Telemedicine in the Post-Pandemic Period: Understanding Patterns of Use and the Influence of Socioeconomic Demographics, Health Status, and Social Determinants.

Introduction: The rapid expansion of telemedicine during the COVID-19 pandemic has transformed health care delivery. However, it remains unclear whether telemedicine utilization is equitable across different demographic groups and whether the high levels of adoption during the pandemic have persisted in the post-pandemic period. This study investigates telemedicine use and patterns of use in the initial phases of the post-pandemic period and explores the impact of socioeconomic factors, social determinants of health, and patients' health-related factors on telemedicine utilization. Methods: This study analyzes data from the Health Information National Trends Survey (HINTS) 6, comprising responses from 6,046 U.S. adults collected between March and November 2022. Results: Of 6,046 HINTS respondents, 39.3% (2,517 individuals) reported using telemedicine in the past year. Among telemedicine users, 18.5% used video visits, 12.08% used telephone-based telecare, and 8.72% used both. The main reasons for telehealth visits were minor illnesses (29.67%), chronic condition management (21.4%), annual visits (18.82%), mental and behavioral health concerns (15.72%), and medical emergencies (1.58%). Among non-users, only 17% (578 individuals) were offered telehealth visits, with privacy concerns (16.43%), preference for in-person consultation (84.42%), and difficulty using telemedicine technology (18.96%) being the main reasons for non-use. Logistic regression analysis revealed significant associations of social determinants, socioeconomic demographics, and health factors with telemedicine utilization. Women had a higher likelihood of using telemedicine (odds ratio [OR] = 1.39, 95% confidence interval [CI] = 1.09-1.78). Older adults showed lower inclination toward telemedicine. Married individuals were more likely to use telemedicine (OR = 1.35, 95% CI = 1.06-1.72), while Whites (OR = 1.52, 95% CI = 1.04-2.22) and Hispanics (OR = 1.80, 95% CI = 1.17-2.75) had higher odds of utilizing telemedicine compared with non-Hispanic African Americans. Lack of reliable transportation (OR = 1.29, 95% CI = 1.01-1.66), frequent provider visits (OR = 1.37, 95% CI = 1.28-1.46), a higher number of chronic conditions (OR = 1.39, 95% CI = 1.22-1.57), and residences in metropolitan locations were also associated with increased telemedicine usage. Greater satisfaction with internet connectivity positively influenced telemedicine utilization. Conclusions: This study highlights the continued preference for in-person visits among U.S. adults in the early post-pandemic period, despite the widespread use of telemedicine. Addressing barriers such as limited access, privacy concerns, technological difficulties, and demographic disparities is crucial for achieving equitable utilization of telemedicine.

The influence of the Covid-19 pandemic and climate change on water use and supply: experience of Istanbul, Türkiye.

The coronavirus (Covid-19) pandemic has affected not only populations around the world but also the environment and natural resources. Lockdowns and restricted lifestyles have had wide-ranging impacts on the environment (e.g., air quality in cities). Although hygiene and disinfection procedures and precautions are effective ways to protect people from Covid-19, they have significant consequences for water usage and resources especially given the increasing impacts of climate change on rainfall patterns, water use and resources. Climate change and public health issues may compound one another, and so we used a drivers, pressures, state, impact, response framework (not previously used to examine the actual and potential impacts of Covid-19 and climate change on water consumption and resources) to scope the main factors that may interact to affect water use and resources (in the form of reservoirs) using evidence from Istanbul, Türkiye, with some discussion of the comparative situation elsewhere. We modified initial views on the framework to account for the regional, city and community level experiences. We note that water consumption in Istanbul has been increasing over the last two decades (except in times of very low rainfall/drought); that there were increases in water consumption in the early stages of the Covid-19 pandemic; and, despite some increase in rainfall, water levels in reservoirs appeared to decrease during lockdowns (for a range of reasons). Through a new simple way of visualising the data, we also noted that a low resource capacity might be recurring every 6 or 7 years in Istanbul (a similar finding to Thames Reservoir in London). We made no attempt in this paper to quantify the relative contribution that climate change, population growth, etc., are making to water consumption and reservoir levels as we focused on looking at those social, environmental and economic factors that appear to play a role in potential water stress and on developing a drivers, pressures, state, impact, response framework for policy and adaptive management options for Istanbul and other large complex conurbations. If there are periodic water resource issues and temperatures rise as expected in climate projections with an accompanying increase in the duration of hot spells, the subsequent additional stress on water systems might make managing future public health emergencies, such as a pandemic, even more difficult.

