Champions in usage of medial unicompartmental knee arthroplasty : The story behind the Danish success

Historically, the use of medial unicompartmental knee arthroplasty (mUKA) as treatment for end-stage anteromedial osteoarthritis (AMOA) of the knee was limited by contraindications due to age, weight, and activity level; however, now evidence-based, validated, and less selective criteria are used rendering nearly 50% of end-stage OA patients eligible for mUKA. Recent studies have showcased benefits, such as shorter hospital stays, cost efficiency, and comparable functional outcomes to total knee arthroplasty (TKA). Notably, revision rates have been shown to markedly decrease with increased usage, with an ideal usage of > 30% but an acceptable usage of 20-60%. The usage of unicompartmental knee arthroplasty (UKA) varies among countries, with Denmark achieving a notably higher usage compared to Sweden, the UK, the Netherlands, the USA and Germany. This article investigates potential factors contributing to Denmark having a higher national usage of mUKA, surpassing the recommended threshold of a usage > 20%. We explore the tradition for national alliances and streamlined surgical education as possible explanations of this development. These insights offer valuable perspectives for potentially optimizing surgical approaches and implant choices in the surgical treatment of end-stage AMOA of the knee across diverse healthcare settings, underscoring the impact of collective strategies in advancing knee arthroplasty practices, ultimately benefiting patients.

The relation between usage of an eHealth intervention for stress urinary incontinence and treatment outcomes: an observational study

BACKGROUND

Stress urinary incontinence (SUI), though a prevalent condition among women, is undertreated in primary care. EHealth with pelvic floor muscle training is an evidence-based alternative to care-as-usual. It is unknown, however, how eHealth usage is related to treatment outcome, and this knowledge is required for general practitioners to implement eHealth in their practice. This study examines the relation between usage of eHealth for SUI and treatment outcomes by examining log data. Baseline factors were also explored for associations with treatment success.

METHOD

In this pre-post study, women with SUI participated in "Baasoverjeblaas.nl", a web-based intervention translated from the Swedish internet intervention "Tät®-treatment of stress urinary incontinence". Usage was based on log data and divided into three user groups (low, intermediate and high). Online questionnaires were sent before, after treatment and at six-months follow-up. The relation between usage and the primary outcome - treatment success (PGI-) - was studied with a binomial logistic regression analysis. Changes in the secondary outcomes - symptom severity (ICIQ-UI SF) and quality of life (ICIQ-LUTSqol) - were studied per user group with linear mixed model analysis.

RESULTS

Included were 515 users with a mean age of 50.5 years (12.0 SD). The majority were low users (n = 295, 57.3%). Treatment success (PGI-I) was reached by one in four women and was more likely in high and intermediate users than in low users (OR 13.2, 95% CI 6.1-28.5, p < 0.001 and OR 2.92, 95% CI 1.35-6.34, p = 0.007, respectively). Symptom severity decreased and quality of life improved significantly over time, especially among high users. The women's expected ability to train their pelvic floor muscles and the frequency of pelvic floor muscle exercises at baseline were associated with treatment success.

CONCLUSION

This study shows that usage of eHealth for SUI is related to all treatment outcomes. High users are more likely to have treatment success. Treatment success is more likely in women with higher expectations and pelvic floor muscle training at baseline. These findings indicate that general practitioners can select patients that would be more likely to benefit from eHealth treatment, and they can enhance treatment effect by stimulating eHealth usage.

TRIAL REGISTRATION

Landelijk Trial Register NL6570;  https://onderzoekmetmensen.nl/nl/trial/25463 .

Evaluating rates of chiropractic use and utilization by patient sex within the United States Veterans Health Administration: a serial cross-sectional analysis

BACKGROUND

Within the United States Veterans Health Administration (VHA), the number of patients using healthcare services has increased over the past several decades. Females make up a small proportion of overall patients within the VHA; however, this proportion is growing rapidly. Previous studies have described rates of VHA chiropractic use; however, no prior study assessed differences in use or utilization rates between male and female veterans. The purpose of this study was to assess rates of use and utilization of chiropractic care by sex among VHA patients receiving care at VHA facilities with on-station chiropractic clinics.

METHODS

A serial cross-sectional analysis of VHA national electronic health record data was conducted in Fall 2021 for fiscal year (FY) 2005-2021. The cohort population was defined as VHA facilities with on-station chiropractic clinics, and facilities were admitted to the cohort after the first FY with a minimum of 500 on-station chiropractic visits. Variables extracted included counts of unique users of any VHA on-station facility outpatient services, unique users of VHA on-station facility chiropractic services, number of chiropractic visits, and sex. To calculate use, we determined the proportion of patients of each sex who received chiropractic services to the total patients of the same sex receiving any outpatient care within each facility. To calculate utilization, we determined the number of chiropractic care visits per patient per fiscal year. A linear mixed effects model was applied to examine the difference in chiropractic care utilization by sex.

RESULTS

The percentage of female VHA on-station chiropractic patients increased from 11.7 to 17.7% from FY2005-FY2021. Among VHA facilities with on-station chiropractic care, the percentage of female VHA healthcare users who used chiropractic care (mean = 2.3%) was greater than the percentage of male VHA healthcare users who used chiropractic care (mean = 1.1%). Rates of chiropractic utilization by sex among VHA facilities with on-station chiropractic clinics were slightly higher for females (median = 4.3 visits per year, mean = 4.9) compared to males (median = 4.1 visits per year, mean = 4.6).

CONCLUSION

We report higher use and utilization of VHA chiropractic care by females compared with males, yet for both sexes rates were lower than in the private US healthcare system. This highlights the need for further assessment of the determinants and outcomes of VHA chiropractic care.

A systematic review on factors influencing learning management system usage in Arab gulf countries

Although the successful implementation of the Learning Management System (LMS) in most of the universities in the Arab Gulf Countries (AGC), little consideration has been paid to exploring LMS usage. This paper provides a systematic review of the current literature focusing on the most critical factors influencing LMS usage in AGC. The extant literature was identified through six electronic databases from 2013 to 2023. Academic articles were reviewed if they contained a relevant discussion of the factors influencing LMS acceptance and adoption conducted in AGC. Results from a systematic review of 34 studies showed that 15 studies were centred in Saudi Arabia. The results also, revealed that Technology Acceptance Model was the dominant model employed, and students were the main subject of studies. Moreover, the quantitative approach was the preferred design. Overall, forty-one factors were identified, and the results show that the following eight factors appear most frequently: Perceived Ease of Use, Perceived Usefulness, Social Influence, Performance Expectancy, Effort Expectancy, Facilitating Conditions, Self-efficacy, and Attitude. This review will be valuable for future research and helpful for higher education decision-makers who intend to use eLearning to overcome the challenges they face in using LMS effectively.

Mosquito bed net use and associated factors among pregnant women in Rwanda: a nationwide survey

BACKGROUND

In malaria-endemic countries such as Rwanda, the appropriate use of mosquito bed nets is an effective intervention for malaria prevention. Despite being one of the demographics most impacted by malaria, there is a dearth of literature on the usage of mosquito bed nets by pregnant women in Rwanda. The study aimed to assess the prevalence and associated factors for mosquito bed net use among pregnant women in Rwanda.

METHODS

We used weighted data from the 2020 Rwanda Demographic and Health Survey of 870 pregnant women, and multistage stratified sampling was used to select participants. Multivariable logistic regression was conducted to determine the factors associated with mosquito bed net use, using SPSS (version 26).

RESULTS

Of the 870 pregnant women, 57.9% (95%CI: 54.6-61.1) used mosquito bed nets. However, 16.7% did not use bed nets among those owning bed nets. On one hand, older age (AOR = 1.59, 95%CI: 1.04-2.44), primary education (AOR = 1.18, 95%CI: 1.07-2.23), being married (AOR = 2.17, 95%CI: 1.43-3.20), being from Kigali region (AOR = 1.97, 95%CI: 1.19-3.91), partner's education (AOR = 1.22, 95%CI: 1.13-3.41), having recently visited a health facility (AOR = 2.07, 95%CI: 1.35-3.18), and being in the third pregnancy trimester (AOR = 2.14, 95%CI: 1.44-3.18) were positively associated with mosquito bed net use. On the other hand, low wealth index (AOR = 0.13, 95%CI: 0.07-0.24), and being from Eastern region (AOR = 0.42, 95% CI: 0.26-0.66) had a negative association.

CONCLUSIONS

About half of the pregnant women in Rwanda used mosquito bed nets and the usage was associated with various socio-demographics. There is a need for appropriate risk communication and continuous sensitisation to improve mosquito net use among pregnant women. Early antenatal care attendance and partner engagement in malaria prevention and mosquito net use, as well as consideration of household dynamics, are also crucial in improving not only mosquito net coverage but also utilization.

Robotic-arm assisted unicompartmental knee arthroplasty system has a learning curve of 11 cases and increased operating time

PURPOSE

UKA has higher revision risk, particularly for lower volume surgeons. While robotic-arm assisted systems allow for increased accuracy, introduction of new systems has been associated with learning curves. The aim of this study was to determine the learning curve of a UKA robotic-arm assisted system. The hypothesis was that this may affect operative times, patient outcomes, limb alignment, and component placement.

METHODS

Between 2017 and 2021, five surgeons performed 152 consecutive robotic-arm assisted primary medial UKA, and measurements of interest were recorded. Patient outcomes were measured with Oxford Knee Score, EuroQol-5D, and Forgotten Joint Score at 6 weeks, 1 year, and 2 years. Surgeons were grouped into 'low' and 'high' usage groups based on total UKA (manual and robotic) performed per year.

RESULTS

A learning curve of 11 cases was found with operative time (p < 0.01), femoral rotation (p = 0.02), and insert sizing (p = 0.03), which highlighted areas that require care during the learning phase. Despite decreased 6-week EQ-5D-5L VAS in the proficiency group (77 cf. 85, p < 0.01), no difference was found with implant survival (98.2%) between phases (p = 0.15), or between 'high' and 'low' usage surgeons (p = 0.23) at 36 months. This suggested that the learning curve did not lead to early adverse effects in this patient cohort.

