Changes In Perception Research Articles

Pilot Implementation of a Primary Care Disease Management Concept for Venous Leg Ulceration: Results of a Mixed-Methods Process Evaluation

Background: Within the project “Ulcus Cruris Care”, a disease management intervention to improve general practice care for patients with venous leg ulcer was developed, comprising online teaching for practice teams, standardized patient education, and case management. Implementation of the intervention was piloted and evaluated via a process evaluation. This study aims to evaluate contentedness with the intervention, implementation effort, implementation determinants, intervention fidelity, and perceived intervention effects using a mixed-methods process evaluation. Methods: The mixed-methods process evaluation explored the views of general practitioners, medical assistants and patients regarding the intervention components. Data were collected through semi-structured telephone interviews and a survey questionnaire. Qualitative data were first analyzed inductively, followed by a deductive–inductive approach based on the Theoretical Domains Framework. Survey data were analyzed descriptively. Results: Participants (n = 21) reported a strong contentedness with the intervention, high intervention fidelity, low implementation effort, and a change in perception of compression therapy as the central treatment element. Healthcare professionals emphasized increased patient education and patient and family involvement. Patients reported feeling better informed and empowered to take an active role in their treatment, primarily due to increased knowledge and skills in compression therapy. As a result, they were more content with their care and reported positive experiences with wound healing since trial participation. Conclusions: The Ulcus Cruris Care intervention can lead to a noticeable change in knowledge and potentially influence practice teams’ approach to venous leg ulcer management, facilitating a significantly more frequent use of compression therapy in VLU care. A confirmatory evaluation of potential effects in a definitive RCT seems warranted.

Farmers’ Perception and Adaptation Strategies on Climate Change and Variability in Rice Production in Sarlahi, Nepal

A study conducted in Sarlahi, Nepal, from February to July 2024 examined farmers' perceptions of climate change and their adaptive strategies to sustain rice yields. Among the 94 surveyed households, 96.8% reported rising temperatures, while 90.4% noted reduced rainfall frequency and intensity. Additionally, most respondents (70.2%) observed decreased flooding intensity, and 90.4% reported lower water availability in tube wells, ponds, and rivers. The study revealed limited climate knowledge among farmers, with only 2.1% being well-informed; personal experience was the primary source of information for 75.5% of respondents. Farmers employed various adaptation techniques, including improved rice varieties (66%), green manuring (34%), and alternate wetting and drying (24.5%), although only a small percentage (8.5%) utilized crop insurance. Key challenges included climate-induced disease outbreaks like blast and bacterial blight, along with pests such as the rice stem borer and leaf roller. The findings indicated that gender and landholding size significantly influenced the adoption of adaptation practices, with larger landholders more likely to adapt than smaller ones. This research contributes valuable insights into the adaptive capacities of farmers facing climate change, underscoring the need for targeted policy interventions to enhance resilience in rice cultivation through comprehensive education and resource support.

Еco-Аnxiety and Perception of Climate Change

The present study highlights the growing need to understand eco- anxiety as a significant contemporary phenomenon associated with climate change and its impact on mental health. It aims to measure eco-anxiety levels among the Bulgarian population and to assess the applicability of the scale within the Bulgarian sociocultural using an adapted version of the “Hogg Eco-Anxiety Scale” (HEAS-13). The results of the study confirm the original four-factor structure of the instrument and demonstrate that the scale possesses strong psychometric properties, making it a reliable tool for assessing eco-anxiety in Bulgaria. The study also reveals higher levels of eco-anxiety among women compared to men, suggesting a gender disparity in environmental concerns, consistent with previous studies showing that women often exhibit stronger reactions to climate change. The findings enrich the understanding of eco-anxiety as a multidimensional construct and provide an empirical basis for a deeper comprehension of environmental concerns within the Bulgarian population. The application of this scale in Bulgaria has the potential to support the development of more effective policies and programs to address the negative psychological effects of climate change, drawing attention to the need for gender-sensitive approaches and psychological support.