Differentiating people who use cannabis heavily through latent class analysis.

BACKGROUND: People who use cannabis daily or near-daily vary considerably in their daily dosage and use frequency, impacting both experienced effects and adverse consequences. This study identified heavy cannabis user groups according to consumption patterns and factors associated with class membership. METHODS: We conducted a cross-sectional study of 380 Spanish residents (61.8% male; average age = 30.3 years) who had used cannabis ≥ 3 days/week throughout the past year. Participants were recruited through chain referral and cannabis social clubs. We applied latent class analysis (LCA) to cluster participants according to use intensity. LCA indicators included frequency of weekly cannabis use, joints smoked each day, cannabis dosage, and if cannabis was consumed throughout the day or only at specific times. Associations between class membership and socio-demographics, use patterns, motives, supply sources, adverse outcomes, and use of other substances were measured using ANOVA and chi-squared tests. Multinomial regression identified the factors associated with latent class membership. RESULTS: Three latent classes (moderately heavy: 21.8%, heavy: 68.2%, very heavy: 10%) had average weekly cannabis intakes of 2.4, 5.5, and 18.3 g, respectively. Very heavy users were older ([Formula: see text]=17.77, p < 0.01), less educated [Formula: see text]=36.80, p < 0.001), and had used cannabis for longer (F = 4.62, p = 0.01). CAST scores (F = 26.51, p < 0.001) increased across the classes. The prevalence of past-month alcohol use was lower among the heaviest users ([Formula: see text]=5.95, p = 0.05). Cannabis was usually obtained from a club by very heavy users ([Formula: see text]=20.95, p < 0.001). CONCLUSIONS: People who use cannabis heavily present three groups according to frequency and quantity of cannabis consumption. Use intensity is associated with increased cannabis-related problems. Differences among heavy users must be considered in harm reduction interventions in cannabis clubs and indicated prevention.

Typology of Users of Psychedelics and Alike Psychoactive Substances in Czechia: Results of the National Online Survey.

The aim of this study was to define the typical groups of users of psychedelics and alike psychoactive substances in Czechia regarding various variables such as demographics, their patterns of use, or motivation for use. Data from 890 Czech respondents were collected through an online questionnaire as a part of The National Psychedelic Research Project. Subjects reported experience with the use of 29 selected substances by answering 133 questions of the questionnaire. Cluster analysis based on answers on last year use was performed, and descriptive statistics was used for 18 questions from the questionnaire. Six groups of users were identified with distinguished users and demographic characteristics, namely, The most experienced; Pure smokers; Highly educated mild users; Past-time users with families; Responsible (party) students and Deep meaning natural substance users. Groups differ mainly in the type of substances used, frequency of use last year, and demographics. Our findings highlight several patterns typical for psychedelics and alike psychoactive substances use in Czechia in each of the groups and the need for targeted drug prevention services, the raise of public awareness regarding this topic, and a possible reevaluation of the legal status of some substances. Results can be useful for health-care providers, social workers, and policy-makers.

Development, psychometric validation, and cross-cultural comparison of the "Instagram Motives Questionnaire" (IMQ) and the "Instagram Uses and Patterns Questionnaire" (IUPQ).

Background and aims: Social network use is widespread, and the study of Instagram seems to have captured more attention in recent years. However, scale development and validation in the field has fallen short of providing sound scales of Instagram motives and usage patterns that consider the uniqueness of Instagram-related behavior. This paper describes the development, psychometric and cross-cultural validation of two new measurement instruments: the "Instagram Motives Questionnaire" (IMQ) and the "Instagram Uses and Patterns Questionnaire" (IUPQ). Methods and results: A preliminary set of items was developed for each questionnaire based on a previous qualitative interview study on Instagram motives, uses, and consequences. In the first study, the questionnaires were distributed to a sample of 312 participants aged 18-35 years (M = 23.81; SD = 4.49), and an exploratory factor analysis was performed. A parsimonious and interpretable 6-factor solution that displayed adequate factor loadings and adequate Omega coefficients for both instruments were found. In a second study, the two instruments and other measures of known social network usage correlates and mental health consequences were administered online to 1,418 English-speaking participants aged 18-34 years (M = 21.35; SD = 3.89). Both scales showed good psychometric properties and the factor structure identified in study 1 was reproduced through confirmatory factor analysis. Omega reliability coefficients were adequate. Finally, when performing multi-group CFA along with a French (n = 1,826) and a Spanish (n = 3,040) sample, language and gender invariance were supported. Correlations with other relevant measures indicate good convergent validity of both scales. Conclusions: The present research provides psychometrically sound instruments for further investigations on Instagram use behaviors.