CONCLUSION

Introduction of a UKA robotic-arm assisted system showed learning curves for operative times and insert sizing but not for implant survival at early follow-up. The short learning curve regardless of UKA usage indicated that robotic-arm assisted UKA may be particularly useful for low-usage surgeons.

LEVEL OF EVIDENCE

Level III, Retrospective cohort study.

Usage of a Web-Based Workplace and Symptom Self-Management Intervention Tool to Improve Work Ability for Breast Cancer Survivors

This work aimed to evaluate the usage of a web-based intervention (WISE: Work ability Improvement through Symptom and Ergonomic strategies) developed to improve work ability for women recently diagnosed with breast cancer. Twenty-two women undergoing adjuvant treatment for breast cancer were provided access to WISE. This website includes content pages (e.g., information on ergonomics, symptom management, and other work-related resources) and worksheets (e.g., journals to track symptoms or goals). It could be personalized based on individual work activities and symptoms. Measures assessed at 3 months included usage of the website and perceived usefulness. Thirteen of the 22 participants (60%) accessed WISE; 11 personalized their information. Content and worksheet pages had 97 and 79 visits, respectively. Most frequently visited pages were "setting goals" (i.e., prioritize and track symptoms; 45 visits) and "steps to creating your WISE plan" (i.e., incorporate symptom and ergonomic strategies; 16 visits). Median duration time was 11.05 (range 0.35-79.55) minutes. Usefulness of the content and worksheet pages assessed via a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree) was 5.08 (SD = 1.59) and 4.26 (SD = 2.03), respectively. Participants were likely to recommend WISE to other women undergoing cancer treatment (mean = 6.11; SD = 1.05). The majority of participants personalized WISE work and symptom strategies. Overall, participants agreed that WISE content pages were useful and would recommend WISE for other breast cancer survivors. Results support that majority of breast cancer survivors, undergoing treatment with curative intent, accessed a web-based intervention that provided personalized information on workplace and symptom strategies.

Qualitative study on the use and maintenance of long-lasting insecticidal nets (LLINs) in Bouaké (Côte d'Ivoire), 17 months after the last mass distribution campaign

Background

The use of long-lasting insecticide-treated nets (LLINs) is one of the main malaria prevention method promoted by the World Health Organization (WHO) in Côte d'Ivoire. LLIN-coverage has reached 95% since 2015 and nearly 16 million LLINs were distributed in 2017. Despite these efforts, malaria incidence at the national level remains high (120‰ in 2012 to 164‰ in 2017) although this could be partly explained by increased screening efforts. This study aimed at determining what preventative measures were used against mosquito bites, as well as LLIN maintenance practices used by the inhabitants of the city of Bouaké, capital city of the Gbêkê region with a malaria incidence of 257‰ in 2017.

Methods

A descriptive qualitative investigation took place in Bouaké, in four neighbourhoods that were selected through purposive sampling based on their social composition. Data were collected using an interview guide based on convenience sampling.

Results

The results of the study reveal that LLINs are the most reported used malaria prevention measure (66.4%). Environmental health (28.8%) came second in their declarations, smoke coils (23.5%) third and aerosol cans (18.8%) last. The percentage of respondents who answered that they had slept under an LLIN the previous night was 53%. 57.7% reported that they wash their LLINs, 12.1% that they do not wash them, and 4% that they replace dirty LLINs with new ones. The LLINs washing methods described by the respondents did not comply with the WHO recommendations and there was no mention of LLINs repairs.

Conclusion

Despite mass distributions of LLINs in Côte d'Ivoire, this key malaria control tool remains under-used by the population. Regarding LLIN maintenance, more than half of the population reports that they wash their nets while not complying with recommended practices or repairing them.

The management of hand osteoarthritis: The rheumatologist's perspective

Hand osteoarthritis (OA) is treated by several medical professionals. In this review the rheumatologist's perspective will be conveyed. The rheumatologist tasks are to diagnose hand OA, exclude other causes of patient's complaints, and provide treatment. The rheumatologist therefore has a distinctive and important role in hand OA treatment. Although no disease modifying treatment exists, there are multiple options for managing hand OA in rheumatology practice, with the goal of achieving symptom relief and optimizing hand function. These treatments can be non-pharmacological or pharmacological. In this review we will provide a summary of evidence-based management options based on existing guidelines. Furthermore, we will describe common practice among rheumatologists for hand OA management. In order to do so, we performed a literature review of studies addressing treatment modality usage for hand OA. The review comprised 25 studies, which were heterogeneous in terms of treatment modality usage. In addition, a detailed description of care usage by patients in a Rheumatology outpatient clinic is given, based on data of our Hand OSTeoArthritis in Secondary care primary hand OA cohort. The large majority of these patients used any form of hand OA treatment (83%). Non-pharmacological treatment was less frequently used (47%) than pharmacological treatment (77%).

An industrial exoskeleton user acceptance framework based on a literature review of empirical studies

Studying the acceptance of exoskeletons in industry has gained increased attention. Exoskeletons (wearable support devices) are envisioned to alleviate heavy work. Examining what factors influence the use of exoskeletons is important, because influencing these factors could positively contribute to the adoption of industrial exoskeletons. The factors identified in this paper have been systematically derived from empirical research with (potential future) end users, most of whom have tried on an exoskeleton. Our framework with factors influencing the acceptance of industrial exoskeletons can be used during the (ideally iterative) design, (re)development and evaluation phase of new or existing exoskeletons. This could improve the quality of exoskeletons since this allows designers to already consider acceptance factors early in the design process instead of finding out what is important late in the design process during (field) testing. In turn, this might accelerate the adoption of exoskeletons. Also, our framework can be used to study the ongoing introduction of exoskeletons at work since it also addresses policy decisions companies interested in implementing exoskeletons should consider.

Low percentage of surgeons meet the minimum recommended unicompartmental knee arthroplasty usage thresholds: Analysis of 3037 Surgeons from Three National Joint Registries

PURPOSE

The reported usage of UKA is around 10% in the UK, Australian and New Zealand joint registries. However, some authors recommend that a higher UKA usage of 20%, or a minimum 12 UKA cases per year, would reduce revision rates. The purpose of this study was to analyze the percentage of surgeons performing the recommended thresholds in these 3 registries.

METHODS

Data from the UK, Australian and New Zealand registry databases was utilized from the time period since their respective introduction until 2017. All primary TKA and UKA performed for the diagnosis of osteoarthritis by surgeons with more than 100 recorded knee arthroplasties in their respective registry were included. The results between the registries were compared and a pooled analysis was performed. The number of surgeons meeting the recommended caseload of > 20% UKA yearly or 12 UKA cases yearly was calculated.

RESULTS

We identified 3037 knee surgeons performing 1,556,440 knee arthroplasties, of which 131,575 were UKA (8.45%). Over 50% of knee surgeons in each registry had a proportion of less than 5% UKA of their knee replacement procedures. After pooling of data, median surgeon UKA usage was 2.0% (IQR 0-9.1%). The percentage of surgeons meeting the proposed caseload criteria was highest in New Zealand, 16.3%, followed by the UK at 12.4% and Australia 11.3% (p = 0.28).

CONCLUSION

More than 50% of knee surgeons in UK, Australian and New Zealand joint registries perform less than 5% of UKA yearly. The majority of experienced knee surgeons are not meeting the recommended minimum thresholds, which might indicate that the recommended thresholds are not feasible for the vast majority of knee surgeons. The reasons behind this require further research.

LEVEL OF EVIDENCE

Level III retrospective registry study.

Measuring appropriate need for unicompartmental knee arthroplasty: results of the MANUKA study

PURPOSE

Indications for unicompartmental knee arthroplasty (UKA) are controversial. Studies based solely on radiographic criteria suggest up to 49% of patients with knee osteoarthritis (OA) are suitable for UKA. In contrast, the 'Appropriate use criteria' (AUC), developed by the AAOS, apply clinical and radiographic criteria to guide surgical treatment of knee OA. The aim of this study was to analyze patient suitability for TKA, UKA and osteotomy using both radiographic criteria and AUC in a cohort of 300 consecutive knee OA patients.

METHODS

Included were consecutive patients with clinical and radiographic signs of knee OA referred to a specialist clinic. Collected were demographic data, radiographic wear patterns and clinical findings that were analyzed using the AUC. A comparison of the radiographic wear patterns with the treatment suggested by the AUC as well as the Surgeon Treatment Decision was performed.

RESULTS

There were 397 knees in 300 patients available for analysis. Median age was 68 [IQR 15], BMI 30 [6] with 55% females. Excellent consistency for both the radiographic criteria and the AUC criteria was found. Based on radiological criteria, 41% of knees were suitable for UKA. However, when using the AUC criteria, UKA was the appropriate treatment in only 13.3% of knees. In 19.1% of knees, no surgical treatment was appropriate at the visit, based on the collected data.

CONCLUSION

Application of isolated radiologic criteria in patients with knee OA results in a UKA candidacy is misleadingly high. AUC that are based on both radiological and clinical criteria suggest UKA is appropriate in less than 15% of patients.

LEVEL OF EVIDENCE

III retrospective study.

[Measuring adolescents' use of social media: A systematic review]

OBJECTIVE

The purpose of this review was to provide an overview of the methods used to measure social network site use among adolescents. Such a review is important given the number and diversity of sites and the prevalence of their use among adolescents.

METHODS

A systematic review of the literature was conducted in line with PRISMA guidelines to arrive at an analysis of 58 peer-reviewed studies indexed in PubMed, PsychInfo, or Scopus. To be included in the review, articles had to be peer-reviewed, available in full text, and published in French or English. For inclusion, studies were required to pertain to adolescents aged between 11 and 18 years; to focus on social network site use and indicate how their use was estimated. Studies that simultaneously examined social network sites and general internet use or video games and only provided a combined analysis were excluded. The keywords for the search were: social media use, social media usage, social media misuse, measure, teen, and adolescents.

