Invitation Letter Research Articles

Guideline-endorsed follow-up after percutaneous valve therapies-non-attendance of TAVI and MitraClip patients.

Percutaneous valve therapies (PVT) are performed on alarge number of patients. With increasing procedural volume, the need for follow-up has also increased. Follow-up in the heart valve clinic is endorsed by recent guidelines but utilization is unknown, making resource allocation in the clinic difficult. Central follow-up in valve centers may not be feasible for all patients in the future. In our center, follow-up for PVT patients is scheduled at 1month and 12months after the index procedure. Patients are reminded of their appointment by invitation letters or phone calls. We analyzed 150 consecutive patients who underwent transcutaneous aortic valve implantation (TAVI) and MitraClip implantation (n = 300) at our center. At 1month,72.7% of patients attended their follow-up, while at 12months the rate dropped to 58%. Patients who underwent TAVI were older than the MitraClip patients (82.7 vs. 76.1years) but had lower mean logEuroSCORE (22.6% vs. 25.9%). There was no significant difference in 1‑year mortality between TAVI and MitraClip patients (20%vs. 17.3%). By contrast, the rate of missed follow-up visits was higher for TAVI compared to MitraClip patients (52%vs. 33.3%; p = 0.002). Female patients less frequently attended follow-up (p = 0.005), whereas age, EuroSCORE, NYHA class, ejection fraction, and health status (EQ-5DVAS) were not predictors of attendance in multivariable analysis. Although the result of the EQ-5D assessment was not associated with mortality or attendance, completing the questionnaire was associated with overall survival (p < 0.001). In our heart valve clinic, we observed ahigh percentage of missed follow-up appointments (42% at 12months) despite astructured follow-up plan. Factors significantly associated with non-attendance in multivariable analysis were female gender and having aTAVI rather than MitraClip. Future follow-up concepts should take such findings into account, and decentralized approaches need to be explored.

Obstetrician, Family Physician, or Midwife: Preferences of the Next Generation of Maternity Care Consumers

Objective: The purpose of this study was to identify the views of a cohort of Canadian university students related to maternity care provider preferences and the reasons for these preferences. Relationships between care provider preferences, childbirth attitudes, and desire for epidural anesthesia and cesarean section (CS) were also examined. Methods: This was a large cross-sectional survey (N = 3,680) of male and female university students at the University of British Columbia (male, 991; female, 2,676). Students were invited to participate via an electronic letter of invitation containing a link to this online survey.Results: Approximately half of all participants (51.8% for women and 43.7% for men) selected an obstetrician as one of their preferred care providers; somewhat fewer selected a family physician (40.1% for women and 32.8% for men), and even fewer selected a registered midwife (30.1% for women and 18.0% for men). Among the 11 reasons for these preferences (coded from open-ended responses), the most common were expert/specialist, safety, and quality of relationship with care provider. Attitudes toward vaginal birth as well as mode of delivery and pain management preferences were found to relate to caregiver preferences.Conclusion: Provider preferences among university students are largely driven by perceived risk, level of confidence in birth, and attitudes toward obstetric interventions. These preferences, in combination with the current shortage of maternity providers in Canada, indicate a need for restructuring maternity care human resources.

Recruitment strategies for reaching adults aged 50 years and older with low socioeconomic status for participation in online physical activity interventions.

Generally, the health condition of those with higher socioeconomic status (SES) is better compared to those with lower SES. The application of appropriate strategies to reach low SES populations with electronic health (eHealth) interventions is thus of major importance to reduce health inequalities. eHealth-studies providing detailed information on recruitment strategies are scarce, despite the fact that this information is crucial for comparable research and implementation. To provide insight into the reach, sample characteristics and costs of three pre-planned strategies for recruiting adults aged 50 years and older with low SES for participation in an online physical activity intervention, as part of a field study. Recruitment took place via (1) invitation letters via a municipality, (2) gyms and (3) social media advertisements, aiming to include 400 participants. Additional procedures were followed to reach specifically the low SES group. Response rates, sociodemographic characteristics and costs per strategy were assessed. The highest response was shown for the municipality approach (N = 281), followed by social media (N = 71) and gyms (N = 45). Ten participants were recruited via family/friends. The most low-educated participants were reached via the municipality (N = 128) followed by social media (N = 9), gyms (N = 8) and family/friends (N = 5). Recruitment costs were with €2,142.37 the highest for the municipality compared to €96.81 for social media and no costs for gyms. Recruitment via invitation letters through a municipality has the highest potential for reaching low SES participants of the three applied strategies, although the higher recruitment costs need to be taken into account.