Exploration of patient loyalty through value integration and customer satisfaction in class B university hospitals on Java Island

This study aims to analyze the relationship between accessibility, brand image, and service quality on customer value, customer satisfaction, and revisit intention at the University Hospital (RSPT). The main focus of the study is the mediating role of customer value and customer satisfaction in influencing patient loyalty. With a holistic approach, this study highlights the unique dynamics of RSPT that integrates education and health care functions. The findings indicate that accessibility and service quality have a significant influence on customer value, while brand image has a more limited contribution in this context. In addition, customer satisfaction plays an important role in bridging the relationship between customer value and revisit intention, making it a strategic dimension in increasing patient loyalty. A statistical approach using the SmartPLS method was carried out to evaluate the validity and reliability of the research model. The test results showed that the Average Variance Extracted (AVE) value of all constructs was greater than 0.50, reflecting that convergent validity was met. The Composite Reliability and Cronbach's Alpha values were each greater than 0.70, indicating good internal consistency. Discriminant Validity is assessed through the Heterotrait-Monotrait Ratio (HTMT) with a value of less than 0.85, ensuring clear differences between constructs. The results of the path analysis show that accessibility (X2) significantly affects customer value (Z) with a coefficient of 0.826 (T = 6.993, p < 0.000). Likewise, service quality (X3) has a positive effect on customer value with a coefficient of 0.291 (T = 2.521, p < 0.012). In contrast, brand image (X1) does not have a significant effect on customer value (coefficient -0.192, T = 1.783, p = 0.075). Customer value has a significant effect on customer satisfaction (coefficient 0.922, T = 55.068, p < 0.000), which in turn affects patient revisit intention (coefficient 0.922, T = 53.495, p < 0.000). This study provides theoretical contributions by expanding the healthcare management literature, especially in the unique context of RSPT. Practically, these findings recommend improving accessibility and service quality to enhance patient loyalty. This study also opens up opportunities for further research with a longitudinal approach to understand changes in patient perceptions over time.

Assessment of changes in environmental pollution by road noise using a scalar measure

The article addresses the issue of assessing the impact of road rebuilding on traffic noise pollution. To assess noise hazards, parameters expressed on the decibel scale were used, and a new measure was proposed - a scalar reference that compares the sound level value to the recommended threshold. This measure is based on Weber Fechner's law, which relates to human perception of changes in sound levels. It was derived through the decibel algebra applied to measurement results and is called the “coefficient of exceedance of the recommended sound level”. Its usefulness was verified by analyzing the results of measurements of traffic and noise parameters before and two years after the reconstruction of a section of the national road in Kielce. An assessment was made of traffic volume, vehicle speed, and road vehicle noise. The analysis evaluated the absolute values, variability and uncertainty of results obtained for the entire year, Fridays and Sundays. Significant differences in traffic parameter values were observed between the lanes entering and leaving the city on weekdays and weekends. The analysis showed a 28% increase in traffic volume following the road reconstruction. The current measure, which compares the difference in noise levels before and after the road reconstruction, indicates that while noise levels have decreased, they still exceed the normative values. For the same parameters, the median coefficient of exceedance decreased by approximately 17%, and the maximum coefficient of exceedance decreased by approximately 15%. The diagnostic usefulness of the coefficient of exceedance was further assessed using noise simulations based on the Cnossos-EU model. These simulations showed the high sensitivity of the proposed scalar noise measure to changes in vehicle speed and traffic volume. The simulations also indicated that to meet the Polish noise normative values, traffic volume would need to reduced by 50%, and the vehicle speed would need to be capped at 50 km/h. Additionally, the simulations suggested that even more stringent traffic restrictions would be necessary to meet the World Health Organization's noise recommendations.

Change in leisure-time physical activity and perception of weight gain during the COVID-19 pandemic: results from the ELSA-Brasil Cohort.

this study aimed to identify the association between changes in Leisure-Time Physical Activity (LTPA) and Perceived Weight Gain (PWG) during the COVID-19 pandemic among participants enrolled in the Longitudinal Study of Adult Health (ELSA-Brasil). an observational longitudinal study utilizing data from the ELSA-Brasil, Wave 3 - W3 (2017-2019), and Wave-COVID - WC (July/2020 to February/2021). LTPA was assessed using the International Physical Activity Questionnaire, collected at both time points, while PWG was evaluated through a questionnaire in WC. Statistical analyses were performed using the SPSS 21.0, with significance set at p < 0.05. among 4402 adults (57.8 % women), after adjusting for potential confounding variables, individuals who reduced their LTPA levels to the extent of changing their classification were more likely to experience PWG - specifically, those who were moderately active in W3 and became sedentary in WC (OR = 1.5 [95 % CI, 1.2-1.9]) or had low LTPA in WC (OR = 1.6 [95 % CI, 1.2-2.1]), and those who were highly active in W3 and presented a low level of LTPA in WC (OR = 2.3 [95 % CI, 1.05-5.4]). our findings suggest that individuals who engaged in LTPA (moderately and highly levels) during W3 but transitioned to insufficiently active or sedentary lifestyles during the WC, were more likely to experience PWG.