RESULTS

In the literature, different methods were used to operationalize the use of social network sites: quantitative methods with the measurement of frequency and duration of use of social network sites, and qualitative methods to measure the different activities adolescents engage in on such sites. In this review, 28 articles investigated the use of social media through a measurement of frequency and 22 articles through a measurement of the duration of use. Most of the studies focused on social network sites in general, without specifying which sites in particular were considered by the respondents when answering the question. However, some articles provided cross measures of quantitative and qualitative measurements resulting in the examination of both the frequency of use and the time spent on specific activities on social network sites.

CONCLUSIONS

The present review highlights the great diversity in the methods used to measure the use of social network sites among adolescents. The reliance on frequency-based measurements without taking into account the specificities of the activities or sites involved limits the investigation of their impact on adolescent functioning and behaviors. Given the observed discrepancies in the literature concerning the measurement of social network site use among adolescents and their associated biases, the development of specific instruments is needed to advance in this important field of research.

Leukocyte reduction filters as an alternative source of peripheral blood leukocytes for research

INTRODUCTION

Peripheral blood leukocytes are a suitable cell model for science research. However, blood samples from healthy volunteers are limited in volume and difficult to obtain due to the complexity of volunteer recruitment.

OBJECTIVE

Therefore, it is urgent to find an alternative source of peripheral blood leukocytes.

METHOD

One of the possibilities is the use of leukocyte reduction filters (LRFs) in blood banks that is used for preparation of leukoreduced blood products. More than 90% of the leukocytes are trapped in the leukofilters allowing the desired blood product to pass through.

RESULTS

It has been reported that the biological function of leukocytes collected from the filters are no different from those isolated from buffy coats, leukapheresis products and whole blood (WB) cells. Moreover, LRFs are waste products that are discarded after leukoreduction.

CONCLUSION

Thus, leukofilters represent an economic source of human cell populations that can be used for a variety of investigative purposes, with no cost. In the present study, we reviewed the different usage of LRFs in the research, clinical and commercial applications.

The visual story of data storage: From storage properties to user interfaces

About fifty times more data has been created than there are stars in the observable universe. Current trends in data creation and consumption mean that the devices and storage media we use will require more physical space. Novel data storage media such as DNA are considered a viable alternative. Yet, the introduction of new storage technologies should be accompanied by an evaluation of user requirements. To assess such needs, we designed and conducted a survey to rank different storage properties adapted for visualization. That is, accessibility, capacity, usage, mutability, lifespan, addressability, and typology. Withal, we reported different storage devices over time while ranking them by their properties. Our results indicated a timeline of three distinct periods: magnetic, optical and electronic, and alternative media. Moreover, by investigating user interfaces across different operating systems, we observed a predominant presence of bar charts and tree maps for the usage of a medium and its file directory hierarchy, respectively. Taken together with the results of our survey, this allowed us to create a customized user interface that includes data visualizations that can be toggled for both user groups: Experts and Public.

Integrative pediatrics survey: Parents report high demand and willingness to self-pay for complementary and integrative medicine in German hospitals

BACKGROUND

In Germany, there is hardly any institutionalization of pediatric complementary and integrative medicine (CIM) present, which is one reason why the statutory health insurance companies usually do not cover the costs. Which in turn serves as an obstacle for integrating CIM into routine pediatric care. Within the present study, we assessed existing demand for CIM methods in parents of children in clinical primary care and whether the parents would be willing to cover the costs privately.

METHODS

Parents who visited the Pediatric Department of the Elisabeth Hospital, Essen, Germany and the Children's Hospital St. Marien, Landshut, Germany with their children in 2015 and 2016 were asked to take part in a paper-pencil survey. Both outpatients and inpatients were interviewed.

RESULTS

1323 parents took part in the survey. 40 % of them stated that they already use CIM for their children. Homeopathy was the most frequently mentioned with almost 60 %, followed by osteopathy and phytotherapy. More than 80 % of the participants endorsed the expansion of the CIM offers in respective hospitals. Homeopathy was the method most desired by the parents, followed by osteopathy, phytotherapy and massage therapies. The majority (88 %) of the parents stated that they would like to take advantage of an extended range of services, including extra services that they would have to pay privately for.

CONCLUSION

Many parents are already using CIM for their children and are looking forward to CIM being incorporated in clinical primary care. They would also be willing to bear the costs themselves if the therapy in question is not covered by their insurance. pay for the costs themselves if the therapy is not covered by their insurance.

Predicting response to transdiagnostic iCBT for emotional disorders from patient and therapist involvement

BACKGROUND

Transdiagnostic iCBT has been shown to be effective for the treatment of emotional disorders. Less is known about the optimal level of therapist and patient involvement in these interventions. Specific characteristics of Internet-delivered interventions include treatment adherence (e.g., amount of review of the materials) and guidance (e.g., amount of therapist support). Exploring the importance of these elements in treatment outcome may help to maximize the efficiency of Internet-delivered psychological interventions.

AIM

In this study, we aimed to analyze the relationship between patient and therapist involvement (i.e., platform usage and amount of therapist guidance) in a sample of patients with emotional disorders who received transdiagnostic iCBT in Spanish public specialized mental healthcare services.

METHOD

This is a secondary analysis of a randomized controlled trial. The sample included 63 patients who completed transdiagnostic iCBT for emotional disorders. Platform usage metrics included number of logins into the platform and number of times the participants reviewed the modules. Therapist guidance was measured as the number of support phone calls with a therapist and their total duration (minutes). Logistic regressions and ROC analyses were performed to explore the predictive value of platform usage and therapist guidance in symptom reduction. Clinical outcomes included depressive and anxiety symptoms assessed at baseline and post-intervention. The bivariate relationship between the platform usage and therapist guidance variables was also explored.

RESULTS

Overall, platform usage and therapist guidance were not associated with symptom improvement. However, the patient and therapist involvement parameters were intercorrelated. Specifically, the number of calls and their duration were associated with a greater number of logins (r = 0.61; p < .001) and more frequent reviews of the modules (0.46 ≤ r ≤ 0.60; p < .001). Higher baseline depression and anxiety were, respectively, associated with greater improvements in depression (r = -0.37, p = .003) and anxiety after treatment completion (r = -0.48, p < .001).

DISCUSSION

The results suggest that there is no reliable cut-off point for platform usage and therapist guidance in predicting optimal symptom reduction. However, significant associations were found between platform usage and guidance variables that warrant additional research. More research on this topic is necessary to further clarify the role of these and other platform usage and guidance variables in Internet-delivered iCBT outcomes.

What virtual laboratory usage tells us about laboratory skill education pre- and post-COVID-19: Focus on usage, behavior, intention and adoption

COVID-19 pandemic has brought uncertainty in educational response, skilling methods, and training practices among teachers and institutions. Even before the pandemic shutdowns, the incorporation of virtual laboratories within classroom education had brought transformations in teaching laboratory courses. Virtual laboratories were integrated as training platforms for complementing learning objectives in laboratory education especially during this pandemic imposed shutdown. In context of suspended face-to-face teaching, this study explores the role of virtual laboratories as Massive Open Online Courses (MOOCs) in ensuring the continuity of teaching-learning, providing alternative ways for skill training from home. As an innovative approach, the study presents push-pull mooring theory to analyze switching intention of users from offline conventional education to online education. The study explores the complements of physical experiments brought in with animations, simulations, and remote laboratory set-ups for providing skill trainings to learners. To test whether virtualization techniques have global impact in education sector, the study included a comparative analysis of student users during the academic year 2019 (before-COVID) who had a blended approach of learning and those of the year 2020 (post-COVID), with remote learning. Initial before-COVID behavioral analysis on university students (n = 1059) indicated the substantial popularity of virtual laboratories in education for skill training and instructor dependency. Usage adoption of virtual laboratories increased during the pandemic-imposed lockdowns and learners were being less instructor dependent. 24% of students accessed more 10 times a week without the instructor being present and overall, 90% contributed to a minimum of 5 usages a week. In terms of Kolb's learning styles, most of the virtual laboratory learners were assimilators. The results suggest virtual laboratories may have a prominent role in inquiry based and self-guided education with minimum instructor dependency, which may be crucial for complementing practice skills and planning online tools to add to this post-COVID-19 teaching and learning scenarios.

Long lasting insecticidal mosquito nets (LLINs) ownership, use and coverage following mass distribution campaign in Lake Victoria basin, Western Kenya

Background

Long-lasting insecticidal nets (LLINs) are the most widely used malaria prevention and control intervention in Africa. However, their effectiveness may vary depending on their local geographic coverage, ownership and use at household level. This study aimed at assessing LLINs ownership and use following mass distribution campaign in western Kenya.

Methods

A cross-sectional study was conducted in November 2017. A total of 160 households were randomly selected from 16 villages. Structured questionnaires were used to collect data on households’ knowledge on malaria, LLINs ownership, utilization and their perceived benefits. Data was analyzed using IBM Statistical Package for Social Sciences (SPSS) version 21 for windows. Variables were presented as proportions and associations between variables tested using Pearson’s chi-square test.

Results

Malaria was reported to be the most frequently occurring disease (87.5%) in the area. Children under 5 years of age were reported to be at higher risks of malaria infection (28.6%). Around 31% of the respondents reported to have at least one member of the household sick with malaria a week before the interview. Commonly cited signs and symptoms of malaria were; fever (24.1%), headache (17.7%), vomiting (14.5%) feeling cold (12.6%) and loss of appetite (10%). There were 382 reported LLINs among 753 occupants in the 160 households surveyed. The average LLIN ownership was 2.4 nets per household and 1.97 persons per LLIN. Among the surveyed households, 96.9% owned at least one LLIN and 64.1% owned at least one LLIN for every two people. Among those who owned LLINs, 98.1% reported using them the previous night. Ownership per household ranged from 0 to 6 with a mean of 2.39. More than three quarter of the nets were acquired through free mass distribution campaigns and 80% were acquired less than 6 months prior to the survey.

