensively approached with other social policies that design various social interventions in order to enhance equity within the society.

Survey of the Preparation of Cardiovascular Emergency Medications for Adult Cardiovascular Anesthesia

OBJECTIVES

To describe current practices and safety concerns regarding cardiac emergency medications in cardiac anesthesia.

DESIGN

An anonymous survey with multiple-choice questions.

SETTINGS

Online survey using Opinio platform.

PARTICIPANTS

Cardiac anesthesiologists from United States and Canada.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Response rate was 12% (n = 320), with 78% of respondents from the United States and 22% from Canada. The majority of the respondents were experienced (66%), academic (60%), and worked in large cardiac institutions (81%). Most cardiac emergency medications were prepared in the operating room (53.4%), followed by the pharmacy (34%) and industry (8.2%). American respondents had more medications prepared by a pharmacy (53%) versus Canadian (10%, p < 0.001). The majority (85%) considered expiration time of cardiac medications prepared in the operating room to be more than 12 hours. Familiarity with the American Society of Anesthesiologists guidelines on labeling was 58%, other medication safety guidelines 25%, and 34% were not familiar with any guidelines. The majority used color-coded labeling (95%), and a minority (11%) used bar-code systems. Most respondents (69%) agreed that lack of availability of preprepared medications could compromise patient safety. Having to prepare medications by themselves was a concern for respondents based on distractions (66%), lack of availability for emergencies (53%), labeling errors (41%), incorrect concentration (36%), sterility (33%), and stability (30%).

CONCLUSION

This survey found that cardiac emergency medications commonly are prepared in the operating room. The authors identified gaps in familiarity with parenteral medications safety guidelines. Most safety concerns could be addressed with the application of current medication safety guidelines.

Environmental Methamphetamine Exposures and Health Effects in 25 Case Studies

The clandestine manufacture and use of methamphetamine can result in contamination of residential properties. It is understood that this contamination remains in homes for a significant period, however there are a lack of data available to understand the health effects of exposure to environmental methamphetamine contamination (third-hand exposure). Our study collected information from 63 individuals in 25 separate case studies where the subjects had unwittingly suffered third-hand exposure to methamphetamine from former manufacture, use, or both. Data included environmental contamination data, information on subjects' health effects, and evidence of exposure using hair analysis. This study identified a range of health effects that occur from residing in these properties, including behavioural effects or issues, sleep issues, respiratory effects, skin and eye effects, and headaches. Methamphetamine was detected in hair samples from some individuals, including children. The exposures and concomitant reported health effects covered a wide range of environmental methamphetamine levels in the properties, including low levels close to the current Australian guideline of 0.5 µg methamphetamine/100 cm². There were no discernible differences between health effects from living in properties contaminated from former manufacture or use. This study demonstrates that residing in these properties can represent a serious public health risk.

Main Challenges and Actions Needed to Improve Conservation and Sustainable Use of Our Crop Wild Relatives

Crop wild relatives (CWR, plural CWRs) are those wild species that are regarded as the ancestors of our cultivated crops. It was only at the end of the last century that they were accorded a high priority for their conservation and, thus, for many genebanks, they are a new and somewhat unknown set of plant genetic resources for food and agriculture. After defining and characterizing CWR and their general threat status, providing an assessment of biological peculiarities of CWR with respect to conservation management, illustrating the need for prioritization and addressing the importance of data and information, we made a detailed assessment of specific aspects of CWRs of direct relevance for their conservation and use. This assessment was complemented by an overview of the current status of CWRs conservation and use, including facts and figures on the in situ conservation, on the ex situ conservation in genebanks and botanic gardens, as well as of the advantages of a combination of in situ and ex situ conservation, the so-called complementary conservation approach. In addition, a brief assessment of the situation with respect to the use of CWRs was made. From these assessments we derived the needs for action in order to achieve a more effective and efficient conservation and use, specifically with respect to the documentation of CWRs, their in situ and ex situ, as well as their complementarity conservation, and how synergies between these components can be obtained. The review was concluded with suggestions on how use can be strengthened, as well as the conservation system at large at the local, national, and regional/international level. Finally, based on the foregoing assessments, a number of recommendations were elaborated on how CWRs can be better conserved and used in order to exploit their potential benefits more effectively.