Measuring the One Health impacts associated with creating access to veterinary care before and during the COVID-19 pandemic

Integrating community perceptions into One Health assessments is critical to understanding the structural barriers that create disproportionate health outcomes for community members, their pets, and the ecosystems that encompass them, particularly in historically marginalized and under-resourced communities. The validated One Health Community Assessment (OHCA) survey instrument was used to evaluate the associated impacts of The Humane Society of the United States’ Pets for Life (PFL) programming on communities’ perceptions of One Health. This evaluation took place across two phases, totaling four years. In phase one (May 2018 – December 2019), the PFL intervention was administered to one urban and one rural under-resourced community, while two demographically-paired communities served as comparison sites. Five OHCA subscales (human health, pet health, environmental health, community health, perceived links) were employed to measure changes in perceptions of One Health and fourteen OHCA items were used to measure perceptions of access to human healthcare, pet care, and the environment. Initiation of the confirmatory second phase of the study (May 2020–October 2021), in which all four communities received the intervention, coincided with the onset of the COVID-19 pandemic. The pandemic and its resulting public health mandates hindered both PFL programming and data collection. Generalized Estimating Equations were employed in both the first and second phase analyses to model changes in perceptions of One Health associated with the PFL intervention. In the study’s first phase, PFL in the urban community was associated with significant increases in perceptions of community health and environmental health, and perceived access to human health care, pet care, and the environment. The presence of PFL during the study’s second phase was associated with increased perceptions of environmental health. The variables of PFL and the pandemic were not able to be isolated within the analyses. However, due to the severe, negative One Health implications associated with the COVID-19 pandemic, the phase two results were interpreted from the perspective of the pandemic being the largest driver of the results. The results are consistent with previous research on the effects of the pandemic on community perceptions of health. These findings offer initial support for the hypothesis that deployment of resources focused on companion animals may affect perceptions across the One Health triad and confirms previous research on effects of the COVID-19 pandemic.

Preoperative susceptibility to developing secondary hyperalgesia is associated with post-thoracotomy pain at 2 months.

Identifying the subset of patients at risk for developing persistent pain after surgery is clinically important as they could benefit from targeted prevention measures. In this prospective study, we investigated if the preoperative assessment of the individual susceptibility to developing experimentally induced secondary hyperalgesia is associated with post-thoracotomy pain at 2 months. Forty-one patients scheduled to undergo a posterolateral thoracotomy were recruited before surgery and followed prospectively for 2 months. The day before surgery, we experimentally induced secondary hyperalgesia at one of the two forearms and measured the change of perception to mechanical pinprick stimuli and the area of hyperalgesia. On postoperative Day 4, Day 15 and at the 2-month follow-up, patients were asked about their pain intensity at rest and during coughing and the area of secondary hyperalgesia around the scar as well as the change in perception to mechanical pinprick stimuli was measured. Of the 41 patients that were recruited only 20 could be analysed. Forty per cent reported pain at the 2-month follow-up. All of them reported cough-evoked pain and 10 per cent also reported pain at rest. A binary logistic regression model with both the magnitude and extent of experimentally induced secondary hyperalgesia was statistically significant (chi-squared = 12.439, p = 0.002, McFadden R2 = 0.462) and showed excellent discriminative power (AUC = 0.938) for the presence or absence of cough-evoked pain at the 2 month follow-up. Our findings indicate that the individual susceptibility to developing experimentally induced secondary hyperalgesia preoperatively may identify patients who are potentially vulnerable to develop persistent post-thoracotomy pain. Our data suggests that preoperatively assessed experimentally induced secondary hyperalgesia displays excellent discriminative power for the presence or absence of cough-evoked pain 2 months after thoracotomy.

