Cardiovasc Diabetol

Lower-extremity arterial disease (LEAD) is a major endemic disease with an alarming increased prevalence worldwide. It is a common and severe condition with excess risk of major cardiovascular events and death. It also leads to a high rate of lower-limb adverse events and non-traumatic amputation. The American Diabetes Association recommends a widespread medical history and clinical examination to screen for LEAD. The ankle brachial index (ABI) is the first non-invasive tool recommended to diagnose LEAD although its variable performance in patients with diabetes. The performance of ABI is particularly affected by the presence of peripheral neuropathy, medial arterial calcification, and incompressible arteries. There is no strong evidence today to support an alternative test for LEAD diagnosis in these conditions. The management of LEAD requires a strict control of cardiovascular risk factors including diabetes, hypertension, and dyslipidaemia. The benefit of intensive versus standard glucose control on the risk of LEAD has not been clearly established. Antihypertensive, lipid-lowering, and antiplatelet agents are obviously worthfull to reduce major cardiovascular adverse events, but few randomised controlled trials (RCTs) have evaluated the benefits of these treatments in terms of LEAD and its related adverse events. Smoking cessation, physical activity, supervised walking rehabilitation and healthy diet are also crucial in LEAD management. Several advances have been achieved in endovascular and surgical revascularization procedures, with obvious improvement in LEAD management. The revascularization strategy should take into account several factors including anatomical localizations of lesions, medical history of each patients and operator experience. Further studies, especially RCTs, are needed to evaluate the interest of different therapeutic strategies on the occurrence and progression of LEAD and its related adverse events in patients with diabetes

Mobile banking usage and gamification: the moderating effect of generational cohorts

Purpose: The extended unified theory of acceptance and use of technology (UTAUT2) model has been adapted and applied by scholars to gain insight into mobile banking (m-banking) usage. By combining three perspectives, UTAUT2, gamification (GM) and generational cohort theory, this study aims to investigate the factors which impact m-banking usage and examine the moderating effect of generations Y and Z on the relationship between GM and intention to use m-banking. Design/methodology/approach: The adopted model was tested in a quantitative study by using partial least square structural equation modelling. A total of 380 valid questionnaires from a transition country, Albania, have been examined. Findings: In the study, scientific evidence concerning the UTAUT2 model and GM elements are provided. Thus, facilitation conditions, habit and hedonic motivation were found to be significant determinants of GM. Moreover, the results revealed that age moderates the relationship between GM and behavioural intention (BI). Compared to generation Z, individuals born prior to 1996 (generation Y), exhibited a much stronger relationship. Research limitations/implications: Although Albania bears similarities with other transition countries in terms of regional, economic and political environments, the generalisation of these results to another context is rather limited. Practical implications: This paper offers a model integrating UTAUT2, GM and generational cohorts in the context of a transition country. The findings can be applied in the form of guidelines for a number of financial institutions. Originality/value: Besides identifying the determinants of m-banking adoption and GM, this study notably reveals the importance of generational cohorts because it governs the effect of GM on m-banking BI. © 2020, Emerald Publishing Limited