Broad Spectrum project: factors determining the quality of antibiotic use in primary care: an observational study protocol from Italy

INTRODUCTION

The overuse of antibiotics is causing worldwide spread of antimicrobial resistance (AMR). Compared with other countries, Italy has both high antibiotic consumption rates and high rates of AMR. Due to the fact that around 90% of antibiotics are prescribed by general practitioners (GPs), this study aims to measure the impact of knowledge, attitudes and sociodemographic and workplace-related factors on the quality of antibiotic prescriptions filled by GPs in the Italian Region of Sardinia.

METHODS AND ANALYSIS

Knowledge, attitude, sociodemographic and workplace-related factors deemed to influence physicians prescribing behaviour will be evaluated in a cross-sectional study conducted among all GPs of the Italian Region of Sardinia (n=1200). A knowledge and attitudes questionnaire (Knowledge and Attitudes on Antibiotics and Resistance - Italian version: ITA-KAAR) accompanied by a sociodemographic form will be linked to drug prescription data reimbursed by the National Health System. European Surveillance of Antibiotic Consumption quality indicators for outpatient antibiotic use will be calculated from drug prescription records. Every GP will be deemed to have demonstrated an adequate quality of prescriptions of antibiotics if half of the indicator score plus one is better than the median of the region. A multivariate Poisson regression model with robust variance estimation will be used to evaluate the impact of the determinants of antibiotic prescriptions on the actual prescribing quality of each physician.

ETHICS AND DISSEMINATION

The project has been approved by the ethics committee of the Regional Health Trust of Sardinia (176/2019/CE, 24 September 2019). The results will be useful to inform evidence-based interventions to tackle irrational antibiotic use in the community.

The Effect of the COVID-19 Pandemic on Physicians' Use and Perception of Telehealth: The Case of Lebanon

The COVID-19 pandemic forced physicians to quickly adapt and find ways to provide their usual offline services by using online tools. We aimed to understand how physicians adapted to the sudden need for telehealth and if their perception of telehealth changed due to their experience during the COVID-19 pandemic. We conducted an exploratory sequential mixed-methods study. We interviewed five Lebanese physicians and thematically analyzed the interviews. We developed a questionnaire based on the analysis results and administered it online to physicians in Lebanon. In total, 140 responses were collected. We found that, during the COVID-19 pandemic, physicians engaged in more telehealth activities in the realms of telemedicine, public awareness, continuing medical education, research, administration, and teaching. They also expanded their repertoire of information-technology tools. Our results also show that there was a significant shift in the physicians' perceptions, indicating greater openness and willingness to adopt telehealth services. However, a significant amount of skepticism and uncertainty regarding telemedicine remains, especially concerning its efficiency, safety, and the adequacy of existing regulations. Based on our findings, we offer recommendations for health IT policy makers, developers, and researchers, to sustain the continuity of telehealth activities beyond the COVID-19 pandemic.

Nurses' Viewpoints on Barriers and Facilitators to Use Hospital Information Systems

In this qualitative study, we explored the nurses' experience in using hospital information systems (HIS) to identify barriers and facilitators of using this system. We interviewed twenty one purposefully-selected nurses who have experience in using HIS and analyzed the data using conventional content analysis. We identified 17 facilitators and 12 barriers classified into main themes. Lack of support for nurses, their resistance, any force for using HIS, perceived difficulty of using HIS, inadequate system quality, data loss, discontinuity of information in different systems are the main barriers. However, considering nurses' perspectives, pilot implementation of HIS, training, planned implementation, appropriate financial and non-financial incentives, adding new and appropriate functionalities, increased ease of use and usability, easy access to information, improved data quality in HIS, and saving nurses' working time through using HIS result in increased adoption the system to use.