Kualitas Pelayanan Izin Mendirikan Bangunan Pada Desa Waiheru Kota Ambon

The aim of this research is to find out how the quality of the service of the Building Permit Entry Letter (IMB) at the office of Waiheru Village, Baguala district, Ambon City. The research method used is descriptive research with a qualitative approach. The findings of this research are that the quality of the service of the building permit registration to the community that carries out the management of the Building License Registration in the Waiheru village office of Baguala district of Ambon has been running effectively, besides it is still a lack of public participation in building permit management (IMB) every year it rises down. And there's still a lot of people who haven't understood and are doing the management of letters of invitation to make building permits.

When to Text? How the Timing of Text Message Contacts in Mixed-Mode Surveys Impacts Response

Abstract Using multiple modes of contact has been found to increase survey participation over a single contact mode. Text messaging has emerged as a new mode to contact survey participants in mixed-mode survey designs, especially for surveys that include web and/or phone data collection. However, it is unclear how to best combine text messages with mailings and other outreach contacts to improve response rates and data quality. To explore the effectiveness of using text messaging as a contact mode, we conducted a full factorial experiment that varies the sequencing of text messages with mailing contacts (early versus late reminder) and the time text messages were sent (morning versus afternoon). The experiment was implemented in a follow-up wave of a mixed-mode nationally representative longitudinal survey with two sample groups (Cooperative versus Other Respondents). For Cooperative Respondents, text reminders seemed to be effective at increasing completion rates, with the early text reminder being somewhat more effective than the late text reminder, at least early in the field period. For Other Respondents, text invitations were effective at improving the completion rate, but effects diminished quickly once the invitation letter was sent. Additionally, the early text reminder appears to be more effective than the late text reminder at increasing completion rates for Other Respondents. The sequencing of text messages did not affect data quality across sample groups or substantially impact nonresponse. The time of day the text messages were sent did not affect any of the outcome measures examined.

Strategies to increase survey participation: A randomized controlled study in a population of breast cancer survivors

BackgroundData collection by mailing questionnaires to the study population is one of the main research methods in epidemiologic studies. As participation rates are decreasing, easy-to-implement and cost-effective strategies to increase survey participation are needed. In this study, we tested the effect of a pragmatic combination of evidence-based interventions. MethodsWe conducted a two-armed randomized controlled trial, nested in a cohort of breast cancer survivors (n = 1000) in the setting of a health outcomes survey. The intervention arm received a postal pre-notification, a non-monetary incentive (ballpoint with the study logo) and an alternative invitation letter in which several lay-out and textual adjustments were implemented according to behavioural science techniques. The alternative invitation letter also contained a QR-code through which an information video about the study could be accessed. The control arm was invited according to standard practice. Participants had the option to fill-out a questionnaire either on paper or online. A questionnaire with more than 50% of the questions answered classified as participation. ResultsOverall participation rate was 62.9%. No significant difference in participation rate was observed between intervention and control arm (64.5% vs 61.3%, Risk Ratio (RR) 1.05, 95% CI [0.96 – 1.16]). Older age at study (>65 vs <51 years), and high socio-economic status (highest vs lowest quartile) were associated with higher participation rates (RR 1.30, 95% CI [1.07 – 1.57] and 1.24, 95% CI [1.09 – 1.42] respectively). In-situ carcinoma compared to invasive cancer and longer interval since treatment were associated with lower participation (RR 0.86, 95% CI [0.74 – 0.99] and RR 0.92, 95% CI [0.87 – 0.99] per 5 year increase, respectively). ConclusionOverall, the combination of four interventions tested in this study did not improve survey participation among breast cancer survivors. The overall participation rate was relatively high, possibly due to the study population of cancer survivors.

Effective interventions to increase representation of under-served groups in randomised trials in UK and Ireland: a scoping literature review.