The Spillover Effect of US Monetary Policy: A Literature Review

In an era of globalization, the interconnectedness of financial markets means that monetary policy decisions in one country, particularly the United States, can have significant global repercussions. This interconnectedness necessitates a deeper understanding of how US monetary policy influences economic conditions worldwide. This paper reviews the impact of US monetary policy through various channels on advanced and emerging countries differently. The research finds that US monetary policy involves an element of uncertainty. In advanced countries, this uncertainty primarily influences the term premium component of yields, whereas in emerging countries, it affects the expected component of yields. Furthermore, the impact of US monetary policy shocks varies with the business cycle, having a larger effect when growth is weak outside the US. Different channels of spillover include interest rate differentials, exchange rate movements, capital flows, financial market reactions, and changes in risk perception and sentiment. For advanced countries, significant impacts are seen in interest rate spillovers, exchange rate dynamics, financial market volatility, and global trade and economic growth. In emerging countries, the effects are pronounced in exchange rate channels, capital flows, financial stability, term premium, risk perception, and local monetary conditions. Solutions include strengthening financial regulation, diversifying economic structures, building foreign exchange reserves, managing capital flows, improving monetary policy frameworks, fostering regional cooperation, promoting long-term investment, and enhancing data transparency.

UNDERSTANDING THE ADOPTION AND IMPACT OF INFORMATION AND COMMUNICATION TECHNOLOGIES ON CLIMATE CHANGE AWARENESS: EVIDENCE FROM UNIVERSITY GRADUATES IN PAKISTAN

Climate change is a pressing issue that significantly impacts agriculture, health, biodiversity, water resources, forests, and the socioeconomic well-being of populations, particularly in developing and least developed nations. Raising public awareness of climate change through accurate knowledge is a key strategy to encourage proactive mitigation and adaptation efforts. This study investigates the use of Information and Communication Technologies (ICTs) by university graduates to enhance climate change awareness, focusing on the role of both educators and students in knowledge transfer within academic environments. The research was conducted across 15 major universities in Pakistan, using a structured questionnaire to collect data on demographic, socio-cultural, technological, and economic factors influencing graduates’ awareness and perceptions of climate change. A binary logistic regression analysis was used to assess the impact of ICTs on climate change awareness. The results indicate that access to smartphones, agricultural magazines, news bulletins, newspapers, television, and internet connectivity significantly enhances climate change awareness. However, access to radio and computers or laptops did not show a significant impact. Universities should integrate ICT-based training and outreach activities into their curricula, promoting technological solutions that address climate change challenges. Furthermore, collaboration between technological solution providers, environmental departments, and academic institutions is recommended to design ICT-driven strategies for raising climate change awareness among the youth.

Analysis of User Satisfaction in Banten with Shopeepay Mobile Payment Based on E-Service Quality

The rapid development of technology has led to innovations in various areas, including mobile payments. Mobile payments are one of the innovations in financial technology designed to facilitate online transactions. In Indonesia, there are numerous mobile payment service providers, making competition increasingly fierce. One of the popular e-wallets in Indonesia is ShopeePay, a service created by Shopee. This study aims to analyze the importance and performance levels of various electronic service quality factors and assess user satisfaction with ShopeePay. This research is a survey-based study with a sample of 100 respondents. The analysis was conducted using Importance Performance Analysis (IPA) and Customer Satisfaction Index (CSI) to measure the importance and performance of each ShopeePay service quality factor and the satisfaction of its users. The results show that out of 24 ShopeePay service quality factors, 13 were considered important by respondents. The average importance rating was 4.07, while the average performance rating was 3.94. This results in a harmony between importance and performance of 97%. The Customer Satisfaction Index (CSI) for ShopeePay services in the Banten area was 78.77%, placing it in the "satisfying" category. This study has several limitations, including its focus on the Banten area, a limited and homogeneous respondent group, potential bias from online surveys, and not accounting for external factors or long-term changes in user perceptions of ShopeePay.

Changes in taste perception in elderly population and its potential impact on oral health: a systematic review with meta-analysis

AimGustatory function plays a fundamental role in various aspects related to nutrition and health, and the decline in taste perception can result in a series of adverse consequences. This is expected with aging due to a decrease in taste buds and other conditions, leading to systemic and oral diseases. We aimed to compare taste sensitivity in the elderly population vs. adults.MethodsThis systematic review was reported according to PRISMA guidelines. The search was performed in four databases, as well as in grey literature. The risk of bias was assessed using the JBI's critical appraisal tools for observational studies. A meta-analysis with subgroups according to each flavor was conducted to obtain differences in means for adults vs. elderly (random-effects model).ResultsOut of the 5,660 studies retrieved, 18 observational studies were included, representing a total of 1,680 aged 18–59 years and 1,048 aged ≥ 60 years. Elderly individuals need higher concentrations to distinguish flavors compared to adults. In a qualitative analysis, all flavors showed differences between the groups, with sweet flavor being the easiest to recognize and the thresholds between the groups not being highly discrepant. However, in the meta-analysis, statistical differences were observed for sweet, salty, and umami flavors, while there were no statistical differences for sour and bitter flavors between the groups.ConclusionsThere are significant differences for distinguishing sweet, salty, and umami flavors between adults and elderly. Bitter and sour flavors did not exhibit differences in elderly.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=463873, PROSPERO (CRD42023463873).