An observational study demonstrating the adherence and ease of use of the injector device, RebiSmart®

Background: Adherence to Multiple Sclerosis (MS) treatment is considered one of the crucial factors for ensuring optimal clinical outcomes. Research has shown that the use of self-injector devices improves patient compliance with treatment. Therefore, the main purpose of this study is to evaluate the ease of use of RebiSmart® 2.0 in clinically isolated syndrome/relapsing-remitting MS patients during 12 months treatment period.Methods: A total number of 290 subjects entered into data collection; 249 (86%) of them completed the whole 12 months study period. The primary endpoints and the secondary endpoints were assessed by the User Study Questionnaire. Adherence data were retrieved from RebiSmart® 2.0 (Menu - Dose History) on the respective patient's visit. Outcome measures also included Expanded Disability Status Score, Kurtzke Functional Systems, and Modified Social Support Survey, Modified Social Support Survey-5.Results: This study demonstrated a very high proportion (>95%) of patients with a positive rating of the overall ease of use and the overall convenience of RebiSmart®. The proportion of patients with a positive rating of the ease of use by individual domains and the functions of RebiSmart® were also high (>80%).Conclusion: The findings demonstrate a very good perception of the usability of the device by patients overall and in its individual functions.

Inequalities Between Migrants and Non-Migrants in Accessing and Using Health Services in Greece During an Era of Economic Hardship

A cross-sectional study was conducted from April 2013 until March 2014 to explore the existence of inequalities in access to and utilization of health services by migrants compared to non-migrants in Greece and to test the influence of various factors on these disparities. Also, we investigated the influence of several socioeconomic and demographic characteristics. Study population included 1,152 migrants and 702 non-migrants. Migrants, participants suffering from a chronic disease, those without health insurance, and patients who assessed their health status as not at all good/a little good/moderate were statistically more likely to report unmet needs in getting their medication. Uninsured participants, females, those unemployed or without a permanent occupational status, and those who assessed their health status as not at all good/a little good/moderate were statistically more likely to report unmet needs in access to health services during the last year. Regarding the use of health services, those with health coverage, non-migrants, and females were statistically more likely to go for a blood test as a hospital outpatient. Greece, despite administrative delays and barriers, provided full coverage to the uninsured, asylum seekers, and migrants, even many groups of undocumented migrants.

Hall Technique for Carious Primary Molars: A Review of the Literature

The high frequency of caries in primary teeth and its inadequate treatment are major public health problems during childhood. Nowadays, the Hall technique is one of the methods used for biological sealing in carious lesions in primary molars. Thus, the bacteria will be sealed from oral environment and the caries will be inactive. The objective of this article was to provide an updated search on the Hall technique description, indication, contraindication, advantages, concerns, success and failure, cost-effectiveness, acceptability, and preference in pediatric dentistry, and to compare the Hall technique with traditional crown preparation and conventional treatment options for carious primary molars. A discussion of the recently published articles on the Hall technique reveals that the Hall technique is considered a promising restorative option with high acceptability and longevity; with low failure rate for managing carious primary molars compared to conventional treatment modalities used in primary care settings. Furthermore, the survival rate of stainless steel crowns (SSCs) is considered high, whether provided using Hall technique or traditional preparation by a pediatric dentist. Thus, the Hall technique can be an effective addition to the clinician’s range of treatment options for carious primary molars. However, it should be chosen in restricted cases.

Addressing Inequity: Evaluation of an Intervention to Improve Accessibility and Quality of a Green Space

Green space areas offer several benefits that support our physical, psychological, and social health. However, the level of engagement with green space areas may not be the same across population groups. Using a mixed-method research design, we investigated the use of a green space area and whether and how the area was beneficial for health, social inclusion, and physical activity for all socioeconomic groups in a suburban area in Norway. The study showed significantly increased use of the area from 2015-2018 and that users belonged to different socioeconomic groups. The motivation for using the area was the opportunity to experience nature and to interact socially. While no significant changes in self-rated health, life satisfaction, or levels of physical activity were found, the study indicates that factors such as location, availability, and designated places for social interaction are important motivating factors for use. Users from the lower socioeconomic groups were among the frequent users but were also the least satisfied with the quality and availability of the path. Our findings call for closer consideration of the location and availability of green spaces and that including places for social interaction and relaxation can contribute to increased use of green spaces.