Conclusion

Despite high net coverage and use, a number of households experienced malaria episodes in the study area. There is need to investigate the likelihood of outdoor malaria transmission and assess the physical integrity of the existing LLINs and their insecticidal effectiveness in protecting household members against malaria.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11062-7.

Local Anesthetic Usage Among Dentists: German and International Data

The aim of this study was to analyze the use of dental local anesthetics in Germany compared with international data. The type and distribution of dental local anesthetics and added vasoconstrictors based on a representative sample of German dentists itemized over a period of 7 years (2011 to 2017) were evaluated and statistically analyzed. The results were compared with international dental local anesthetic consumption data published since 2005. With a consistent market share of nearly 98%, articaine was the first-line local dental anesthetic agent in Germany. During the investigation period, German dental local anesthetics with epinephrine 1:200,000 had ∼50% market shares, whereas formulations with epinephrine 1:100,000 had 40% to 45% market shares. Articaine, with market shares between 38% and 81%, was also the preferred anesthetic agent in various other countries, with the notable exceptions of the United Kingdom and the United States, where lidocaine was the preferred local anesthetic agent. Epinephrine was the preferred vasoconstrictor internationally, similar to Germany. The larger market share of higher concentrated epinephrine 1:100,000 was remarkable, considering the increasing number of medically compromised patients. Increased consideration for using agents with reduced dosages of epinephrine (1:200,000) is generally recommended.

Complementary and Alternative Medicine Use Among Croatian Health Studies Students - A Single Center Cross-Sectional Study

OBJECTIVE

The use of complementary and alternative medicine (CAM) among healthy population and in patients with certain health conditions has been investigated in Croatia; however, no studies have been carried out among health studies students and professionals. The aim of the study was to measure the extent of CAM use among health studies students.

MATERIALS AND METHODS

An online survey was used to question students enrolled at the Faculty of Health Studies, University of Rijeka, Croatia. The questionnaire entailed several parts, including sociodemographic data, frequency of use of 31 CAM methods, the source of obtaining CAM information, as well as the main reason for using CAM.

RESULTS

Seven hundred and twenty-three students were invited to take part in the survey, of whom 207 (29%) responded, mostly females (N=172; 83.1%). The median age of the respondents was 22 years. More than half of the respondents (N=113; 54.6%) were employed. The most used CAM methods were natural products, such as vitamins and minerals (93.2%), probiotics (80.7%) and herbs (78.3%). The most used mind and body practices were massages (76.3%), deep breathing (61.4%), and spirituality and prayer (56%). The main source of information on CAM was the Internet (N=151; 72.9%). Maintenance/improvement of health was the most common reason for using CAM (49.3%).

CONCLUSION

The findings in this study suggest that the most used CAM methods among students were similar to general population; moreover, information about CAM is mostly derived from the Internet.

Unicompartmental knee arthroplasty has higher revisions than total knee arthroplasty at long term follow-up: a registry study on 6453 prostheses

PURPOSE

The purpose of this study is to analyse long-term unicompartmental knee arthroplasty (UKA) focusing on survivorship, causes of failure and revision strategy.

METHODS

This study is a retrospective analysis of data from a regional arthroplasty registry for cases performed between 2000 and 2017. A total of 6453 UKAs were identified and the following information was analysed: demographic data, diagnosis leading to primary implant, survivorship, complication rate, causes of failure, revision strategies. UKA registry data were compared with total knee arthroplasty (TKA) registry data of 54,012 prostheses, which were implanted in the same time period.

RESULTS

6453 UKAs were included in the study: the vast majority of them (84.4%) were implanted due to primary osteoarthritis followed by deformity (7.1%) and necrosis of the condyle (5.1%). When compared to TKA, UKA showed lower perioperative complication rate (0.3% compared to 0.6%) but higher revision rate (18.2% at 15 years, compared to 6.2% for TKA). No correlation was found between diagnosis leading to primary implant and prosthesis survival. The most frequent cause of failure was total aseptic loosening (37.4%), followed by pain without loosening (19.8%). Of the 620 UKAs requiring revision, 485 were revised with a TKA and 61 of them required a re-revision; on the other hand, of the 35 cases where another UKA was implanted, 16 required a re-revision.

CONCLUSION

UKA is associated with fewer perioperative complications but higher revision rates when compared to TKA. Its survivorship is not affected by the diagnosis leading to primary implant. Revision surgery of a failed UKA should be performed implanting a TKA, which is associated with a lower re-revision rate when compared to another UKA.

LEVEL OF EVIDENCE

Level 3, therapeutic study.

A systematic review of the dose-response relationship between usage and outcomes of online physical activity weight-loss interventions

BACKGROUND

Online physical activity interventions can be an effective strategy for weight loss. However, there is a lack of systematic reviews examining the relationship between intervention usage (dose) and participants' response to online physical activity interventions for weight loss. It remains unclear whether certain usage metrics (e.g. login frequency, percent of content accessed) would be associated with improvements in behavioral outcomes. Understanding the dose-response relationship for online physical activity interventions for weight loss would be important for designing and evaluating future interventions.

OBJECTIVE

1) Review the methods used to assess intervention usage and 2) to explore the association between intervention usage metrics and outcomes for online physical activity interventions for weight-loss.

METHODS

We conducted a systematic review following the PRISMA guidelines to examine the dose-response relationship of online-based interventions targeting physical activity. We used the following keywords: web OR internet OR online OR eHealth AND physical activity OR exercise, AND engagement OR dose OR dose-response OR usage AND obesity OR weight*. Peer-reviewed articles published between 2006 and 2019 were included.

RESULTS

A total of five articles met the inclusion criteria. The mean intervention length was 10 ± 6 months (range 2-30 months). The usage metrics were total number of logins, login frequency, and usage of online tools. All usage metrics reported were found to be related to outcomes in physical activity interventions for weight-loss.

CONCLUSION

Our findings suggest that usage metrics for online physical activity interventions for weight-loss included login frequency, login duration, and use of online tools. Increased intervention usage appeared to be associated with an improvement in participant's weight, physical activity behaviors, and intervention retention. Future research should examine innovative ways to maintain intervention usage throughout the intervention.

The usage of Mate Select, a web-based selection tool for pedigree dogs for promoting sustainable breeding

BACKGROUND

Inbreeding is a phenomenon that accumulates through the mating of relatives within closed populations, such as pedigree dog breeds, and results in reduced genetic variation within breeds, and may lead to poorer health and fertility from inbreeding depression. The impact of inbreeding is driven by the selection and mating of parents, but information on choices to reduce inbreeding is difficult to assess for individual breeders. Tools to inform dog breeders on the current state of the inbreeding and the relationships among possible parents are potentially useful for providing guidance towards choices that are more beneficial to the breed. However, their utility depends on their usage and this study examines the usage of Mate Select, a web-based tool offered by The Kennel Club, covering 222 breeds for a period of 7 years following its launch in 2011.

RESULTS

The average usage was 2830 searches/week in 2012 with a slight fall of 2.2% per year (P < 0.001) to 2480 searches/week in 2018. Of these, 4% originated from outside the UK, across all continents except Antarctica, with the majority coming from English speaking countries. Searches/week showed a cyclical pattern with two cycles of 26.0 and 50.1 weeks. Since Mate Select's launch there has been a steady increase in searches from mobile devices, from 11% in 2012 to 43% in 2018. For the 197 breeds with at least 10 dams registered with the Kennel Club during the study period, there was a relationship between usage and registrations, with the average number of searches as a multiple of the number of dams increasing from 2 to 10 for breeds with up to 70 dams and declining towards 2 again for the largest breeds with approximately 20,000 registered dams. However, there remained substantial variation among breeds of similar size, and breeds for which EBVs had become available during the study period had a 2.46 fold greater frequency of searches per registered bitch (P < 0.001), but this was not linked directly to the publication of EBVs.

CONCLUSIONS

Mate Select has sustained and substantial usage, although there is also substantial variation in usage among breeds, which offers an opportunity to develop further guidance.

An app for supporting older people receiving home care - usage, aspects of health and health literacy: a quasi-experimental study

Background

During the last decade, there has been an increase in studies describing use of mHealth, using smartphones with apps, in the healthcare system by a variety of populations. Despite this, few interventions including apps are targeting older people receiving home care. Developing mobile technology to its full potential of being interactive in real time remains a challenge. The current study is part of a larger project for identifying and managing health concerns via an app by using real-time data. The aim of the study was to describe older people’s usage of an app and to evaluate the impact of usage on aspects of health and health literacy over time.

Methods

A quasi-experimental design was employed. Seventeen older people self-reported health concerns via Interaktor twice a week for 3-months and answered questionnaires at baseline, the end of the intervention and at a 6–month follow-up. Logged data on app usage and data on Sense of Coherence, Health Index, Nutrition Form for the Elderly, Geriatric Depression Scale-20, Swedish Communicative and Critical Health Literacy and Swedish Functional Health Literacy were collected and analysed using descriptive and non-parametric inferential statistics.

Results

The median usage of the app as intended was 96%. Pain was one of the most reported health concerns and was also the health concern that triggered an alert (n = 33). The older people’s communicative and critical health literacy improved significantly over time. Regarding the scores of Sense of Coherence, Health Index, Nutritional Form for the Elderly, Geriatric Depression Scale-20 and Swedish Functional Health Literacy scale, there were no significant differences over time.

Conclusions

The high app usage showed that an app may be a suitable tool for some older people living alone and receiving home care. The results indicate that the usage of Interaktor can support older people by significantly improving their communicative and critical health literacy. Aspects of health were not shown to be affected by the usage of the app. Further research with larger sample is needed for evaluation the effect on health literacy, and which aspects of health of importance to support by an app.

Adaptive servo-ventilation in patients with chronic heart failure and sleep disordered breathing: predictors of usage

PURPOSE

Adaptive servo-ventilation (ASV) is a therapy designed for patients with central sleep apnea (CSA) and Cheyne Stokes respiration. The aim of this study was to find predictors of ASV usage in patients with CSA in a routine sleep clinic cohort.

