Music streaming services: understanding the drivers of customer purchase and intention to recommend.

The music industry has undergone tremendous changes in relation to its production, distribution, and consumption habits due to the exponential development of new technologies, namely streaming platforms. The fact that sales of physical copies continue to decline significantly made it mandatory for this industry to reinvent itself by introducing music streaming services as a key part of its business development. This study aims to understand the factors that influence music consumption through streaming platforms, particularly studying the intention to adopt premium (paid) versions of a music streaming service and recommend them. An extension of the UTAUT2 model (version of the Unified Theory of Acceptance and Use of Technology, applied to the consumer side) was created. Based on data collected from 324 music streaming services users, the framework of this study was tested using structural equation modelling (SEM). Research also included in-depth semi-structured interviews in order to generate a more profound knowledge about the profile, behaviours and motivations of the new music consumer. Our findings confirm that habit, performance expectancy and price value play the most important role in influencing the intention to use a paid music streaming service. Simultaneously, new dimensions such as personalisation, attitude towards piracy and perceived freemium-premium fit arise as having an additional relevant role in adopting this type of service. The research contributes insights into music streaming services consumer behaviour, providing several theoretical and practical implications to music streaming services providers.

Low Serum Levels of DKK2 Predict Incident Low-Impact Fracture in Older Women.

There are currently no robust noninvasive markers of fragility fractures. Secreted frizzled related protein-1 (sFRP-1), dickkopf-related protein 1 (DKK1) and DKK2, and sclerostin (SOST) inhibit Wnt signaling and interfere with osteoblast-mediated bone formation. We evaluated associations of serum levels of sFRP-1, DKK1, DKK2, and SOST with incident low-impact fracture and BMD in 828 women aged ≥65 years from EpiDoC, a longitudinal population-based cohort. A structured questionnaire during a baseline clinical appointment assessed prevalent fragility fractures and clinical risk factors (CRFs) for fracture. Blood was collected to measure serum levels of bone turnover markers and Wnt regulators. Lumbar spine and hip BMD were determined by DXA scanning. Follow-up assessment was performed through a phone interview; incident fragility fracture was defined by any new self-reported low-impact fracture. Multivariate Cox proportional hazard models were used to analyze fracture risk adjusted for CRFs and BMD. During a mean follow-up of 2.3 ± 1.0 years, 62 low-impact fractures were sustained in 58 women. A low serum DKK2 level (per 1 SD decrease) was associated with a 1.5-fold increase in fracture risk independently of BMD and CRFs. Women in the two lowest DKK2 quartiles had a fracture incidence rate of 32 per 1000 person-years, whereas women in the two highest quartiles had 14 fragility fractures per 1000 person-years. A high serum sFRP1 level was associated with a 1.6-fold increase in fracture risk adjusted for CRFs, but not independently of BMD. Serum levels of SOST (r = 0.191; p = 0.0025) and DKK1(r = -0.1725; p = 0.011) were correlated with hip BMD, but not with incident fragility fracture. These results indicate that serum DKK2 and sFRP1 may predict low-impact fracture. The low number of incident fractures recorded is a limitation and serum levels of Wnt regulators should be further studied in other populations as potential noninvasive markers of fragility fractures. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Challenges of Ageing in Portugal: Data from the EpiDoC Cohort.

INTRODUCTION: Portuguese adults have a long lifespan, but it is unclear whether they live a healthy life in their final years. We aimed to determine the prevalence of multimorbidity and characterize lifestyle and other health outcomes among older Portuguese adults. MATERIAL AND METHODS: We performed a cross-sectional evaluation of 2393 adults, aged 65 and older, during the second wave of follow-up of the EpiDoC cohort, a population-based study involving long-term follow-up of a representative sample of the Portuguese population. Subjects completed a structured questionnaire during a telephone interview. Socioeconomic, demographic, lifestyle behaviours, chronic diseases, and health resources consumption were assessed. Cluster analysis was done to identify dietary patterns. Descriptive and analytic analysis was performed to estimate multimorbidity prevalence and its associated factors. RESULTS: Multimorbidity prevalence among older adults was 78.3%, increased with age strata (72.8% for 65 - 69 years to 83.4% for ≥ 80 years), and was highest in Azores (84.9%) and Alentejo (83.6%). The most common chronic diseases were hypertension (57.3%), rheumatic disease (51.9%), hypercholesterolemia (49.4%), and diabetes (22.7%). Depression symptoms were frequent (11.8%) and highest in the oldest strata. The mean health-related quality of life (EQ-5D-3L) score was 0.59 ± 0.38. Hospitalization in the previous 12 months was reported by 25.8% of individuals. Overall, 66.6% of older adults were physically inactive. 'Fruit and vegetables dietary pattern' was followed by 85.4% of individuals; however, regional inequalities were found (69% in Azores). Obesity prevalence was 22.3% overall and was highest among Azoreans (33%). CONCLUSION: The high prevalence of multimorbidity, combined with unhealthy lifestyle behaviours, suggests that the elderly populationconstitutes a vulnerable group warranting dedicated intervention.