Patterns of use of recombinant zoster vaccine among commercially-insured immunocompetent and immunocompromised adults 50-64 years old in the United States.

PURPOSE: The Centers for Disease Control and Prevention (CDC) recommends recombinant zoster vaccination (RZV) for adults ≥ 50 years to prevent herpes zoster (HZ) and its sequelae. Initially, no distinct recommendation was made for immunocompromised adults, who experience higher HZ rates and more severe outcomes. We characterized receipt of first RZV dose (initiation) and both doses (completion) over time, and the impact of immune function on RZV uptake among adults aged 50-64 years in the United States. METHODS: We identified RZV claims from the IBM MarketScan database between 1/1/2018 and 12/31/2019. We characterized immunocompromised enrollees as having malignancy, HIV, solid organ transplant, primary immunosuppression, or medication-induced immunosuppression using inpatient, outpatient, and prescription claims in the 6 months prior to study start. We evaluated patterns of vaccine uptake by demographic and healthcare access characteristics and immune status. RESULTS: The cumulative incidence of RZV initiation during the study period was 10.0%. Incidence increased with age and number of medical office visits, and was higher among women, urban residents, high-deductible insurance beneficiaries, and those who were immunocompromised compared to immunocompetent. Among immunocompromised adults, RZV initiation was highest among those with HIV and primary immunodeficiencies. Of those who initiated RZV, 89.5% received both doses. RZV completion was highest among those who received the first dose at a pharmacy. Most enrollees (88.6%) who completed RZV vaccination did so within the recommended dosing schedule. CONCLUSIONS: RZV uptake was low in the two years since the CDC recommendation, and differed by demographic, healthcare access, and clinical characteristics. Initiation rates were higher among immunocompromised adults compared to immunocompetent adults, despite no CDC recommendation for vaccination in these groups during the study period. The CDC has since recommended RZV for immunocompromised individuals, and our findings may inform efforts to increase RZV uptake in individuals at higher risk of severe disease.

Integrating Observation and Network Analysis to Identify Patterns of Use in the Public Space: A Gender Perspective.

In the last few decades, increasing attention has been given to gender issues in urban design. However, research on the urban environment continues to show large gender inequalities, which are especially evident when studying the use and enjoyment of the public space. This study aims to identify predominant patterns of use in public places and to explore the possible existence of traditional gender roles in the urban space. The study uses, three public spaces in the city of Barcelona as a case study, an innovative combination of systematic observation techniques and network analysis procedures. Variables collected by EXOdES, a dedicated software analysis tool for systematic observation, are represented as nodes of a network system and analyzed using network analysis tools. Findings confirmed that, in spite of the progressive consolidation of feminist urbanism, uses in the public realm resulting from traditional gender roles remained explicitly recognizable. Whereas women's occupation of space was related to playground and resting areas, generally involving care activities concerned with children or elderly people, men were primarily located in resting and sports areas, practicing sports, or participating in leisure activities. These patterns of use were more prone to emerge when users were part of a group than when they were alone. From a gender perspective, a contribution of the study is that it informed about main aspects of the analyzed public spaces reconfirming the existence of traditional roles in society, and the significance of exploring the public space as a key scenario where social features are explicitly exposed. From a methodological perspective, the processing of observational data with network analysis tools proved to be relevant and suitable for dealing with the intricacies of urban place analysis. Compared to more classical approaches and systems, these techniques allowed to identify and interpret complex systems composed of many variables and relationships in a relatively straightforward manner, which turns it into a useful aid for urban designers and architects.

Sensory approaches in psychiatric units: Patterns and influences of use in one Australian health region.