METHODS

In this retrospective study, consecutive patients in whom ASV therapy was initiated at the University Hospital Regensburg between 2011 and 2015, were analyzed. Analysis included polysomnographies of diagnostic and ASV initiation nights, a phone questionnaire on ASV usage, readout of the ASV device 1 month after initiation ("early ASV usage," 1 month after ASV initiation), and the readout of the last month before a reappointment date set in 2015 ("late ASV usage," median 17 months after ASV initiation).

RESULTS

In 69 consecutive patients, the mean early and late ASV usage per night was 4.8 ± 2.5 h and 4.1 ± 3.0 h, respectively. Seventeen months after initiation, 57% of patients used the device ≥ 4 h per night, and of those 91% reported a subjective benefit from ASV therapy. Early ASV usage was significantly associated with late ASV usage (univariable regression: Beta 0.8, 95%CI [0.6; 1.0] p < 0.001). In multivariable regression analysis, short duration of slow wave sleep (N3) during diagnostic polysomnography (Beta - 6.2, 95%CI [- 11.0; - 1.5]; p = 0.011) and subjective benefit from ASV (Beta 174.0, 95%CI [68.6; 279.5]; p = 0.002) were significantly associated with longer late ASV usage.

CONCLUSION

Early ASV usage predicts late ASV usage. In addition, low slow wave sleep before ASV initiation and subjective benefit from ASV may contribute to higher late ASV usage.

A Survey of Usage of Penile Prosthesis

BACKGROUND

Implantation of an inflatable penile prosthesis (IPP) has high success and satisfaction rates, but there remains a paucity of evidence examining non-usage of IPP and reasons for discontinuation.

AIM

To identify how frequent patients use their prosthesis and their personal reasons for no longer using it.

METHODS

We conducted a survey of all patients who underwent an IPP implantation by a single surgeon over a 6-year period, between 2012 and 2018. After application of inclusion and exclusion criteria, a total of 114 patients formed the final cohort. Patients were initially surveyed via mail with a questionnaire; those who did not respond were surveyed via telephone. The factors determining patient selection for IPP implantation included suitability for general anesthesia, manual dexterity to use the device by the patient or their partner on a demonstration device, and presence of refractory erectile dysfunction, HbA1C lower than 8.5, or need for a revision of a previously placed IPP. Universally, a 3-piece AMS 700 Series implant was placed via the penoscrotal approach. Data were analyzed with Pearson chi square test, and survivability of the device was assessed with Kaplan-Meier survival curve.

OUTCOMES

The main outcomes of this study are the frequency of IPP usage and reasons for discontinuation.

RESULTS

The survey participation rate was 97%. The mean age of patient was 64 years (range 34-83 years), and the mean time between surgery and completion of survey was 2.98 years (range 0.25-7.4 years). Kaplan-Meier curve demonstrated that 68% of the patients were using the IPP at 5 years after implantation. Using the age 70 years as a cutoff, 18 (22%) patients younger than 70 years and 14 (42%) patients older than 70 years discontinued using the IPP (P = .029). The commonest reasons for discontinuation were poor health to engage in sexual activity (2.6%), loss of companion (19%), loss of interest in sex (2.6%), and device malfunction with no further interest in revision of prosthesis (14%).

CLINICAL IMPLICATIONS

The clinical implication of this study was improved patient selection for device implantation.

STRENGTHS AND LIMITATIONS

To our knowledge, no other study has investigated reasons for patients no longer using their prosthesis. Our study has several limitations including that it is a cross-sectional analysis, our survey is not validated, this is a single-surgeon experience, we have a small sample size, and we did not differentiate between virgin implant and reimplantation.

CONCLUSION

Our study shows a high rate (28%) of non-usage of IPP, more so in men older than the age of 70 years in the first 5 years of implantation. Knoll P, Rai S, Talluri S, et al. A Survey of Usage of Penile Prosthesis. J Sex Med 2020;17:2287-2290.

Assessing mobile phone access, usage, and willingness among women to receive voice message-based mobile health intervention to improve antenatal care attendance in district Thatta, Sindh, Pakistan

Background

Pakistan has one of the highest maternal mortality ratios worldwide at 276/100,000 live births and only 51% percent of women receive four or more ANC visits. This means that there are missed opportunities for almost half of the women who were not able to seek the recommended antenatal visits. In Thatta district, the maternal mortality ratio is estimated at 313/100,000 live births. Various studies reported that mHealth interventions have proven to be effective to improve antenatal care and postnatal care services. However, the feasibility and effectiveness of mobile health interventions to increase uptake of preventive maternal healthcare services among pregnant women in different settings may be different due to differing patient demographics, cultural diversity, environmental and behavioral factors, availability and accessibility to mobile phones, and budgetary constraints. Prior to implementing a similar intervention in Thatta District, it is crucially important to assess the mobile phone access, usage and willingness among women to receive voice-message based mHealth intervention to improve antenatal care attendance.

Methods

A cross-sectional quantitative study will be used to assess mobile phone access, usage and willingness among women to receive voice-message based mHealth intervention to improve antenatal care attendance in district Thatta. The study will be conducted in Thatta district of Sindh province. Married women of reproductive age (MWRA), who are residing in selected villages of Mirpur Sakro and willing to participate will be included in the study. Multistage sampling technique will be used to recruit the 415 study participants. A structured questionnaire has been designed on Epicollect to collect data from 415 women. Data will be analyzed using IBM SPSS Statistics version 23, with a level of significance as < 0.05.

Discussion

This research project will provide invaluable information on the current access, usage of mobile phones among women of district Thatta and their willingness to receive voice messages to improve the antenatal care services. The study will also highlight demographic, sociocultural and economic factors associated with women willingness and readiness to receive voice messages regarding antenatal care.

Food supplements to reduce stunting in Pakistan: a process evaluation of community dynamics shaping uptake

Background

There is an increasing interest in use of food supplements to prevent childhood stunting, however the evidence on the process indicators is scarce. We in this study explore the barriers to the effective implementation of food supplementation programs and the possible mitigation strategies which can guide the design of future programs.

Methods

We undertook a process evaluation of a stunting prevention food supplementation pilot program in rural Pakistan that distributed Wheat Soy Blend (WSB) to pregnant & lactating women, and Lipid-based Nutrient Supplement (LNS) and micronutrient powder (MNP) to < 5 years children. We used a mixed methods approach through a quantitative survey of 800 households and conducted 18 focused group discussion (FGDs) (with male and female caregivers), 4 FGDs (with Community Health Workers (CHWs)) and 22 key informant interviews (with district stakeholders) to evaluate the community side factors affecting uptake through five parameters: value, acceptability, receipt of supplement, usage and correct dosage.

Results

The findings show that proportionately few beneficiaries consumed the full dose of supplements, despite reasonable knowledge amongst caregivers. Sharing of supplements with other household member was common, and the full monthly stock was usually not received. Qualitative findings suggest that caregivers did not associate food supplements with stunting prevention. WSB was well accepted as an extra ration, LNS was popular due its chocolaty taste and texture, whereas MNP sprinkles were perceived to be of little value. The cultural food practices led to common sharing, whereas interaction with CHWs was minimal for nutrition counselling. Qualitative findings also indicate CHWs related programmatic constraints of low motivation, multi-tasking, inadequate counselling skills and weak supervision.

Conclusion

We conclude that the community acceptability of food supplements does not translate into optimal consumption. Hence a greater emphasis is needed on context specific demand creation and focusing on the supply side constraints with improved logistical planning, enhanced motivation and supervision of community workers with involvement of multiple stakeholders. While, similar studies are needed in varying contexts to help frame universal guidelines.

Trial registration

ClinicalTrials.gov Identifier: NCT02422953. Registered on April 22, 2015.

Sleeping space matters: LLINs usage in Ghana

Long Lasting Insecticidal Net (LLIN) is an effective malaria prevention mechanism. However, ownership of LLIN does not imply its use among households. The availability of enough sleeping space is a natural prerequisite to install and use LLINs. The objective of this study was to explore the effect of sleeping space and other socio-demographic factors of households' heads on LLINs usage among households. A cross-sectional household-based study was conducted using a quantitative approach. Data was collected exclusively from households that received LLINs at no direct financial cost to them in a mass malaria campaign conducted in the study area using a structured questionnaire. A total of 383 households sampled for the study received 1,181 LLINs with a range of 1 to 15 LLINs per household. Less than 16% of households that received more than 2 LLINs installed all the LLINs they received during the distribution. Among households that received LLINs, 45% of them did not use them at all and 36% of them used them every night including the night before data collection. The number of bedrooms, children and members per household, and the number of occupants per bedroom were also found statistically associated with the use of LLINs among households. The study used a quantitative approach to investigate sleeping space in relation to LLINs usage and malaria control, an area and topic that has not been adequately covered in the literature.

Current antimicrobial use in farm animals in the Republic of Ireland

Antimicrobial resistance has been recognised as one of the most difficult challenges facing human and animal health in recent decades. The surveillance of antimicrobial use in animal health plays a major role in dealing with the growing issue of resistance. This paper reviews current data available on antimicrobial use in farmed animals in the Republic of Ireland, including each of the major livestock production sectors; pigs, poultry, dairy, beef and sheep. A systematic literature search was conducted to identify relevant published literature, and ongoing research was identified through the network of authors and searches of each of the research databases of the main agriculture funding bodies in Ireland. The varying quantities and quality of data available across each livestock sector underlines the need for harmonisation of data collection methods. This review highlights the progress that has been made regarding data collection in the intensive production sectors such as pigs and poultry, however, it is clear there are significant knowledge gaps in less intensive industries such as dairy, beef and sheep. To comply with European regulations an antimicrobial data collection system is due to be developed for all food-producing animals in the future, however in the short-term surveillance studies have allowed us to build a picture of current use within the Republic of Ireland. Further studies will allow us to fill current knowledge gaps and build a more comprehensive overview of antimicrobial use in farm animals in Ireland.