Tradition Is a Trap

Native Americans seem to be implicated in a disproportionate share of trademark and branding disputes. From the more obvious fight over the cancellation of the disparaging trademark previously used by the D.C. football team to more “every day” trademark registration disputes questioning whether the use of trademark containing the name of a tribe refers simply to a geographic location or “falsely suggests a connection” with the tribe. For example, using “Shinnecock” as a trademark on cigarettes was prohibited for falsely suggesting a connection to the Shinnecock tribe, because Native Americans have a historical affiliation with tobacco products; however, a car company can sell “Jeep Cherokees” because no reasonable consumer would make the false connection between the tribe and cars. This problem of “frozen” minority representations in trademark law is not limited to only Native Americans as prior scholars have explored how trademark law’s implicit focus on the white male consumer gaze has perpetuated stereotypical ideas and images of African Americans and Asian Americans, for example, at various points in United States history. This Article adds to that scholarship by exploring the history of Native Americans in American marketing and trademark law to connect that history to modern cases brought by Native Americans seeking to protect their cultural identity. The struggles of Native Americans to fight racist trademarks and marketing imagery illustrates how trademark law’s reliance on stereotypes is not simply a glitch in the system caused by the speed at which consumer perceptions change. Instead, the entire trademark system is built on a Eurocentric framework with ideas of “tradition” and “authenticity” at its foundation. A trademark system that prioritizes tradition necessarily privileges those in the majority, those in power. Conversely, it can trap minority groups in their disadvantaged “traditional” positions. Because of this trap built into trademark law, Native Americans likely cannot seek redress for trademark-related harms through the courts and instead should consider redirecting their resources to public relations and community organizing efforts.

A metamorfózis tükrözéseiben

If we review the history of the theatre, we can see the pulses of changes in conventions, the form of presentation, dramatic texts, as well as the process of applying various technological achievements. It is now obvious that artificial intelligence will also be associated with more and more stage attempts – and why not – artistic realizations; this is already happening in cinema, where, for example, it can be considered almost obsolete to thematize the so-called virtual human-machine relationship. Theatre history approaches with a technological focus are appearing, which examine more and more thoroughly how machines, tools, and programs that are considered new today and obsolete the next minute influence the creative process, the audience’s attention, and the effect. Just think about the dramaturgical changes in perception and attention management as a result of radio and silent films, or the use of smartphones. All this now seems natural; however, there is a big BUT that triggers a whole series of questions again and again – as if it were Sisyphus’ boulder: we constantly want to model, clarify, illuminate something for the sake of understanding and enlightenment; we want to know. Here is the always-emerging ”but”: can there be enough power, faith, and brilliance in any ingenious innovation to unfold before us the all-giving secret that breaks styles and shatters all known geometries? ”Only the mystery keeps us alive, only the mystery,” writes Federico Garcia Lorca.

A Cross-Sectional Study on Age-Related Changes in Knowledge and Perception of Medico-Legal Autopsies.

Our study investigated the knowledge, attitudes, and perceptions of medical students, residents, and the general public towards medicolegal autopsies in Northern region, India, in the year 2023. Significant disparities were identified in knowledge perspectives, influenced by age. Younger adults, particularly those falling in the age group of 20-29 years showed higher levels of knowledge (35.33%) about autopsies as compared to the older adults falling in the age group of 60 and above showed lower levels of knowledge (100%). Overall, 802 participants (72.6%) had a negative perception in regards to medicolegal autopsy while 302 participants (27.4%)​had a positive perception towards medico legal autopsy. This research study highlights the varying levels of knowledge and perception towards medicolegal autopsies among different age groups, emphasizing the need for targeted educational strategies to bridge the knowledge gaps and calls for collaborative efforts among stakeholders to build public trust, advance forensic medicine practices, and improve public health outcomes.