Introdução: A esperança de vida está a aumentar em Portugal, contudo desconhece-se o estado de saúde dos idosos. Pretende-se determinar a prevalência de multimorbilidade, caracterizar estilos de vida e outros fatores relacionados com a saúde dos idosos. Material e Métodos: Efetuou-se uma avaliação transversal a 2393 adultos com 65 ou mais anos de idade, da coorte EpiDoC que é constituída por uma amostra representativa da população portuguesa. Os inquiridos responderam a um questionário estruturado através de uma entrevista telefónica, tendo-se recolhido dados socioeconómicos demográficos, estilo de vida, doenças crónicas e consumo de recursos em saúde. Análise de clusters foi realizada para a identificação de padrões alimentares. Efetuou-se análise descritiva e analítica para estimar a prevalência de multimorbilidade e fatores associados. Resultados: A prevalência de multimorbilidade nos idosos foi de 78,3% (72,8% entre os 65 - 69 anos, 83,4% com 80 + anos) e foi superior nos Açores (84,9%) e no Alentejo (83,6%). As doenças crónicas mais prevalentes foram a hipertensão arterial (57,3%), doenças reumáticas (51,9%), hipercolesterolemia (49,4%) e diabetes (22,7%). Os sintomas de depressão (11,8%) foram frequentes, aumentando ao longo dos grupos etários. A qualidade de vida (EQ-5D-3L) foi em média de 0,59 ± 0,38 e 25,8% dos idosos reportaram ter sido hospitalizados nos 12 meses prévios à entrevista. Cerca de 66,6% dos idosos são fisicamente inativos. O padrão alimentar caracterizado por '+ fruta e + hortícolas' foi reportado por 85,4% dos idosos, contudo foram encontradas iniquidades regionais (69% para os idosos açorianos). A prevalência de obesidade foi de 22,3%, sendo superior nos açorianos (33%). Conclusões: A elevada prevalência de multimorbilidade combinada com estilos de vida pouco saudáveis sugere que a população idosa constitui um grupo vulnerável que requer uma intervenção direcionada.

EpiReumaPt- the study of rheumatic and musculoskeletal diseases in Portugal: a detailed view of the methodology.

Rheumatic and musculoskeletal diseases (RMD) are prevalent and leading causes of disability and consumption of healthcare and social resources. EpiReumaPt is a national population-based survey developed by the Portuguese Society of Rheumatology that aimed to estimate the prevalence of RMDs and determine their impact on function, quality of life, mental health and use of healthcare resources. This article describes in detail the design, methodology and planned analyses of EpiReumaPt. Recruitment started in September 2011 and finished in December 2013. This study involved a three-stage approach. The first step was a face-to-face survey performed by trained interviewers at the household of 10,661 subjects who where randomly selected by a stratified multistage sampling. A highly sensitive screening questionnaire for RMDs was used. Secondly, participants who screened positive (64%) for at least one RMD as well as 20% of individuals with a negative screening were invited for assessment by a rheumatologist. In total, 3,877 subjects participated in this second phase, where they were also invited to donate a blood sample to be stored at the Biobanco-IMM. History and physical examination, followed by appropriate laboratory and imaging tests were performed. At the end of the visit, the rheumatologist established a diagnosis. Finally, a team of three experienced rheumatologists reviewed all the clinical data and defined the diagnoses according to previously validated criteria. The EpiReumaPt dataset, containing data from several questionnaires, various clinical measurements and information from laboratory and imaging tests, comprises an invaluable asset for research. The large amount of information collected from each participant and the large number of participants, with a wide age range covering and being representative of the adults from the entire country, makes EpiReumaPt the largest study of RMDs performed in Portugal.