Health coaching for promoting physical activity in low back pain patients: a secondary analysis on the usage and acceptance

BACKGROUND

Multicomponent interventions combined with health coaching are widely recommended to improve a healthy lifestyle. The aim of the present study was to analyse the usage and acceptance of a multicomponent intervention (telephone, web and face-to-face coaching) for low back pain patients, and thereby gain an understanding of why this intervention was not as effective as expected.

METHODS

A secondary analysis of a randomised controlled trial, aimed at promoting physical activity, was conducted. It was a cross-sectional study based on data of a multicomponent intervention group (baseline = 201 participants). For evaluating the usage and acceptance, descriptive statistics were applied.

RESULTS

Over half (n = 118) of the patients participated at least once in the telephone coaching. Approximately half of the participants (44 of 90) rated the telephone coaching as "good".34 of 92 (37%) participants reported of visiting the web-platform. The web-platform was comprehensible for nearly one-quarter (n = 8 of 33) and very useful for one participant.The face-to-face-contact was rated highly (range: 79.4-88.2 out of 100).

CONCLUSION

Usage of the telephone coaching approach was moderate with even fewer participants visiting the web-platform. In addition, these approaches were not rated as very useful. The acceptance of the face-to-face contact was high.Since the usage and acceptance could influence the effectiveness, utilisation and acceptance studies might help to explain the reason for non-effective lifestyle interventions. Therefore, more studies analysing the usage and acceptance are needed. To improve the usage and acceptance, a stronger participatory orientation in the design of interventions and the integration of face-to-face contact could be helpful.

European perspectives on efforts to reduce antimicrobial usage in food animal production

New regulations on veterinary medicines and medicated feed will substantially influence antimicrobial prescribing and usage throughout Europe into the future. These regulations have been informed by a very large body of work, including the substantial progress towards reduced antimicrobial usage in food animal production in a number of member states of the European Union (EU). This paper seeks to summarise European perspectives on efforts to reduce antimicrobial usage in food animal production. Work within the EU is informed by the global action plan of the World Health Organization, which includes a strategic objective to optimise the use of antimicrobial medicines in human and animal health. There is ongoing measurement of trends in antimicrobial usage and resistance throughout the EU, and detailed information on strategies to reduce the need to use antimicrobials in food animal production. Substantial scientific progress has been made on the measurement of antimicrobial usage, including at herd-level, and on the objective assessment of farm biosecurity. In a number of EU member states, monitoring systems for usage are well-established, allowing benchmarking for veterinarians and farms, and monitoring of national and industry-level trends. Several countries have introduced restrictions on antimicrobial prescribing and usage, including strategies to limit conflicts of interest around antimicrobial prescribing and usage. Further, a broad range of measures are being used across member states to reduce the need for antimicrobial usage in food animal production, focusing both at farm level and nationally. Veterinarians play a central role in the reduction of antimicrobial usage in farm animals. Ireland's National Action Plan on Antimicrobial Resistance 2017-20 (iNAP) provides an overview of Ireland's commitment to the development and implementation of a holistic, cross-sectoral 'One Health' approach to the problem of antimicrobial resistance. The new regulations offer an important springboard for further progress, in order to preserve the efficacy of existing antimicrobials, which are a critical international resource.

Association between Intimate Partner Violence, Knowledge and Use of Contraception in Africa: Comparative Analysis across Five African Regions

BACKGROUND OR OBJECTIVES

Intimate partner violence (IPV) against women is common globally, and is associated with several adverse consequences. This study provides a comparative analysis of potential regional differences in the association between IPV and knowledge and use of contraceptives within Africa.

METHODS

A multi-country cross-sectional study was conducted using data on women of reproductive age 15-49 years from the Demographic and Health Surveys covering five African regions. Exposure and outcome variables were IPV and reproductive literacy (comprising modern contraception knowledge and contraception usage) respectively. We used survey log-binomial regression models to generate prevalence ratios that estimated the association between IPV versus knowledge and usage of modern contraception.

RESULTS

Overall IPV prevalence in Africa was 30.8% with notable regional differences. Demographic, socioeconomic, and reproductive history markers of IPV were more pronounced in younger women, rural residents, women of low socioeconomic status and those with copious knowledge but poor usage of modern contraception. The level of knowledge of contraception was 84% greater among African women who were victims of IPV compared to their counterparts who were not victims of IPV (p < 0.0001). IPV was not associated with actual usage of modern contraception (p = 0.21).

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

IPV against women in Africa may incentivize knowledge seeking of modern contraception as protective mechanisms. Regional variations notwithstanding, understanding the existing and new characteristics predictive of IPV may inform policy development, resource allocation and prevention of IPV globally.

[Status of non-steroidal anti-inflammatory drugs use in areas with a high incidence of upper gastrointestinal cancer in China: a multi-center cross-sectional survey]

Objective: To describe the status of non-steroidal anti-inflammatory drugs (NSAIDs) use in areas with a high incidence of upper gastrointestinal cancer in China. Methods: This study was based on the National Key Research and Development Program of "National Precision Medicine Cohort of Esophageal Cancer" and "Study on Identification and Prevention of High-risk Populations of Gastrointestinal Malignancies (Esophageal cancer, Gastric cancer and Colorectal cancer)" . From January 2017 to August 2018, 212 villages or communities with a high incidence of esophageal cancer or gastric cancer were selected from 12 regions in 6 provinces. A total of 35 910 residents aged between 40 and 69 years old who met the inclusion criteria and signed the informed consent were investigated and enrolled in this study. The use of NSAIDs, demographic characteristics, health-related habits, height, weight, and blood pressure were collected by the questionnaire and physical examination. The status of main NSAIDs (aspirin, acetaminophen and ibuprofen) use with the difference varying in genders, age groups and regions were analyzed by using χ(2) test and Cochran-Armitage trend analysis method. Results: Of 35 910 subjects, the mean age was (54.6±7.1) years old and males accounted for 43.42% (15 591). The overall prevalence of NSAIDs intake was 4.56% (1 638), but it significantly varied in different provinces (P<0.001). The overall prevalence of NSAIDs intake was 4.87% (1 750) in females, which was significantly higher than that in males 4.24% (1 524) (P<0.001). The prevalence of NSAIDs intake increased with age (P for trend <0.001). As the frequency of NSAIDs intake increased, the incidence of gastrointestinal symptoms, gastrointestinal ulcers and black stools increased (P for trend <0.05 for all). Conclusion: The use of NSAIDs is prevalent in some areas with a high incidence of upper gastrointestinal cancer in China. The increased use of NSAIDs may lead to more adverse effects related to the gastrointestinal tract.

Coverage and usage of insecticide treated nets (ITNs) within households: associated factors and effect on the prevalance of malaria parasitemia in the Mount Cameroon area

Background

Insecticide-treated nets (ITNs) are a widely used tool that has been proven to be effective in the prevention and control of malaria in malaria endemic countries. However, usage varies among households and can greatly affect the benefits of ITNs as a control tool for malaria transmission. This study determined the coverage and usage of ITNS as well as associated factors and the effect of coverage and usage on the prevalence of malaria parasitemia within households in the Mount Cameroon area.

Methods

A cross-sectional survey was conducted between August and September 2014 in six communities within the Mount Cameroon area. Households within the communities were enrolled through multistage sampling and household survey was done using a structured questionnaire. Capillary blood was collected for malaria parasite determination. Data was analysed using SPSS version 20 for windows. Differences in proportions were assessed using the Chi-square test while factors affecting ITNs usage were assessed in multivariate logistic regression at a statistical significance of P ≤ 0.05.

Results

A total of 504 households were surveyed, 1564 bed spaces reported while 915(58.5, 95% CI: 56.1–60.9) of the bed spaces had nets and 391(77.6, 95% CI, 74.0–80.2) of the households had at least one bed net. The odds of using ITNs was 2 folds higher (OR = 2.41; 95% CI 1.58–3.69 p = 0.001) and 3 folds higher (OR = 3.149, 95% CI 1.53–6.47 p = 0.002) among houses with 5 to 9 occupants and above 10 occupants respectively when compared to houses with less than 5 occupants. In addition, Individuals living in cement block houses were less likely to use ITNs.

Compared to those living in wooden houses (OR = 0.488, 95% CI: 0.269–0.885; p = 0 .018). Rural communities had lower ITN coverage compared to semi-urban communities (p = 0.0001). Increase in ITNs coverage significantly reduces malaria prevalence (correlation − 0.899, p = 0.015).

Conclusion

Despite the efforts made to scale up ITN distribution so that universal coverage can be attained, coverage remains low. Increasing coverage and putting in place a mechanism to replace torn nets will go a long way reduce the prevalence of malaria parasitemia.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7555-x) contains supplementary material, which is available to authorized users.

Temporal changes in access to FRAX® in Thailand between 2010 and 2018

The usage of FRAX® tool in Thailand and other countries was explored using Google Analytics data. Over the period 2010-2018, Thailand ranked 35th in the world for FRAX usage (the US is ranked first). Incorporation of FRAX into a national osteoporosis guideline in Thailand appears to have increased its usage.

PURPOSE

To document access to the web-based FRAX® tool and specifically its access in Thailand between 2010 and 2018.

METHODS

A descriptive retrospective study using data from Google Analytics that provides numerical and geographical information on internet access to the FRAX tool website worldwide.

RESULT

In Thailand, Bangkok is the highest ranked site for FRAX access with more than 20,000 usage sessions since 2010 (3.6 usage session per 1000 population) followed by Khon Kaen and Chiang Mai. It has been accessed from within 76 out of 77 provinces (98.7%). There was a steady increase in access to FRAX from within Thailand of approximately 1000 usage sessions per year between 2010 and 2016. After the FRAX fracture risk calculation was included in the national guideline for osteoporosis management published in late 2016, the rate of increase in access was four-fold higher compared with the previous period. In world ranking, the USA is the country with the most frequent access to the FRAX tool, whereas Thailand was ranked 35th in the world. There were weak but significant correlations between the absolute number of FRAX sessions and population size (r = 0.165, p = 0.011) and land area (r = 0.375, p < 0.001).