BACKGROUND/AIM: Australian guidelines and policies recommend the use of sensory approaches in mental health care. Nevertheless, many Australian psychiatric units report difficulty sustaining these approaches. To inform efforts to close the gap between recommendations and practice, the aim of this study was to understand the patterns of use of sensory approaches and what demographic and clinical factors influence their use, across one health region in Queensland, Australia. METHODS: Using a cross-sectional survey design, a custom-designed questionnaire was distributed via email and in paper form to health professionals and peer support workers working in acute, secure, and community care psychiatric units across one health region. Information on demographics and the use of various sensory interventions was gathered utilising both open-ended and Likert scale questions. RESULTS: Useable questionnaires were collected from 183 participants from various disciplines (77% nursing). The majority reported using sensory approaches with a limited number of consumers, and almost 9% never used the approach. Activity-based sensory interventions and sensory equipment were most often used, whereas sensory assessments, sensory plans, and sensory groups were least used. Sensory interventions were mainly used to reduce consumer anxiety and agitation and to assist with emotional regulation. Factors positively correlated with frequency of use for all interventions were discipline (occupational therapy); working in an acute inpatient unit; and training in sensory approaches. Age was negatively correlated with frequency of use only for weighted modalities. CONCLUSIONS: This study revealed that sensory approaches were used by most staff though with a limited proportion of consumers in psychiatric units in one large metropolitan health service. It provides insights into the factors influencing frequency of use, highlighting the importance of training in sensory approaches and access to occupational therapists. With this knowledge, we can work towards closing the gap between recommendations and the practice of sensory approaches.

Exploring the use of mobile phones by children with intellectual disabilities: experiences from Haryana, India.

PURPOSE: Covid-induced lockdowns have increased the importance of technology in education. Though access to technology as well as availability of the internet remain a major concern for a lot of children in the global south, children with intellectual disabilities are disadvantaged even more as most of the e-content is developed keeping in mind the average learner. MATERIALS AND METHODS: Unstructured interviews were conducted with children with intellectual disabilities studying in government schools in Haryana as well as their teachers and parents. Thematic analysis of the interviews was conducted to understand the use-patterns of mobile phones by children with intellectual disabilities. RESULTS: Findings suggest that these children are learning to use mobile phones on their own or with some support and are able to navigate the complexities of these smartphones quite well. They use these devices mostly for their entertainment. This paper then reflects on the need and strategies to develop these technologies in ways that they can be used as effective tools for teaching children with intellectual disabilities, especially in the inclusive education system in developing countries. CONCLUSION: The paper reflects on the need to develop technology and tools using flexible and exploratory designs to enhance the learning processes for children with intellectual disabilities from the lower income strata.IMPLICATIONS FOR REHABILITATIONThis study highlights the importance of being able to use mobile phones by children with intellectual disabilities belonging to low income families.Following this, the article argues for designing of mobile phones suitable for use by children with intellectual disabilities using playfulness and explorations, andBuilding e-content keeping the elements of playfulness and exploration which can enhance the learnings of this group of students which is often ignored.

Effects of Naturalistic Psychedelic Use on Depression, Anxiety, and Well-Being: Associations With Patterns of Use, Reported Harms, and Transformative Mental States.

Survey-based studies suggest naturalistic psychedelic use provides mental health benefits similar to those observed in clinical trials. The current study sought to confirm these findings in a large group of psychedelic users and to conduct a novel examination of associations between amount of psychedelic use and behavioral outcomes, as well as frequency of harms ascribed to psychedelic use. A cross-sectional, online survey was completed by 2,510 adults reporting at least one lifetime psychedelic experience. Participants retrospectively completed a battery of instruments assessing depression, anxiety, and emotional well-being prior to and following psychedelic exposure. Participants also reported preferred psychedelic agent, number of uses, and harms attributed to psychedelic use. Psychedelic use was associated with significant improvements in depressive and anxious symptoms and with increased emotional well-being. These improvements increased in magnitude with increasing psychedelic exposure, with a ceiling effect. However, improvements were noted following a single lifetime use. Strong evidence for benefit of one preferred psychedelic agent over another was not observed, but enduring increases in factors related to mystical-experience and prosocial perspective taking associated with enhanced mental health. Thirteen percent of the survey sample (n = 330) endorsed at least one harm from psychedelic use, and these participants reported less mental health benefit. Results from the current study add to a growing database indicating that psychedelic use-even outside the context of clinical trials-may provide a wide range of mental health benefits, while also posing some risk for harm in a minority of individuals.