Participants in clinical trials often do not reflect the populations that could benefit from the treatments being investigated. There are known barriers to trial participation for under-served groups, but limited evidence on strategies to alleviate these barriers to improve representation. This scoping review aimed to identify effective interventions and design features that improve the representation `of under-served groups in trials, focusing on the UK and Ireland. We included methodological research studies that reported interventions to improve representation of ethnic minority groups, socioeconomically disadvantaged groups, older people, or those with impaired capacity to consent to randomised controlled trials, conducted in the UK and Ireland, published between 2000-2021. Systematic searches were conducted in November 2021 and data were independently extracted by two authors and narratively synthesised. Seven studies were included: one randomised controlled study embedded in five trials, one mixed-methods study, and five studies reporting 'lessons learnt' from one trial. We categorised the 47 reported interventions or strategies into nine broad themes: Recruitment sites, recruitment settings, community engagement, and communication with participants, incentives, inclusion criteria, flexibility, patient documentation, and the consent process. Only 28/47 interventions were evaluated, 23 of which were comparison of recruitment pathways.The randomised study found that a £100 incentive mentioned in the invitation letter increased positive responses overall across drug trials in cardiovascular disease and hypertension, but not for older people or those living in the most deprived areas. Invitation letters via GPs and working with communities were reported as successful recruitment pathways in recruiting different under-served populations. Interventions aiming to improve the recruitment of under-served groups in the UK and Ireland were reported across seven papers, but their effectiveness was rarely rigorously evaluated. Included studies were context specific. Using a variety of recruitment methods is likely to help achieve a more diverse cohort.

Abstract 2161: Recruitment feasibility of Hispanic women in breast cancer survivorship research using state cancer registry procedures

Abstract Objectives: Hispanic populations are underrepresented in epidemiologic studies. Although the Florida State Cancer Registry’s primary role is cancer surveillance and control, it can also aid in population-based epidemiologic studies of cancer survivors. This study aimed to evaluate the viability of using the Florida Cancer Data System’s (FCDS) patient recruitment methods to enlist Hispanic women with breast cancer for a cross-sectional survey. Methods: During August 2023 - November 2023, we recruited adult (age ≥ 20) women who were diagnosed with breast cancer at least six months ago before enrollment, self-identified themself as Hispanic, and currently living in Central Florida, using state-mandated recruitment procedure which includes two invitation letters sent via mail three weeks apart and calling to non-responders after three weeks, but up to 4 times. Potential interested participants were asked to complete a survey in English or Spanish via print or online packet, providing data on demographics, health, lifestyle, and quality of life. An Excel log was used to track the response and return dates. Results: As of October 25, 2023, we sent the invitation letters to a total of 667 participants deemed eligible per FCDS. Most of them did not respond to the letters or follow-up telephone calls, with 364 being unreachable due to incorrect contact information, which led to 303 accessible participants. The accessible sample included 22 Cubans, 73 Puerto Ricans, 65 South/Central Americans, 20 Dominicans, 39 Mexicans, and 83 Other Hispanics, with 48.7% speaking Spanish. Among the accessible participants, 113 refused to participate, 34 were not eligible, 13 have not decided yet, 118 agreed to participate but have not completed the survey yet, and 25 agreed to participate and completed the survey as of November 15. Common reasons for not qualifying included “not being Hispanic,” “dead,” “not living in Central Florida,” “not having cancer,” or “inability to read English or Spanish.” The most common reasons for refusal were “too sick,” “too old,” or “not interested.” The average response time to the first and second invitations was 20.1 and 19.6 days, respectively, and most participants responded to the second or third call within 8.3 days of the first call. Conclusions: The FCDS can be used to recruit Hispanics for epidemiology studies. However, the state-mandated patient recruitment procedure needs improvement. For example, the procedure should collect participants' email addresses in addition to their mail and telephone numbers, allow researchers to contact participants via email instead of written mail, and remove all dead individuals before sending the contact information to researchers. (Supported by Florida Breast Cancer Foundation Scientific Research Grant 2023 and UCF SEED grant). Citation Format: Eunkyung Lee, Brian Sukhu, Mia Griffin, Rhea Griffin, Nathalia Mercado-Almodovar, Nelisa Utrera, Keidy Bello, Meera Lakshmanan. Recruitment feasibility of Hispanic women in breast cancer survivorship research using state cancer registry procedures [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2161.