“Ask Google”. The role of the search machinery in the construction of knowledge about climate change

The increased media attention to climate change is closely tied to the development and accessibility of web and social media platforms. These networked channels have partially replaced traditional media as information intermediaries and provide a direct voice to climate change stakeholders, some denialists or skeptical about the seriousness of the climate emergency. This research investigates the actors involved and their visibility in search engines to better understand how Google algorithms structure the communication in Spanish surrounding this issue. The searches and results about climate change in six Spanish-speaking countries have been observed using a mixed methodology based on digital methods and discourse qualitative analysis. Many searches directly engage with the debate about the veracity of climate change. Traditional media or well-established sources in each country’s market tend to have better positioning in Google. However, most of the content is opinion articles, which facilitates the perception of climate change as a debatable topic.

A systems perspective on gaps in the person-centered sick leave and rehabilitation process: a Swedish interview study

Background Consensus on priorities to optimize the sick leave and rehabilitation process (SRP) is lacking. Objective To explore perspectives of stakeholders in the SRP on bridging the gap between desired process scope, and actual practice, from a multi-professional, multi-organizational, and interdisciplinary approach. Design and setting Focus group interviews were conducted with various SRP frontline professionals in Region Västra Götaland, Sweden, using purposive sampling to capture a range of experiences. Participants discussed their perceptions of critical changes and priorities needed to meet patients’ SRP needs in a primary care context. All interviews were analyzed using systematic text condensation, as described by Malterud. Subjects General practitioners (n = 6), rehabilitation coordinators and licensed healthcare professionals from primary healthcare (n = 13), administrators from the Social Insurance Agency, the Employment Agency and Social Services (n = 12). Results Through data analysis, the following themes emerged: 1) The need for rules and regulations to enable coherent process governance 2) Challenges and opportunities in person-centered SRP: Professional collaboration, organizational priorities, and the need for enhanced leadership, and 3) Balancing resources and patient needs in the SRP: How to improve care quality and accessibility. In summary, participants mainly discussed how to improve process efficiency and quality of care while balancing available resources and a heavy workload. A main goal was to prevent negative spirals of suboptimal decision-making in individual cases, which could lead to increased work, unfortunate outcomes, and patient suffering. Conclusions This qualitative study indicated that gaps between a desired process scope and actual practice might be bridged by enabling coherent cross-organizational process governance, prioritizing person-centered ways of working, and balancing available resources and workload. The above changes were believed to improve process quality and overall efficiency. Trial registration The study project plan was pre-registered on September 21st, 2020, in the database FOU i VGR (researchweb.org), project number 274941.

Relationship Between Perceived COVID-19 Risk and Change in Perceived Breast Cancer Risk: Prospective Observational Study.

Whether COVID-19 is associated with a change in risk perception about other health conditions is unknown. Because COVID-19 occurred during a breast cancer study, we evaluated the effect of COVID-19 risk perception on women's breast cancer risk perception. This study aims to evaluate the relationship between perceived risk of COVID-19 and change in perceived breast cancer risk. We hypothesized that women who perceived greater COVID-19 risk would evidence increased perceived breast cancer risk and this risk would relate to increased anxiety and missed cancer screening. Women aged 40-74 years with no breast cancer history were enrolled in a US breast cancer prevention trial in outpatient settings. They had provided breast cancer risk perception and general anxiety before COVID-19. We performed a prospective observational study of the relationship between the perceived risk of COVID-19 and the change in perceived breast cancer risk compared to before the pandemic. Each woman was surveyed up to 4 times about COVID-19 and breast cancer risk perception, general anxiety, and missed medical care early in COVID-19 (May to December 2020). Among 13,002 women who completed a survey, compared to before COVID-19, anxiety was higher during COVID-19 (mean T score 53.5 vs 49.7 before COVID-19; difference 3.8, 95% CI 3.6-4.0; P<.001) and directly related to perceived COVID-19 risk. In survey wave 1, anxiety increased by 2.3 T score points for women with very low perceived COVID-19 risk and 5.2 points for those with moderately or very high perceived COVID-19 risk. Despite no overall difference in breast cancer risk perception (mean 32.5% vs 32.5% before COVID-19; difference 0.24, 95% CI -0.47 to 0.52; P=.93), there was a direct relationship between change in perceived breast cancer risk with COVID-19 risk perception, ranging in survey wave 4 from a 2.4% decrease in breast cancer risk perception for those with very low COVID-19 risk perception to a 3.4% increase for women with moderately to very high COVID-19 risk perception. This was not explained by the change in anxiety or missed cancer screening. After adjustment for age, race, education, and survey wave, compared to women with very low perceived COVID-19 risk, perceived breast cancer risk increased by 1.54% (95% CI 0.75%-2.33%; P<.001), 4.28% (95% CI 3.30%-5.25%; P<.001), and 3.67% (95% CI 1.94%-5.40%; P<.001) for women with moderately low, neither high nor low, and moderately or very high perceived COVID-19 risk, respectively. Low perceived COVID-19 risk was associated with reduced perceived breast cancer risk, and higher levels of perceived COVID-19 risk were associated with increased perceived breast cancer risk. This natural experiment suggests that a threat such as COVID-19 may have implications beyond the pandemic. Preventive health behaviors related to perceived risk may need attention as COVID-19 becomes endemic.