[Patterns of electronic cigarette and tobacco heating products use in Spain.] / Patrones de consumo del cigarrillo electrónico y de los productos de tabaco calentado en España.

OBJECTIVE: The new tobacco related products (TRP) have modified the smoking patterns, which have been scarcely evaluated by independent studies. Our objective was to describe the patterns of electronic cigarette (e-cig) and tobacco heating products (THP) use among Spanish population. METHODS: An electronic survey aimed to population who had used at least once in their lifetime e-cigs or THPs was used to gather personal data, patterns of e-cig and THP use, as well as risk perceptions and intention to quit these products. Chi-square and Kruskal-Wallis test were used to analyze qualitative and non-parametric quantitative variables, respectively, establishing statistical significance if p values <0.05. RESULTS: The responses of 175 subjects were included. From them, 107 had consumed e-cig, 33 THP and 35 both devices. The daily use was more common among THP users, who were older than e-cig and both devices' consumers (median age 43 vs 38 vs 35 years old, p=0.013). Of the overall group, 94% referred to have smoked conventional cigarettes at least once in their lifetime, and from them 36% referred a daily cigarette consumption at the time of the survey. Regarding the risk perception of the TRP, 70%, 55% y 63% of the subjects that had used e-cig, THP, and both devices, respectively, considered that these products were less harmful for their own health than conventional cigarettes. Concerning their intention to quit any tobacco product, 51% and 64% of e-cig and THP users respectively, showed interest in quitting these devices. CONCLUSIONS: The previous and current conventional cigarettes use is frequent among TRPs consumers. The risk perception of these products is low; however, a considerable intention to quit these products is reported.

OBJETIVO: Los nuevos productos relacionados al tabaco (PRT) han diversificado la forma en que se fuma, sin embargo, existen pocos estudios independientes que analicen los patrones de este consumo. Nuestro objetivo fue describir los patrones de uso del cigarrillo electrónico (CE) y de los productos de tabaco calentado (PTC) en España. METODOS: A través de una encuesta digital dirigida a población que había usado al menos una vez CE y/o PTC se recabaron datos personales, patrones de consumo, percepción de riesgo e intención de abandono. Se utilizaron chi-cuadrada y Kruskal-Wallis para analizar variables cualitativas y cuantitativas no paramétricas respectivamente, estableciendo significancia estadística con un p valor <0,05. RESULTADOS: Se incluyeron a 175 personas, de las cuales 107 habían usado CE, 33 PTC y 35 ambos dispositivos. El uso diario fue más frecuente entre la población que había consumido PTC (p=0,018) cuya mediana de edad fue mayor a la de la que había usado CE o ambos dispositivos (43 vs 38 vs 35 años p=0,013). El 94% del grupo total había consumido cigarrillos convencionales con anterioridad y el 36% de éstos los usaba diariamente al momento de la encuesta. El 70%, 55% y 63% de las personas que habían usado CE, PTC y ambos productos, respectivamente, consideraba que el riesgo de estos dispositivos era menor frente al de los cigarrillos convencionales. El 51% y 64% de los usuarios habituales y ocasionales de CE y PTC, respectivamente, querían abandonar estos productos. CONCLUSIONES: El consumo previo y actual de cigarrillos convencionales entre la población usuaria de PRT es frecuente. A pesar de una baja percepción de riesgo, se observa una alta intención de abandonar el consumo de CE y PTC.

Prevalence and description of kratom (Mitragyna speciosa) use in the United States: a cross-sectional study.