Abstract P317: Patient Perceptions and Satisfactions of a Remote Blood Pressure Monitoring Program in an Integrated Healthcare System

Background: Uncontrolled high blood pressure (BP) is a leading contributor to cardiovascular disease. Remote BP monitoring (RBPM) can empower patients to participate in their healthcare which may be important for improving BP control. The aim of this study was to understand patients’ attitudes toward and satisfaction with a RBPM program. Methods: We identified Kaiser Permanente (KP) Southern California members aged 18 years and older enrolled in a RBPM program. Eligibility criteria include having uncontrolled BP (≥140/90 mmHg), a smartphone, and an email address. Between July 27 and August 17, 2023, we emailed a letter of invitation and link to an online survey to 716 eligible members followed by 2 reminder emails. The survey consisted of 5 domains to assess patients’ experiences with a BP monitor and the KP Health Ally app: ease of use, trust, perceived benefits, privacy and overall satisfaction. Responses to each question were rated on a scale from 1 (disagree) to 7 (agree). The average score for each domain was calculated as the weighted sum of the questions. Antihypertensive medication adherence was reported on a scale ranging from “all of the time” to “less than half the time”. Results: A total of 71 patients (9.9%) responded to the survey with 60 (8.4%) completing all questions. Respondents had a mean age of 60.4 (SD 13.1) years, with 70.4% being female and 50.5% African American. Overall satisfaction and perceived benefits were the highest scoring domains followed by ease of use and trust in the monitor and app (Figure). Privacy concerns were minimal. The overwhelming majority of respondents (89.7%) reported taking their BP medications all or nearly all of the time. Conclusion: Most respondents rated the RBPM program with a high level of satisfaction, perceived benefits and had limited concern about privacy with the potential opportunity to improve patients’ trust in the BP monitor and app functionality. This high level of patient satisfaction and acceptability should lead to increased implementation and scaling of the RBPM program.

Abstract P318: Provider Barriers and Facilitators to Treatment Intensification for Patients With Uncontrolled Blood Pressure

Background: Hypertension is the leading cause of cardiovascular disease and premature death worldwide, however, therapeutic inertia, failure to intensify pharmacotherapy when blood pressure (BP) is not at goal, is a key obstacle to hypertension control. We aimed to identify barriers and facilitators to increasing the dose or adding a different antihypertensive medication class for patients with uncontrolled BP. Methods: We conducted a qualitative study of healthcare providers from Kaiser Permanente Southern California (KPSC). Using a stratified purposeful sampling approach, we identified 300 providers across 15 medical centers and specialties and with a mix of treatment intensification rates. In 2 separate waves, we emailed a letter of invitation to 150 eligible providers followed by 2 reminder emails each two weeks apart. We sought to conduct 30 semi-structured interviews about management of patients newly diagnosed with hypertension including use of single-pill combination therapy (SPC) (the recommended first-line therapy within KPSC), barriers to therapeutic intensification and use of home BP monitoring for treatment intensification decision making. We used rapid analysis methods to code responses and develop themes. Results: A total of 11 interviews were completed with providers from family medicine (n=7), internal medicine (n=3) and cardiology (n=1) who had an average of 6 years of practice within KPSC. The majority of providers reported using monotherapy as first-line treatment while SPC therapy was reserved for younger patients and those with baseline systolic BP &gt;160 mm Hg. Monotherapy was often preferred to help providers determine if the first-line medication is causing side effects. Nearly all providers reported maximizing the dose of one medication before adding another medication class. Providers ranked the barriers to intensifying patients’ treatment in order of importance as 1) side effects such as frequent urination, hyperkalemia, and hypotension, 2) nonadherence to the current antihypertensive medication regimen and patient preference/hesitancy, 3) comorbidities (e.g., kidney function), and 4) age-related factors such as memory loss and ability to complete follow-up labs. All providers reported using patients’ home BP readings for treatment decision-making with most recognizing that patients’ out-of-clinic BP may be lower than clinic BP. Conclusion: Providers embraced stepped-care treatment for newly diagnosed patients with hypertension with most preferring monotherapy as first-line treatment. Concerns with side effects, nonadherence to the medication regimen and shared decision-making are key factors in providers’ decisions to intensify therapy for patients with uncontrolled BP. Targeted interventions to address provider barriers to treatment intensification may be needed.

