Structural social support predicts functional social support in an online weight loss programme

Background Online weight loss programmes allow members to use social media tools to give and receive social support for weight loss. However, little is known about the relationship between the use of social media tools and the perception of specific types of support. Objective To test the hypothesis that the frequency of using social media tools (structural support) is directly related to perceptions of Encouragement, Information and Shared Experiences support (functional support). Design Online survey. Participants Members of an online weight loss programme. Methods The outcome was the perception of Encouragement (motivation, congratulations), Information (advice, tips) and Shared Experiences (belonging to a group) social support. The predictor was a social media scale based on the frequency of using forums and blogs within the online weight loss programme (alpha = 0.91). The relationship between predictor and outcomes was evaluated with structural equation modelling (SEM) and logistic regression, adjusted for sociodemographic characteristics, BMI and duration of website membership. Results The 187 participants were mostly female (95%) and white (91%), with mean (SD) age 37 (12) years and mean (SD) BMI 31 (8). SEM produced a model in which social media use predicted Encouragement support, but not Information or Shared Experiences support. Participants who used the social media tools at least weekly were almost five times as likely to experience Encouragement support compared to those who used the features less frequently [adjusted OR 4.8 (95% CI 1.8–12.8)]. Conclusions Using the social media tools of an online weight loss programme at least once per week is strongly associated with receiving Encouragement for weight loss behaviours.     

Standard nurse phone triage versus tele–emergency care pilot on Veteran use of in-person acute care: An instrumental variable analysis

Objectives

Use of acute care telemedicine is growing, but data on quality, utilization, and cost are limited. We evaluated a Veterans Affairs (VA) tele–emergency care (tele-EC) pilot aimed at reducing reliance on out-of-network (OON) emergency department (ED) care, a growing portion of VA spending. With this service, an emergency physician virtually evaluated selected Veterans calling a nurse triage line.

Methods

Calls to the triage line occurring January–December 2021 and advised to seek care acutely within 24 h were included. We described tele-EC user characteristics, common triage complaints, and patterns in referral to and management by tele-EC. The primary outcome was acute care visits (ED, urgent care, and hospitalizations at VA and OON sites) within 7 days of the index call. Secondary outcomes included mortality, OON acute care spending, and the effect of tele-EC visit modality (phone vs. video). We used both standard regression and instrumental variable (IV) analysis, using the tele-EC physician schedule as the instrument.

Results

Of 7845 eligible calls, 15.5% had a tele-EC visit, with case resolution documented in 57%. Compared to standard nurse triage, tele-EC users were less likely to be Black, had more prior ED visits, and were triaged as higher acuity. Calls concerning dizziness/syncope, blood in stool, and chest pain were most likely to have a tele-EC visit. Tele-EC was associated with fewer ED visits than standard nurse triage in both regression (average marginal effect [AME] −16.8%, 95% confidence interval [CI] −19.2 to −14.4) and IV analyses (AME −17.5%, 95% CI −25.1 to −9.8), lower hospitalization rate (AME −3.1%, 95% CI −6.2 to −0.0), and lower OON spending (AME –$248, 95% CI −$458 to −$38).

Conclusions

Among Veterans initially advised to seek care within 24 h, use of tele-EC compared to standard phone triage led to decreased ED visits, hospitalizations, and OON spending within 7 days.     

Friction and orthodontic mechanics: clinical studies of moment and ligation effects

The efficiency of tooth movement associated with orthodontic sliding mechanics can be compromised by friction between arch wire and tube or bracket slot. The described studies measured the apparent coefficient of static friction (μ_a) during sliding along an arch wire. Known moments were applied to simulate tooth tipping. Measurements tested whether intraoral vibration during gum chewing reduced friction. The first experiments measured intraoral friction associated with the sliding of 4 and 8 mm stainless steel (SS) tubes along a SS auxiliary arch wire, in 10 subjects. Mean intraoral μ_a for 4 and 8 mm tubes were 0.12 (SD = 0.04) and 0.17 (SD = 0.05), respectively. Analysis of variance (ANOVA) showed that μ_a was significantly higher (P < 0.001) for the longer tubes. Although intraoral vibration decreased μ_a compared with bench-top tests (P < 0.001), frictional resistance was never completely eliminated.

The second experiments studied the effects of ligation. Ten professionals performed exercises to characterize average tight and loose SS ligation forces. These ligation forces (F_{N Ligation}), and those associated with elastic ligation, were reproduced by a calibrated operator in a modified intraoral device, where SS orthodontic brackets slid along a SS auxiliary wire. Ten subjects chewed gum with the device in place. Nested ANOVA and Tukey Honest Significant Difference tests determined the effects of ligation type and environment. No significant differences (P > 0.01) were found between ex vivo and intraoral μ_a values for tight and loose SS ligation. Intraoral values for μ_a were significantly greater than ex vivo values (P < 0.001) for elastic ligation. Overall, the results suggested that vibration introduced by gum chewing did not eliminate friction. Tipping moments and ligation forces were equally significant in determining frictional forces. As well, there was considerable intraoperator variation in F_{N Ligation} for SS ligatures. Variations in clinical ligation forces are likely to be equal or greater than these experimental data and have potential to affect treatment efficiency during orthodontic sliding mechanics.