BACKGROUND AND AIMS: Mitragyna speciosa ('kratom') contains mu opioid partial agonists. It is widely available, and occasionally used as a home remedy for opioid use disorder. The Drug Enforcement Agency considers kratom a drug of concern; however, prevalence of use and role in drug misuse are unknown. This study aimed to characterize kratom use in the United States. DESIGN: Cross-sectional Survey of Non-Medical Use of Prescription Drugs (NMURx) Program, 2018 third quarter and 2019 first quarter. SETTING: A validated non-probability online survey in the United States. PARTICIPANTS: A total of 59 714 respondents aged 18 years or older, weighted to represent the adult US population (n = 252 063 800). MEASUREMENTS: In addition to prevalence of past-year kratom and other drug use, behavior proportions were estimated. The Drug Abuse Screening Test (DAST-10) estimated consequences of drug abuse. FINDINGS: The estimated prevalence of past-year kratom use in the adult US population was 0.8% [95% confidence interval (CI) = 0.7-0.9], representing 2 031 803 adults. Life-time prevalence was 1.3% (95% CI = 1.2-1.4), representing 3 353 624 adults. Kratom users were younger (mean 35 years, P < 0.001), with higher proportions of males (61.0 versus 48.6%, P < 0.001), students (14.1 versus 7.5%, P < 0.001) and health-care professionals (9.7 versus 4.5%, P < 0.001) and fewer bachelor's/advanced degree graduates (33.4 versus 42.6%, P < 0.001) compared with non-users. Results were inconclusive on whether there was a difference in kratom use by race, household income or employment status. Among those with past-year kratom use, 36.7% (95% CI = 32.1-41.3) non-medically used prescription opioids, 21.7% (95% CI = 18.0-25.5) used illicit opioids, 54.4% (95% CI = 49.5-59.3) used another illicit drug and 67.1% (95% CI = 62.5-71.8) used cannabis. The DAST-10 profile was more often substantial/severe in kratom users (21 versus 1%, P < 0.001) compared with non-users. CONCLUSIONS: Estimated United States past-year prevalence of kratom use is 0.8%, and kratom users tend to have more serious substance abuse profiles than non-users or users of cannabis, alcohol or cigarettes. To our knowledge, this is the first description of kratom use at the national level.

Uso de sustancias psicoactivas en estudiantes de escuelas secundarias de Rosario (Argentina) / Psychoactive Drugs Use Among High-School Students In Rosario (Argentina)

Resumen El consumo de Sustancias psicoactivas (SPs) es un problema de salud mundial que afecta particularmente a los adolescentes. Por lo tanto, el conocimiento del contacto que los jóvenes tienen con las SPs, permitirá el desarrollo de políticas de prevención. El objetivo del trabajo fue evaluar el contacto con SPs de estudiantes secundarios de Rosario y alrededores. Entre el 2013 y el 2016, contestaron de forma anónima un cuestionario 1064 estudiantes, observándose un aumento significativo del consumo de SPs en el año 2016. Cuando se excluyen el consumo de tabaco y alcohol (SPs legales) el porcentaje permanece constante. El aumento observado se debe al consumo de SPs tales como alcohol y tabaco. Se observó una disminución de la edad de inicio así como un cambio en los porcentajes y patrones de consumo. La SP más consumida fue el alcohol seguida de tabaco o marihuana. Los cambios observados podrían estar relacionados con las edades y los años de cursado de los estudian tes encuestados.

Abstract. Adolescence is characterized by anxiety, peer-pressure, identity search, etc. All these features contribute to experiment with Psychoactive Drugs (P.D.). P.D. use is a global health problem that has its onset during adolescence. The developing of prevention policies according to a specific population needs the knowledge of the levels and patterns of P.D. use. The goal of the present work was to evaluate P.D.'s level of contact and patterns of use among high school students in Rosario (Argentina). Between 2013 and 2016, a total of 1064 students were surveyed. The results showed that P.D. use (at least once in a lifetime) was significantly higher in 2016 compared to previous years. However, when the use of legal vs illegal P.D. was discriminated we found that such increase was due to higher use of alcohol and tobacco; while the illegal P.D. use remained constant. Moreover, in 2016 we found a decrease in the age of onset as well as a change in the patterns of P.D use. However, all these results must be analyzed taking into account intrinsic differences of the sample.

Real-World Patterns of Everolimus Use in Patients with Metastatic Breast Cancer.