Prevalence and Correlates of Food and/or Housing Instability among Men and Women Post-9/11 US Veterans.

Food and/or housing instability (FHI) has been minimally examined in post-9/11 US veterans. A randomly selected nationally representative sample of men and women veterans (n = 38,633) from the post-9/11 US veteran population were mailed invitation letters to complete a survey on health and well-being. Principal component analysis and multivariable logistic regression were used to identify FHI's key constructs and correlates for 15,166 men and women respondents (9524 men, 5642 women). One-third of veterans reported FHI; it was significantly more likely among women than men (crude odds ratio = 1.31, 95% CI:1.21-1.41) and most prevalent post-service (64.2%). "Mental Health/Stress/Trauma", "Physical Health", and "Substance Use" were FHI's major constructs. In both sexes, significant adjusted associations (p < 0.01) were found between FHI and homelessness, depression, adverse childhood experiences, low social support, being enlisted, being non-deployed, living with seriously ill/disabled person(s), and living in dangerous neighborhoods. In men only, posttraumatic stress disorder (adjusted odds ratio (AOR) = 1.37, 95% CI:1.14-1.64), cholesterol level (elevated versus normal, AOR = 0.79, 95% CI:0.67-0.92), hypertension (AOR = 1.25, 95% CI:1.07-1.47), and illegal/street drug use (AOR = 1.28, 95% CI:1.10-1.49) were significant (p < 0.01). In women only, morbid obesity (AOR = 1.90, 95%CI:1.05-3.42) and diabetes (AOR = 1.53, 95% CI:1.06-2.20) were significant (p < 0.05). Interventions are needed that jointly target adverse food and housing, especially for post-9/11 veteran women and enlisted personnel.

Protocol for the ONLOOP trial: pragmatic randomized trial evaluating a province-wide system of personalized reminders for evidence-based surveillance tests in adult survivors of childhood cancer in Ontario

BackgroundChildhood cancer treatment while often curative, leads to elevated risks of morbidity and mortality. Survivors require lifelong periodic surveillance for late effects of treatment, yet adherence to guideline-recommended tests is suboptimal. We created ONLOOP to provide adult survivors of childhood cancer with detailed health information, including summaries of their childhood cancer treatment and recommended surveillance tests for early detection of cardiomyopathy, breast cancer, and/or colorectal cancer, with personalized reminders over time.MethodsThis is an individually randomized, registry-based pragmatic trial with an embedded process and economic evaluation to understand ONLOOP’s impact and whether it can be readily implemented at scale. All adult survivors of childhood cancer in Ontario overdue for guideline-recommended tests will be randomly assigned to one of two arms: (1) intervention or (2) delayed intervention. A letter of information and invitation will detail the ONLOOP program. Those who sign up will receive a personalized toolkit and a screening reminder 6 months later. With the participants’ consent, ONLOOP will also send their primary care clinician a letter detailing the recommended tests and a reminder 6 months later.The primary outcome will be the proportion of survivors who complete one or more of the guideline-recommended cardiac, breast, or colon surveillance tests during the 12 months after randomization. Data will be obtained from administrative databases. The intent-to-treat principle will be followed. Based on our analyses of administrative data, we anticipate allocating at least 862 individuals to each trial arm, providing 90% power to detect an absolute increase of 6% in targeted surveillance tests completed. We will interview childhood cancer survivors and family physicians in an embedded process evaluation to examine why and how ONLOOP achieved success or failed. A cost-effectiveness evaluation will be performed.DiscussionThe results of this study will determine if ONLOOP is effective at helping adult survivors of childhood cancer complete their recommended surveillance tests. This study will also inform ongoing provincial programs for this high-risk population.Trial registrationClinicalTrials.gov NCT05832138.