Climate change perceptions and adaptation by Sebei pastoralists in Mount Elgon, Uganda: a qualitative survey

BackgroundPastoralists’ sedentarisation and agriculturalisation might increase their vulnerability to climate change impacts, but few studies have investigated if this is the case in mountain areas. In Uganda, little is known about how Sebei pastoralists have perceived and adapted to such changes. This study sought to establish perspectives of Sebei pastoralists on climate change in terms of its occurrence and impacts as well as access to livelihood assets and or opportunities to withstand such challenges.MethodThis study was conducted in Mount Elgon areas of Uganda. A cross-sectional study design was employed using qualitative approaches. Data were collected using focus-group discussions with men and women village elders to assess their perceptions regarding climatic changes, impacts and adaption strategies used. Data were analysed using thematic and content analysis approaches. All analyses were done using NVivo version 14.ResultsRespondents reported changes in the amount and distribution of rainfall, fog and temperatures, with negative impacts on fodder availability, milk production and pests and diseases. Study participants mentioned using several adaptation strategies with regard to animal rearing, crop farming and livelihood diversification. Among others, participants reduced herd size, migrated longer distances, stored wild grass, used crop residues as feed and increased ‘self-medication’ of their cattle.ConclusionsAccess to funds, markets and technical advice were the main barriers to adaptation identified. Institutional support—now only focused on improved breeds—should consider the multiple strategies used by pastoralists, and the constraints they highlighted, including the need for mutual learning space.

A Content Analysis of Cancer-Related Changes in Perceptions of Self, Relationships, and Health Among LGBTQI+ Cancer Survivors Across the Life Course: Findings From OUT: The National Cancer Survey.

The LGBTQI+population makes up at least 7.6% of the US population. LGBTQI+populations are at increased risk of experiencing LGBTQI+-related discrimination and cis-heteronormativity in healthcare leading to poorer health outcomes throughout the cancer care continuum. We aimed to explore LGBTQI+cancer survivors' perspectives of how cancer has changed their perceptions of self and relationships using data from OUT: The National Cancer Survey. We conducted an inductive qualitative content analysis of responses to four open-ended questions from OUT: The National Cancer Survey. Data were collected from September 2020 to April 2021. Eligible participants were 18years of age or older at time of survey, had been previously diagnosed with cancer, identified as LGBTQI+, and currently lived in the US. Open-ended survey questions asked about the impact of cancer on LGBTQI+cancer survivors' perceptions of self and relationships. To maximize inter-rater reliability, 20% of the survey responses were double coded. Chi-squared tests assessed differences in changes across the life-course. Of the participants in the OUT survey (N=2382), 86.9% (N=2069) provided responses to at least one of the four open-ended questions. The content analysis sample participants were primarily aged 40-59 (39.3%) and 60-79 (49.4%), gay (54.7%), cisgender men (59.4), White (89.7%), and not on active treatment (77.4%). A total of 5179 codes were applied to the 2069 responses. A total of 5 overarching categories and 18 sub-categories were identified. Themes included: (1) changes in perceptions of self; (2) changes to relationships; (3) changes to health and (4) LGBTQI+specific unmet needs. The most commonly reported categories were changes in perceptions of self (77%, n=1593) and changes to health (47%, n=972). Most cancer-related changes were more frequently reported by young adult survivors. This content analysis illuminates the unique challenges that the LGBTQI+population faces while navigating through the cancer care continuum.