BACKGROUND: There is limited literature on patterns of everolimus use and subsequent hospitalizations and emergency room (ER) visits in real-world clinical practice. In this study, we describe patterns of everolimus use and hospitalizations and ER visits in a large cohort of patients with breast cancer (BC). MATERIALS AND METHODS: Patients with BC treated with everolimus were identified in the MarketScan database from 2009 to 2016. The pattern of everolimus use and frequency of associated ER visits and hospitalizations during treatment (between the first claim and 30 days after the last claim for everolimus) were identified. Descriptive statistics and regression models were used. RESULTS: A total of 3,556 everolimus users were identified (median age of 60 years; median days of use, 112). The initial prescribed dose was 10 mg in 74.8% of the patients. Compared with the initial dose, 23.5% of patients had a dose change. Forty-six percent of patients were hospitalized or had an ER visit during the treatment with everolimus. Age greater than 71, higher comorbidity score, treatment year prior to 2012, and lower initial dose were found to be significantly associated with ER visit/hospitalization in the regression models. CONCLUSIONS: A significant proportion of patients receiving everolimus had an ER visit or hospitalization during the use of everolimus. These results provide data regarding risks and benefits of treatment with everolimus. These results will be helpful in identifying patients at higher risk of hospitalizations or ER visits and facilitate evidence-based decision making to avoid serious complications. IMPLICATIONS FOR PRACTICE: Everolimus, a mammalian target of rapamycin inhibitor, is approved in combination with exemestane in patients with hormone receptor-positive tumors previously treated with anastrozole or letrozole. As new drugs become available, it is crucial to understand the adverse events and potential complications associated with the use of such drugs in the general population, outside of the controlled clinical trial setting. This study describes the patterns of everolimus use and adverse events, including hospitalization and emergency room visits, in a large cohort of patients with metastatic breast cancer in routine practice.

Use of QT Prolonging Medications by Hemodialysis Patients and Individuals Without End-Stage Kidney Disease.

Background The rate of sudden cardiac death in the hemodialysis population exceeds that of the general population by >20-fold. Hemodialysis patients may be particularly susceptible to sudden cardiac death provoked by drug-induced QT prolongation because of their substantial cardiovascular disease burden, exposure to electrolyte shifts during dialysis, and extensive polypharmacy. However, population-specific data regarding the frequency and patterns of QT prolonging medication use are limited. Methods and Results We conducted a descriptive drug utilization study using 3 administrative databases, the United States Renal Data System, MarketScan, and Medicare claims. We characterized the extent and patterns of QT prolonging medication use by adult hemodialysis patients and individuals without end-stage kidney disease annually from 2012 to 2016. We also identified instances of high-risk QT prolonging medication use among hemodialysis patients. In total, 338 515 hemodialysis patients and 40.7 million individuals without end-stage kidney disease were studied. Annual utilization rates of QT prolonging medications with known torsades de pointes risk in hemodialysis patients were ~1.4 to ~2.5 times higher than utilization rates in individuals without end-stage kidney disease. Hemodialysis patients with demographic and clinical risk factors for drug-induced QT prolongation were exposed to medications with known torsades de pointes risk more often than patients without risk factors. Conclusions Hemodialysis patients use QT prolonging medications with known torsades de pointes risk more extensively than individuals without end-stage kidney disease. Given the widespread use and instances of high-risk prescribing, future studies evaluating the cardiac safety of these drugs in the hemodialysis population are needed.

Electronic cigarette use among Italian smokers: patterns, settings, and adverse events.

OBJECTIVE: Information is scanty on the patterns and settings of electronic cigarette use and on its possible adverse events. To fill the knowledge gap on these issues, we conducted a survey among ever-smokers attending smoking cessation services (SCS) in Italy. METHODS: In 2016-2018, we enrolled 395 ever-smokers aged ⩾18 years who were current or former electronic cigarette users in 12 SCS from northern, central, and southern Italy. RESULTS: In all, 12.4% of ever smokers were regular, 9.4% occasional, and 78.2% past users of electronic cigarettes. Of all users, 93.8% consumed electronic cigarettes with nicotine, 95.9% used refillable devices, and 76.6% purchased electronic cigarette devices or liquids in vape shops. The mean duration of use was 3.7 months and the mean number of puffs per day was 86. Among users, 71.5% used electronic cigarettes in at least 1 smoke-free indoor environment, 53.7% in workplaces, 49.5% in restaurants and bars, 33.5% in train/metro stations or airports, and 18.4% in public transports. The use of electronic cigarettes in smoke-free environments significantly decreased with age and increased with duration of use and nicotine dependence. In our sample, 47.1% reported at least 1 adverse event attributable to electronic cigarette use: 19.5% dry cough, 12.0% dry mouth, 7.6% throat or mouth irritation, and 6.8% sore throat. CONCLUSION: In Italy, most conventional cigarette smokers use electronic cigarettes where smoking conventional cigarettes is prohibited. About half of users reported 1 or more symptoms attributable to electronic cigarettes, despite the relatively short duration of use.