Would shared decision-making be useful in breast cancer screening programmes? A qualitative study using focus group discussions to gather evidence from French women with different socioeconomic backgrounds

BackgroundTo inform the development of an online tool to be potentially used in shared decision-making about breast cancer screening, French women were questioned about participation in breast cancer screening, the health professional’s role, and their perceptions of the proposed tool.MethodsWe organised focus group discussions with 55 French women. Two different strategies were used to recruit women from high and low socioeconomic backgrounds. We applied both inductive and deductive approaches to conduct a thematic analysis of the discussions. We analysed the responses by using the main determinants from different health behaviour models and compared the two groups.ResultsIndependently of socioeconomic status, the most important determinant for a woman’s participation in breast cancer screening was the perceived severity of breast cancer and the perceived benefits of its early detection by screening. Cues to action reported by both groups were invitation letters; recommendations by health professionals, or group/community activities and public events were reported by women from high and low socioeconomic backgrounds, respectively. Among other positive determinants, women from high socioeconomic backgrounds reported making informed decisions and receiving peer support whereas women from low socioeconomic backgrounds reported community empowerment through group/community events. Fear of cancer was reported as a barrier in both groups. Among other barriers, language issues were reported only by women from low socioeconomic backgrounds; women from high socioeconomic backgrounds reported breast cancer screening-related risks other than overdiagnosis and/or overtreatment. Barriers to accessing the online tool to be developed were mainly reported by women from high socioeconomic backgrounds.ConclusionLimitations in implementing shared decision-making for women from low socioeconomic backgrounds were highlighted. An online tool that is suitable for all women, regardless of socioeconomic status, would provide “on-demand” reliable and tailored information about breast cancer screening and improve access to health professionals and social exchanges.

Disparities in access to breast, colorectal, and cervical cancer screening programmes have intensified during the pandemic period. Findings of a health equity audit conducted by the Pavia Healthcare Protection Agency (Lombardy Region, Northern Italy)

to evaluate the disparities in access to cancer screening programmes in the Province of Pavia (Lombardy Region, Northern Italy), along with identifying the factors influencing these disparities; to assess the impact of the pandemic emergency on invitation and screening coverage in the three organized screening programmes, which are provided free of charge to the target population. observational retrospective study covering both the pre-pandemic and the pandemic periods. for breast cancer screening, the eligible population comprises women aged 45 to 74; colorectal cancer screening is offered to men and women aged 50 to 74; cervical cancer screening is tailored based on women age. The management of all three screening programmes is overseen by the Health Protection Agency of Pavia, which proactively invites the eligible population through invitation letters. for each screening programme, the examination coverage (the number of screened individuals out of the total eligible population) was analysed considering its influencing factors, with a specific emphasis on equity-related factors such as demographics (sex, age), geographic factors (country and continent of birth, residential district), comorbidities. the SARS-CoV-2 pandemic has led to a reorganization of healthcare services and to a reduction of the offer, resulting in an overall reduction in test coverage for all three programmes (-16.3% for breast and colorectal cancer screening, -8.5% for cervical cancer screening). The disparities in coverage among various population groups, reflecting inequalities in access, further escalated from the pre-pandemic to the pandemic period. Noteworthy, equity-related predictors of reduced screening access were non-Italian nationality and residency in rural or mountainous districts. during periods of healthcare system strain, such as the pandemic, disparities in access can become more pronounced. It is crucial to implement measures for enhancing access to screening in a more equitable manner.

Direct mailing of HPV self-sampling kits to women aged 50-65 non-participating in cervical screening in the Czech Republic.

A population-based cervical cancer screening programme is implemented in the Czech Republic. However, participation is insufficient among women over 50 years. This study aimed to estimate the potential improvement in participation through directly mailed HPV self-sampling kits (HPVssk) compared with standard invitation letters in women aged 50-65 non-participating in screening. The study recruited 1564 eligible women (no cervical cancer screening in the last 3 years or more, no previous treatment associated with cervical lesions or cervical cancer). Eight hundred women were mailed with an HPVssk (HPVssk group), and 764 women were sent a standard invitation letter (control group) inviting them to a routine screening (Pap test). The primary outcome was a comparison of the overall participation rate between study groups using a binominal regression model. The participation rate in the HPVssk group was 13.4% [95% confidence interval (CI) 11.2-15.9%; 7.4% of women returned the HPVssk and 6.0% attended gynaecological examination] and 5.0% (95% CI 3.6-6.8%) in the control group. Using the binominal regression model, the difference between the groups was estimated as 7.6% (95% CI 5.0-10.2%; P < 0.001). In the HPVssk group, 22% of women who returned HPVssk had a positive result and 70% of them underwent a follow-up examination. Compared with traditional invitation letters, the direct mailing of the HPVssk achieved a significantly higher participation rate, along with a notable HPV positivity rate among HPVssk responders. This approach offers a potentially viable method for engaging women who have not yet attended a cervical screening programme.