CONCLUSION

Access to the FRAX tool website is increasing in Thailand. The incorporation of FRAX into national guidelines, in parallel to the adoption of osteoporosis fracture prevention into national policy, has had a rapid and significant impact on its use.

Patterns of Pre-pregnancy Care Usage among Reproductive Age Women in Kedah, Malaysia

BACKGROUND

This cross-sectional was aimed to assess the prevalence of pre-pregnancy care services usage and its determinant factors among women of reproductive age in Kedah, Malaysia.

METHODS

Overall, 1347 respondents who attended 24 government health clinics, were chosen using systematic multistage random sampling. A validated self-administered questionnaire which consisted of sections including socio-demographic characteristics, social support, knowledge on pre-pregnancy care, perception on risk of pregnancy, health status, as well as intention and awareness on pre-pregnancy care services were distributed.

RESULTS

The prevalence of utilization of pre-pregnancy care services was still low i.e. 44.0%. Bivariate and multivariate analysis showed consistent significant level between all factors and pre-pregnancy care usage except for family planning practice. The factors that showed significant difference with the usage of pre-pregnancy care services were age of more than 35 (P<0.001), high education level (P<0.001), non-working mothers (P<0.001), multipara (P=0.001), awareness on the existence of pre-pregnancy care services in government health facilities (P<0.001), intention to use the services (P=0.0030), having medical illness (P=0.005), having social support (P=0.001), high knowledge (P<0.001), and positive perception (P<0.001).

CONCLUSION

Low usage of pre-pregnancy care services can be improved through health screening on reproductive-aged women with positive determinant factors at the triage level in integrated clinics. Information and knowledge on pre-pregnancy services should be disseminated among community members through various means including roadshows and pre-wedding workshops.

Evidence of patients' challenges and barriers related to usage of Implanon®: scoping review protocol

BACKGROUND

According to the United Nations Trends in Contraceptive Use 2015 report, at least one in ten married or in-union women in most regions of the world has an unmet need for family planning. Family Planning 2020 reports an estimate of almost 134 million married or in-union women of reproductive age who have an unmet need for modern methods of contraception in 2016 in participating countries. Family planning has therefore been highlighted as a global unmet need. Initiatives such as Family Planning 2020 aim to promote contraceptive use through Implanon® contraceptive implant. Implanon® has been reported to be a highly effective form of contraception. However, poor outcomes from users of the Implanon® have been reported in recent studies. The main objective of this review is to map the literature for the evidence on usage of Implanon® in order to reveal challenges and barriers.

METHODS AND ANALYSIS

A scoping review searching evidence on Implanon® use will be conducted. Relevant studies will be identified from 1998 to present. The following databases: PubMed, MEDLINE, EBSCOhost, Google Scholar and Cochrane library will be searched for peer-reviewed literature. We will also search for grey literature in this study area. The eligibility criteria will guide the study selection. A data charting table will be designed to extract information from the literature. The results of this study will be reported by use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data will be analysed using thematic analysis and the NVIVO software version 10. The mixed method appraisal tool (MMAT) will be used to assess the quality of included studies.

DISCUSSION

We anticipate finding relevant studies on the use of Implanon®. Evidence gathered from included studies will help us identify gaps in research and help guide future research on Implanon® usage. This information can also help guide implementers and users on challenges and barriers related to use of Implanon®.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017072926 .

Exploring the cross-sectional association between outdoor recreational facilities and leisure-time physical activity: the role of usage and residential self-selection

Background

The availability of outdoor recreational facilities is associated with increased leisure-time physical activity (PA). We investigated how much of this association is attributable to selection effects, and explored whether usage of recreational facilities was an explanatory mechanism.

Methods

We analysed data from 5199 participants in the SPOTLIGHT survey residing in five European urban regions. Adults completed a survey and a Google Street View-based virtual audit was conducted to objectively measure the availability of outdoor recreational facilities in the residential neighbourhood. We used negative binomial GEE models to examine the association between objective and subjective availability of outdoor recreational facilities and leisure-time PA, and explored whether this association was attenuated after adjustment for socioeconomic status and preference for neighbourhoods with recreational facilities (as indicators of self-selection). We examined whether reported use of recreational facilities was associated with leisure-time PA (as explanatory mechanism), and summarized the most important motivations for (not) using recreational facilities.

Results

Subjective – but not objective – availability of outdoor recreational facilities was associated with higher levels of total leisure-time PA. After adjustment for self-selection (which attenuated the association by 25%), we found a 25% difference in weekly minutes of total leisure-time PA between individuals with and without self-reported availability of outdoor recreational facilities. For our study population, this translates to about 28 min per week. Participants who reported outdoor recreational facilities to be present but indicated not to use them (RR = 1.19, 95% CI = 1.03;1.22), and those reporting outdoor recreational facilities to be present and to use them (RR = 1.33, 95% CI = 1.22, 1.45) had higher levels of total leisure-time PA than those who reported outdoor recreational facilities not to be present. Proximity to outdoor recreational facilities was the most important motivation for use.

Conclusion

The modest attenuation in the association between availability of outdoor recreational facilities and self-reported leisure-time PA suggests that individuals’ higher activity levels may be due more to the perceived availability of outdoor recreational facilities than to self-selection. The use of these facilities seemed to be an important underlying mechanism, and proximity was the main motivator for using recreational facilities.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0689-x) contains supplementary material, which is available to authorized users.

Comparing usage of a web and app stress management intervention: An observational study

Choices in the design and delivery of digital health behaviour interventions may have a direct influence on subsequent usage and engagement. Few studies have been able to make direct, detailed comparisons of differences in usage between interventions that are delivered via web or app. This study compared the usage of two versions of a digital stress management intervention, one delivered via a website (Healthy Paths) and the other delivered via an app (Healthy Mind). Design modifications were introduced within Healthy Mind to take account of reported differences in how individuals engage with websites compared to apps and mobile phones. Data were collected as part of an observational study nested within a broader exploratory trial of Healthy Mind. Objective usage of Healthy Paths and Healthy Mind were automatically recorded, including frequency and duration of logins, access to specific components within the intervention and order of page/screen visits. Usage was compared for a two week period following initial registration. In total, 381 participants completed the registration process for Healthy Paths (web) and 162 participants completed the registration process for Healthy Mind (app). App users logged in twice as often (Mdn = 2.00) as web users (Mdn = 1.00), U = 13,059.50, p ≤ 0.001, but spent half as much time (Mdn = 5.23 min) on the intervention compared to web users (Mdn = 10.52 min), U = 19,740.00, p ≤ 0.001. Visual exploration of usage patterns over time revealed that a significantly higher proportion of app users (n = 126, 82.35%) accessed both types of support available within the intervention (i.e. awareness and change-focused tools) compared to web users (n = 92, 40.17%), χ2(1, n = 382) = 66.60, p < 0.001. This study suggests that the digital platform used to deliver an intervention (i.e. web versus app) and specific design choices (e.g. navigation, length and volume of content) may be associated with differences in how the intervention content is used. Broad summative usage data (e.g. total time spent on the intervention) may mask important differences in how an intervention is used by different user groups if it is not complemented by more fine-grained analyses of usage patterns over time.

TRIAL REGISTRATION NUMBER

ISRCTN67177737.

Using an Analysis of Behavior Change to Inform Effective Digital Intervention Design: How Did the PRIMIT Website Change Hand Hygiene Behavior Across 8993 Users?

Background

In designing digital interventions for healthcare, it is important to understand not just whether interventions work but also how and for whom—including whether individual intervention components have different effects, whether a certain usage threshold is required to change behavior in each intervention and whether usage differs across population subgroups.

Purpose

We investigated these questions using data from a large trial of the digital PRimary care trial of a website based Infection control intervention to Modify Influenza-like illness and respiratory tract infection Transmission) (PRIMIT) intervention, which aimed to reduce respiratory tract infections (RTIs) by increasing hand hygiene behavior.

Method

Baseline and follow-up questionnaires measured behaviors, intentions and attitudes in hand hygiene. In conjunction with objective measures of usage of the four PRIMIT sessions, we analysed these observational data to examine mechanisms of behavior change in 8993 intervention users.

Results

We found that the PRIMIT intervention changed behavior, intentions and attitudes, and this change was associated with reduced RTIs. The largest hand hygiene change occurred after the first session, with incrementally smaller changes after each subsequent session, suggesting that engagement with the core behavior change techniques included in the first session was necessary and sufficient for behavior change. The intervention was equally effective for men and women, older and younger people and was particularly effective for those with lower levels of education.

Conclusions

Our well-powered analysis has implications for intervention development. We were able to determine a ‘minimum threshold’ of intervention engagement that is required for hand hygiene change, and we discuss the potential implications this (and other analyses of this type) may have for further intervention development. We also discuss the application of similar analyses to other interventions.

The effect of root canal preparation on the surface roughness of WaveOne and WaveOne Gold files: atomic force microscopy study

Objectives

To examine the surface topography of intact WaveOne (WO; Dentsply Sirona Endodontics) and WaveOne Gold (WOG; Dentsply Sirona Endodontics) nickel-titanium rotary files and to evaluate the presence of alterations to the surface topography after root canal preparations of severely curved root canals in molar teeth.

Materials and Methods

Forty-eight severely curved canals of extracted molar teeth were divided into 2 groups (n = 24/each group). In group 1, the canals were prepared using WO and in group 2, the canals were prepared using WOG files. After the preparation of 3 root canals, instruments were subjected to atomic force microscopy analysis. Average roughness and root mean square values were chosen to investigate the surface features of endodontic files. The data was analyzed using one-way analysis of variance and post hoc Tamhane's tests at 5% significant level.

Results

The surface roughness values of WO and WOG files significantly changed after use in root canals (p < 0.05). The used WOG files exhibited higher surface roughness change when compared with the used WO files (p < 0.05).