The use of complementary and alternative medicine in a multi-ethnic Asian population: results from the 2016 Singapore Mental Health Study.

BACKGROUND: This study seeks to investigate factors associated with using complementary and alternative medicine (CAM) for a mental illness among the three major ethnic groups (Chinese, Indians and Malays) in the general population of Singapore. METHODS: Data from the 2016 Singapore Mental Health Study was used; responses from the "Services" section of the Composite International Diagnostic Interview version 3.0 (CIDI 3.0) administered during face-to-face household interviews with participants were analyzed to establish prevalence of CAM use among Singaporeans. Additionally, sociodemographic variables of interest were selected for sub-group regression analyses to yield correlates of CAM use among the three ethnic groups. RESULTS: 6.4% of Singaporeans used at least one form of CAM in the past 12 months for their mental illness. Malays reported using CAM the most, followed by Indians and Chinese. Sociodemographic variables such as education and employment were differently associated with CAM use among the ethnicities. Across all three ethnic groups, CAM users were more likely to report poorer mental health-related quality of life. CONCLUSION: Despite the significant differences in CAM use among Chinese, Malays and Indians, those who had a mental illness were significantly more likely to use CAM regardless of ethnicity. This highlights the need for communication between CAM practitioners and conventional mental healthcare providers for early referral when appropriate which would lead to improved healthcare delivery and better clinical outcomes.

Study of the prevalence and patterns of phosphodiesterase type 5 inhibitor use among sexually active Egyptian males: A National Cross-sectional Survey.

A cross-sectional survey was conducted in Egypt from November 2015 to June 2016. Sexually active adult men were interviewed by a questionnaire designed by the authors. All the participants were evaluated by the abridged 5-item version of the International Index of Erectile Function (IIEF). A total of 3,000 sexually active Egyptian males participated in this study, 946 (31.53%) reported using PDE5Is at least once, and 2054 (68.47%) have never used them. The majority of those who used PDE5Is obtained them for recreational purposes mainly for pleasure (58.35%) and to increase duration/frequency of the intercourse (15.6%). Only 26.05% used PDE5Is to treat ED. The main source of obtaining PDE5Is was friends, relatives and colleagues (62.79%); 25.16% of users obtained the drug by themselves, and 6.66% were prescribed the drug by a pharmacist. Only 5.39% of users obtained the drug after a specialist physician consultation. Sildenafil was the most commonly used PDE5I (90.6%), and most of the users (88.05%) used them in an occasional manner even in the presence of erectile dysfunction, while 11.95% used the drug in a regular manner for every intercourse. PDE5Is are frequently used by the Egyptian male population, and most of them seemed to take them as recreational medications.

Surveying drug consumption: Assessing reliability and validity of the European Web Survey on Drugs questionnaire.

BACKGROUND: The European Web Survey on Drugs aimed to obtain in-depth data on consumption of cannabis, ecstasy/MDMA, cocaine, and amphetamines in different populations of drug users in 16 European countries. This paper examines test-retest reliability, the consistency and the comprehensibility of the prevalence and frequency of use questions in the Czech part of the survey. METHODS: A baseline web survey was performed (N = 610) with follow-up data collection in a sub-sample of volunteers providing email addresses (N = 158). The baseline sample was self-selecting, responding to advertisements made available through multiple channels designed to attract diverse samples of drug users. Test-retest analysis was conducted for core questionnaire items. RESULTS: Respondents to the follow-up were predominantly socially integrated; 91% reported last year cannabis use, 42% used Ecstasy/MDMA, 23% amphetamines, and 27% reported cocaine use. Test-retest reliability was rated moderate to good (reliability coefficients between 0.55-0.87) for most prevalence items with sufficient sample sizes. Items assessing frequency of use were more reliable for most substances when asking about the exact number of days used, compared to categorical items that implicitly assume a regular pattern of use and were interpreted differently by different respondents. CONCLUSIONS: Simplicity and unambiguity of questions increase the reliability of results. Tools measuring drug consumption need to take into consideration the irregularity of drug using patterns. Question testing is important to increase validity and support a correct interpretation of the data.