Decisional needs in people with kidney failure, their relatives and health professionals about end-of-life care options: A qualitative interview study.

To investigate the decisional needs in Denmark of people with kidney failure, relatives, and health professionals when planning end-of-life care. A qualitative interview study. Individual semi-structured interviews were carried out with people with kidney failure, relatives and health professionals from November 2021 to June 2022. Malterud's systematic text condensation was used to analyse transcripts. A total of 13 patients, 10 relatives, and 12 health professionals were interviewed. Overall, four concepts were agreed on: (1) Talking about end of life is difficult, (2) Patients and relatives need more knowledge and information, (3) Health professionals need more tools and training, and (4) Experiencing busyness as a barrier to conversations about end of life. People with kidney failure, relatives, and health professionals shared certain decisional needs while also having some different decisional needs about end-of-life care. To meet these various needs, end-of-life conversations should be systematic and organized according to the patients' needs and wishes. Non-systematic end-of-life care decision-making processes limit patients' involvement. Patients and relatives need more knowledge about end-of-life care, and health professionals need more competences and time to discuss decisional needs. A shared decision-making intervention for people with kidney failure when making end-of-life care decisions will be developed. This empirical qualitative research is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Patients, relatives, and health professionals have been involved throughout the research process as part of the research team and advisory board. The patients are people with kidney failure and the relatives are relatives of a person with kidney failure. For this study, the advisory board has particularly contributed to the validation of the invitation letter for participation, the interview guides and the preparation of the manuscript.

National long-term patient-reported outcomes following mastectomy with or without breast reconstruction: The Swedish Breast Reconstruction Outcome Study Part 2 (SweBRO 2).

The Swedish Breast Reconstruction Outcome Study (SweBRO) initiative is a nationwide study with the primary aim of assessing long-term outcomes after mastectomy with and without breast reconstruction (BR). The current part (SweBRO 2) is designed to evaluate health-related quality of life (HRQoL), with the hypothesis that BR has a positive impact on patient-reported HRQoL in the long-term. Women who underwent mastectomy in Sweden in 2000, 2005, or 2010 and were alive at the time of the survey were identified through the National Breast Cancer Registry. Eligible participants received formal invitation letters to take part in a survey evaluating their HRQoL at 5 , 10, or 15 years post-mastectomy. The EORTC QLQ-C30, EORTC QLQ-BR23, and EQ-5D-3L questionnaires were employed. Of 2904 respondents (50% of 5853 invited), 895 (31%) had received BR. Among them, 516 (58%) were reconstructed with implants and 281 (31%) with autologous tissue. Women with BR scored significantly better in the EORCT QLQ-C30 physical functioning domain (mean 90 versus 81 points), fatigue (mean 21 versus 25), and dyspnoea (mean 16 versus 22) compared to non-reconstructed women. The EORTC QLQ-BR23 revealed that women with BR experienced favourable sexual functioning compared with non-reconstructed women (mean 26 versus 14). The EQ-5D-3L visual analogue scale score was similar between groups. The current study underscores the benefits of BR for long-term well-being, for example, in terms of physical and sexual functioning. These underline the importance of informing women undergoing mastectomy about BR alternatives and its potential benefits in enhancing long-term well-being.

Web-based Survey on the Knowledge, Attitude and Practice of COVID-19 Appropriate Behaviour among Vaccinated and Unvaccinated College Students in Puducherry, India: A Cross-sectional Study

