Abstract Background and aims There has been no comprehensive evaluation of the efficacy of transcutaneous electric nerve stimulation (TENS) for acute low back pain (LBP). The aim of this systematic review was to investigate the efficacy and safety of TENS for acute LBP. Methods We searched MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL and PsycINFO (inception to May 2018) for randomised placebo controlled trials. The primary outcome measure was pain relief in the immediate term (within 2-weeks of administration) assessed using the 100 mm visual analogue scale. A mean difference of at least 10 points on the 100-point pain scale was considered clinically significant. Methodological quality of the eligible studies was assessed using the PEDro scale and overall quality assessment rating was assessed using GRADE. Results Three placebo controlled studies (n = 192) were included. One low quality trial (n = 63) provides low quality evidence that ~30 min treatment with TENS in an emergency-care setting provides clinically worthwhile pain relief for moderate to severe acute LBP in the immediate term compared with sham TENS [Mean Difference (MD) – 28.0 (95% CI – 32.7, −23.3)]. Two other studies which administered a course of TENS over 4–5 weeks, in more usual settings provide inconclusive evidence; MD −2.75 (95% CI −11.63, 6.13). There was limited data on adverse events or long term follow-up. Conclusions The current evidence is insufficient to support or dismiss the use of TENS for acute LBP. Implications There is insufficient evidence to guide the use of TENS for acute LBP. There is low quality evidence of moderate improvements in pain with a short course of TENS (~30 min) during emergency transport of patients to the hospital. Future research should evaluate whether TENS has an opioid sparing role in the management of acute LBP.

The review aimed to examine the views and experiences of ageing gender and sexually diverse (GSD) women—a triple minority in relation to their age, gender and sexual orientation—in accessing health, social and aged care services. Eighteen peer reviewed articles identified from seven electronic databases in health and social sciences were evaluated according to predefined criteria and a thematic review methodology drawing upon socio-ecological theory was used to analyse and interpret the findings. Four major themes were identified from the analysis: “The Dilemma of Disclosure”, “Belonging/Connection”, “Inclusiveness of Aged Care” and “Other Barriers to Access Care”. In the dilemma of disclosure, older GSD women consider factors such as previous experiences, relationship with the provider and anticipated duration of stay with the provider before disclosing their sexual identifies. The review also revealed that aged care services lack inclusiveness in their policies, advertising materials, aged care spaces and provider knowledge and attitude to provide sensitive and appropriate care to GSD women. Overall, older GSD women experience multiple and multilevel challenges when accessing health, aged and social services and interventions are needed at all levels of the socio-ecological arena to improve their access and quality of care.

Background Despite the prevalent use of geosocial networking dating apps (GNDAs), there is limited research on their impact on sexual health outcomes among young music festivals attendees. Objective This study aims to explore the use of GNDAs and risky sexual behaviors of young adults attending a music festival. Methods The music festival attendees (N=862) completed a cross-sectional questionnaire study encompassing demographics, dating app use, and risky sexual behaviors in the past year. Associations between these variables were estimated using bivariate and multivariate logistic regression analyses. Results Of the respondents, 51.9% (448/862) had used GNDAs in the previous year. Compared with people who had 1 partner, people who had 2-5 sexual partners in the previous year had almost 7 times the odds of using dating apps (odds ratio [OR] 6.581, 95% CI 4.643-9.328) and those who had more than 5 partners had 14 times the odds of using dating apps (OR 14.294, 95% CI 8.92-22.906). Condom users were more likely to be app users (P<.001), as were those who relied on emergency Plan B (P=.002), but people using hormonal contraception were less likely to use dating apps (P=.004). After adjusting for sexual orientation and relationship status, those having casual sex had 3.096 (95% CI 2.225-4.307; P<.001) times the odds of using dating apps and those having multiple sexual partners had 3.943 (95% CI 2.782-5.588; P<.001) times the odds of using dating apps. Similarly, after adjusting for sexual orientation, relationship status, and number of sexual partners, people who had no discussions before having sex about sexually transmitted infections (STIs) or boundaries were more likely to use dating apps (OR 1.755, 95% CI 1.232-2.500; P=.002). Those who perceived the risk of having sex without contraception to be very high had 2.486 (95% CI 2.213-5.096; P=.01) times the odds of using dating apps than those who perceived no risk. Compared with those who perceived no risk, people who thought that the risk of having multiple sexual partners was low to high had 1.871 (95% CI 1.024-3.418; P=.04) times the odds of using dating apps. A significant number of app users (389/440, 88.4%) indicated that GNDAs should promote safe sex. Conclusions This study identified that festival goers engaging in certain high-risk sexual behaviors, including casual sex, having multiple sexual partners, and having sex without discussion about STI status and boundaries, are more likely to use dating apps. Festival goers who perceived sex without any form of contraception, having sex while drunk, and having multiple sexual partners as risky were more likely to be app users. Policy makers and GNDA developers should acknowledge the vulnerability of their users to adverse sexual health outcomes and use GNDAs as a platform to promote risk-reduction practices.

Background Despite the popularity of dating apps, there remain scarce data on the motivations, consequences and their influence on sexual behaviour change in the Australian population. Objective To explore motivations, dating app relationships, unintended consequences and change in sexual behaviour in dating app users at an Australian music festival. Methods A cross-sectional study design was used. Festival patrons aged 18–30 at a major Australian music festival completed a paper-based survey. Logistic regression was used to identify which factors were associated with an increase in sexual partners since using dating apps. Results The primary reasons for dating app use (N = 437) were boredom (59.7%), casual sex (45.1%) and casual dating (42.8%). A third of users used them at music festivals (33.8%, n = 432). A third of participants had used dating apps for more than 2 years (33.3%) and a third (33.0%) of users claimed to have changed their sexual behaviour after app use, including increased frequency of sexual activity (70.0%), number of sexual partners (57.1%) and sexual experimentation (42.1%). Dating app users tended not to discuss sexually transmitted infections (STI) status with a sexual partner regardless of whether they had met them on an app or not: 38.5% would ‘never’ and 36.9% would ‘sometimes’ have safe sex discussions with partners met via apps. Condoms were ‘always’ used for 36.9% of dating app users when meeting partners via dating apps, compared to 29.9% met by other means. 8.6% of dating app users reported having contracted STIs, and 2.8% had unwanted pregnancies with those met on dating apps. After adjusting for socio-demographics, those who had an STI after engaging in sexual activity with a person met via a dating app had 2.4 times the odds of reporting an increase in sexual partners, and those who had used a dating app for over 2 years had twice the odds of reporting an increase in sexual partners. When condom use was entered into the model, those that ‘often’ or ‘sometimes’ used a condom with a new dating app partner were twice as likely to report an increase in sexual partners since using dating apps, compared to those who ‘always’ used a condom with a new dating app partner. Sexual orientation and STI discussions with a new sexual dating app partner were not associated with an increase in dating app partners. Conclusion Dating app usage is common and users report increased sexual activity, sexual partners and experimentation. STI discussions with potential partners and condom use remained low regardless of how partners were met and despite an increase in sexual partners since using dating apps. Given the high-risk nature of individuals that utilise dating apps, safe sex discussion, including STIs, pregnancies and condom use should be promoted to improve sexual health outcomes.