Conclusions

Using WO and WOG Primary files in 3 root canals affected the surface topography of the files. After being used in root canals, the WOG files showed a higher level of surface porosity value than the WO files.

How does exposure to pesticides vary in space and time for residents living near to treated orchards?

This study investigated changes over 25 years (1987-2012) in pesticide usage in orchards in England and Wales and associated changes to exposure and risk for resident pregnant women living 100 and 1000 m downwind of treated areas. A model was developed to estimate aggregated daily exposure to pesticides via inhaled vapour and indirect dermal contact with contaminated ground, whilst risk was expressed as a hazard quotient (HQ) based on estimated exposure and the no observed (adverse) effect level for reproductive and developmental effects. Results show the largest changes occurred between 1987 and 1996 with total pesticide usage reduced by ca. 25%, exposure per unit of pesticide applied slightly increased, and a reduction in risk per unit exposure by factors of 1.3 to 3. Thereafter, there were no consistent changes in use between 1996 and 2012, with an increase in number of applications to each crop balanced by a decrease in average application rate. Exposure per unit of pesticide applied decreased consistently over this period such that values in 2012 for this metric were 48-65% of those in 1987, and there were further smaller decreases in risk per unit exposure. All aggregated hazard quotients were two to three orders of magnitude smaller than one, despite the inherent simplifications of assuming co-occurrence of exposure to all pesticides and additivity of effects. Hazard quotients at 1000 m were 5 to 16 times smaller than those at 100 m. There were clear signals of the impact of regulatory intervention in improving the fate and hazard profiles of pesticides used in orchards in England and Wales over the period investigated.

Knowledge and characteristics of herbal supplement usage among community pharmacy customers in a Malaysian population

OBJECTIVES

We investigated the knowledge and characteristics of herbal supplement usage of the customers of community pharmacies in a Malaysian population.

DESIGN AND SETTING

Self-administered questionnaires (in English, Malay, or Chinese) were provided to customers at three community pharmacies in Malaysia (Ipoh, Perak). Questionnaire validation and translation validation were performed. A pilot study was conducted before actual questionnaire distribution. Informed consent was obtained from all participants.

RESULTS

Total number of participants was 270 (99 males and 171 females) with majority from the 31-50 age group (41.5%). Among the participants, 45.6% were herbal users. The most commonly used herbal supplements were evening primrose oil (17.9%), ginkgo biloba (13.0%), and milk thistle (8.5%). The participants seemed to have sufficient knowledge regarding herbal supplements including safety, quality, and indication of use from medical literature. Participants obtained information about herbal supplements from pharmacists (26.9%), package inserts (25.2%), friends (20.5%), and the Internet (13.3%) more often than from their doctors (9.8%). Most herbal users did not inform their doctors about their usage of herbal supplements (68.3%) or the side effects (61.5%). Herbal supplement users also tended to be women, >50-year-old, and those with higher monthly household incomes.

CONCLUSIONS

Community pharmacists have a vital role in educating their customers about the safe use of herbal supplements. The participants had sufficient knowledge about herbal supplement usage; therefore, customers of these community pharmacies may have benefitted from the advice of the pharmacists. Further studies could be carried out in future on the knowledge, skills and roles of community pharmacists in the safe use of herbal supplements.

[Knowledge and use of different support programs in the context of early prevention in relation to family-related psychosocial burden]

BACKGROUND

The Federal Initiative for Early Prevention (funded by German ministry BMFSFJ), through the development of specific assistance programmes, supports families that suffer from psychosocial burden. As nationally representative data are missing, the National Centre for Early Prevention carried out a national survey on the psychosocial burden experienced by families with children aged 0-3 years.

AIMS

Ascertainment of the connections between family-related psychosocial burden and knowledge and use of different assistance programmes.

DATA AND METHODS

Via paediatricians, 8063 parents were recruited to complete a questionnaire on objective burden, subjective experience of burden as well as knowledge and use of assistance programmes. Differences in knowledge and use between educational groups were tested by means of chi-squared tests. Very good knowledge of available assistance programmes and the offer and acceptance of aid by family midwives were subjected to regression analyses.

RESULTS

Clear differences in knowledge and use of individual assistance programmes between educational groups were observed. Many programmes are predominantly used by better educated families, although there are exceptions, for example in the case of family midwives. Despite generally small group differences, less-educated families are the proportionally largest user group of family midwives. Furthermore we present average predicted percentages of knowledge and use for specific groups of psychosocially burdened parents as derived from the regression analyses.

DISCUSSION

The results are discussed in the context of barriers to access for individual assistance programmes as well as their match with families' needs in the practice of early prevention.

Quantitative and qualitative analysis of antimicrobial usage in white veal calves in France

The development of antimicrobial resistance has made it necessary to measure antimicrobial usage in animal production sectors. France is a major European producer of white veal calves, but few data were previously available for that sector, even though these young animals are particularly susceptible to infection and considered as a reservoir of antimicrobial resistance. A cross-sectional study was conducted on 186 batches of French calves to estimate the exposure of white veal calves to antimicrobials and identify the potential risk factors related to antimicrobial usage. An indicator of calf exposure was calculated as a count of the number of antimicrobial treatments per calf. The indicator was based on veterinary prescriptions (products, quantity dispensed and dosage prescribed) and the estimated weight of calves at treatment, using the dates of treatment collected from farm registers. The study showed that calves were exposed to an average of 8.55 antimicrobial treatments (SD: 2.21, range: 2.75-15.86) over the five to six months of the fattening process. Group treatments were predominant (95.8%) and administered by the oral route. The "starting treatments", given during the first two weeks of the fattening period, were administered systematically (to all the calves in all the farms) and accounted for a third of all treatments. Tetracyclines, polypeptides and macrolides were the most widely used antimicrobials, with respectively 4.32, 1.59 and 1.01 treatments per calf. Only rare uses of 3rd and 4th generation cephalosporins and fluoroquinolones, considered as critically important in human medicine, were reported. Despite low variability of exposure between farms, a linear mixed-effects model highlighted a higher variability between farmers (ICC=0.14) or veterinarians (ICC=0.12), than between integrators (ICC=0.06). The number of calves per pen, introduced as a fixed effect in the model, was also significant: calves housed in pens of 6-10 and fed in buckets had on average 2.55 more antimicrobial treatments per calf than calves housed in pairs with the same feeding system. The model also highlighted an increase of 1.48 treatments per calf for farms with more than five percent of mortality, versus those with two percent or less. The present study showed that antimicrobial treatments are numerous in veal calf fattening farms, particularly at the arrival of the animals. Taking into account the development of resistance to antimicrobials, the necessity and the effectiveness of some of these treatments should be re-evaluated.

Experiences of Playscan: Interviews with users of a responsible gambling tool

Online gambling, encompassing a wide variety of activities and around-the-clock access, can be a potential risk factor for gamblers who tend to gamble excessively. Yet, the advent of online gambling has enabled responsible gambling (RG) features that may help individuals to limit their gambling behaviour. One of these features is RG tools that track gamblers' behaviour, performs risk assessments and provides advice to gamblers. This study investigated users' views and experiences of the RG tool Playscan from a qualitative perspective using a semi-structured interview. The tool performs a risk assessment on a three-step scale (low, medium and high risk). Users from every risk category were included. Twenty interviews were carried out and analysed using thematic analysis. Two main themes with associated sub-themes were identified: "Usage of Playscan and the gambling site" and "Experiences of Playscan". Important experiences in the sub-themes were lack of feedback from the tool and confusion when signing up to use Playscan. These experiences counteracted positive attitudes that should have promoted usage of the tool. Providing more feedback directly to users is a suggested solution to increase usage of the RG tool.

Availability, usage, and factors affecting usage of electrophysical agents by physical therapists: a regional cross-sectional survey

[Purpose] The aim of this study was to investigate the availability, usage, and factors affecting usage of electrophysical agents by physical therapists in Nagano Prefecture, Japan. [Subjects and Methods] Questionnaires were sent to all 1,571 physical therapists working in 245 institutions within Nagano Prefecture. A total of 1,110 questionnaires were returned, out of which 1,099 (70%) questionnaires containing valid responses were analyzed. Frequencies and percentages were calculated for 22 modalities with regards to availability, usage, rate of usage, and confidence level in usage. Factors affecting usage and the relationship between rate of usage and confidence level (Spearman’s rho) were also determined. [Results] The top three responses for the various outcome measures were as follows: (1) hot packs (88%), low frequency stimulators (76%), and ultrasound (68%) for availability; (2) hot packs (72%), ultrasound (61%), and cold packs (59%) for usage; (3) hot packs (75%), cold spray (49%), and ultrasound (44%) for confidence in usage; and (4) equipment availability (80%), past experience (79%), and research evidence (78%) for factors affecting usage. There was a significant positive relationship between confidence and usage for all modalities, except for ultraviolet radiation, iontophoresis, and magnetic field. [Conclusion] Usage was strongly correlated with confidence, with the top three used modalities also being the ones with the highest confidence in usage.

Knowledge and Usage of Emergency Contraceptives Among University Students in Ghana

Contraceptive use is an important strategy for the prevention of unwanted pregnancy and avoidance of induced abortion. Of all the contraception methods, emergency contraceptive (EC) offers the last chance to achieve this. However, few studies have documented the use of EC among young people in Ghana. This study explored knowledge and usage of EC as well as the factors associated with it among University of Cape Coast students. Data were obtained on the knowledge and usage of ECs among University of Cape Coast students in 2013. Logistic regression analysis was used to investigate the association between students' socio-demographic characteristics and EC knowledge and use. More male students (72%) than females (59%) were sexually active. Fifty-seven percent of the respondents had ever heard of EC and 36% had ever used EC. Although males were more likely to be sexually active, females were more likely to have knowledge of EC use compared to males. The study underscores the need to increase awareness regarding EC among University students in order to offer them the opportunity that EC provides if other forms of contraceptives are missed.