Introduction: Coronaviruses (CoVs) encompass a large group of viruses known to infect the upper respiratory tract in humans. The devastating impact of the virus has led to widespread infections among millions of individuals. Widespread disregard for ‘Coronavirus Disease-2019 (COVID-19) Appropriate Behaviour’ (CAB) by the public has significantly strained the Indian healthcare system. Despite efforts to educate the public on CAB through social media since 2020, only a minority have incorporated these practices into their daily lives. Notably, some vaccinated individuals have been hesitant to adhere to CAB despite repeated awareness efforts. This study aims to understand adherence to CAB among vaccinated and unvaccinated students not associated with the healthcare system. Aim: To evaluate the Knowledge, Attitude and Practice (KAP) of CAB among vaccinated and unvaccinated college students. Materials and Methods: This descriptive cross-sectional study was conducted at Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India among various engineering and arts college students of Puducherry, India from December 2021 to February 2022. A web-based data collection tool was designed using Google Forms. Data was collected through invitation letters and questionnaires distributed via WhatsApp groups and Instagram. The study included a total of 360 responses, with the questionnaire comprising 40 questions related to KAP, consisting of 17, 7, and 16 questions, respectively. The results were expressed in percentages. Results: Among the vaccinated participants, 263 (89.7%) identified social media as the primary source of COVID-19 related information. Knowledge and attitude towards COVID19 vaccination revealed that over 50% were aware of the safety and efficacy of vaccines and the necessity of receiving two doses as advised by the government. While knowledge and attitude were similar across vaccinated and unvaccinated college students, there was a slightly higher percentage among the vaccinated group. However, there was an increased percentage of practice among unvaccinated students, indicating greater awareness of infection prevention. Conclusion: The study found that the knowledge, attitude, and behaviour of college students, particularly those not in medical fields, were satisfactory, likely due to the widespread availability of information on social media. These findings can be valuable for public health departments to adopt a peoplecentered approach to raise awareness among the public and reduce vaccine hesitancy.

Factors influencing aggressive behavior as perceived by university students

BackgroundThe mainstay of producing highly qualified people in a nation is post-secondary education. A lot of pressure is placed on students to succeed. AimExplore the predictors of aggression within university students in Jordan. MethodsThe study employed a correlation design with a self-administered questionnaire distributed among Jordan University students using convenience sampling. Inclusion criteria encompassed currently enrolled students with adequate language proficiency and cognitive abilities, while exclusion criteria included absent or non-participating students. Prior to data collection, participants were provided with an invitation letter emphasizing privacy protection. Distribution occurred during academic classes, resulting in a 93 % response rate from 1,000 distributed questionnaires. After data screening, 925 questionnaires were deemed suitable for analysis. Ethical approval was obtained from the University of Jordan’s institutional review board (IRB), with participants assured of voluntary participation and confidentiality. These measures uphold rigorous research standards and ethical conduct. ResultsDepression, life satisfaction and spiritual well-being were significant predictors of aggression. life satisfaction and Spiritual well-being was inversely related to aggression, while depression was positively related to aggression. Higher levels of hostility were more frequently reported by male university students than female university students. ConclusionProviding contentious assessment for psychosocial and spiritual well-being are important way to manage aggression among university students. RecommendationsThe current study recommends elevating the function of social workers, mental health nurses, and psychological counselors in order to give periodic assessment, and to screen the psychosocial health indicators of aggression such as depression, a lack of spiritual health and a lack of life satisfaction.

Collective invitation letters: reflections on the written culture of portuguese immigrants in Brazil

A partir das perspectivas teórico-metodológicas da História Social da Cultura Escrita, este texto visa a analisar e discutir quatorze cartas de chamada, com assinaturas coletivas, escritas por imigrantes portugueses, homens e/ou mulheres, entre 1896 e 1929. Para tanto, pretende-se enfatizar a importância do diálogo entre áreas distintas e complementares das ciências humanas por meio do cruzamento de perspectivas: a mobilização de micro histórias, a Linguística, a História Cultural e a Paleografia, retirando, assim, sujeitos históricos do esquecimento, dando voz a seus escritos e possibilitando, então, outros modos de se compreender a história da penetração da língua portuguesa no Brasil, destacando aspectos que podem revisar ou confirmar questões consolidadas pelas grandes narrativas. Afinal, o que se sabe sobre o Brasil e a escrita de imigrantes nesse período? Como eram essas cartas? Quem as escrevia e por quê? Para quem as escrevia? Quem assinava também escrevia? As respostas a estas questões serão apresentadas e, assim como os caminhos para chegar até elas, discutidas, com o intuito de contribuir para a construção de uma História Social da Cultura Escrita no Brasil através da epistolografia.