Postal Survey Research Articles

Willingness of Hearing Help–Seekers With Low Incomes to Pay for Hearing Aids, Services, and Over-the-Counter Devices

Purpose: Our aims were to assess associations between patient-related variables and willingness to pay (WTP) for advanced digital technology (ADT) hearing aids, services, and over-the-counter (OTC) devices. Method: A cross-sectional postal survey was sent to 106 individuals presenting to a low-income community hearing aid bank eliciting patient-related variables (age, monthly income, gender, race, educational level, employment status, number in household, self-reported hearing difficulty without amplification [quiet and noise], hours/day hearing aid use, and satisfaction with services) and their WTP for ADT hearing aids, services, and OTC devices. Logistic regression was used to assess associations between WTP and patient-related variables. Results: Forty-eight surveys were returned for a response rate of 51.1% (48/[106–12 return to sender]). Only monthly income ( Mdn = $1,283) was associated with WTP for one ADT hearing aid ( Mdn WTP = $250). Age was the only variable significantly associated with WTP for services ( Mdn WTP = $100). None of the variables were associated with WTP for OTC devices, and 61.7% (29 of 47) of participants would not be willing to pay any amount for one. Conclusions: Participants' WTP for one ADT hearing aid and services were low and was likely due to a lack of financial resources. Most would not be willing to pay anything for an OTC device.

Development and validation of the motivation for electricity saving behaviour scale (MESBS) among residents living in energy-efficient buildings in Sweden

Even though energy-efficient technologies are well developed, the behaviour of building occupants plays an important role in the search for the optimum level of energy efficiency. In academic literature, however, very few studies have used psychological theories to understand individuals’ drivers of energy use behaviour when interacting with energy-efficient technologies. Specifically, there are no studies solely focused on individuals' motivations for electricity saving behaviour. This paper is based on an empirical study carried out in energy-efficient residential buildings to develop and test a new scale by applying self-determination theory (SDT). A postal survey about the Motivation for Electricity Saving Behaviour Scale (MESBS), including self-reported electricity use, was sent out to 1,084 residents living in newly built energy-efficient multifamily dwellings and eco-villages in Southern Sweden. The answers obtained from 235 participants were analysed for the reliability and validity of MESBS. The findings indicated that i) MESBS items have good internal consistency and are in line with expectations based on SDT, and ii) the autonomous motivation component of MESBS is strongly associated with electricity saving behaviour (i.e. turning off lights when not needed) in energy-efficient buildings. Our results emphasise the importance of considering individuals’ motivations for undertaking electricity saving behaviour in energy-efficient buildings. The study also provides useful information for future studies of energy-efficient buildings as well as designing new technologies and interventions to reach the optimum level of energy-efficiency.

Gendered trends in unpaid labour by educational level in Sweden 2004-2022

Abstract Background Unpaid labour has recently been recognised as an important yet neglected social determinant of health. Our aim was to investigate the gendered trends in unpaid labour/domestic work by educational level in prime working-age Swedish adults (30-49 years) from 2004-2022. Methods The study is based on a postal survey sent to a random general population sample of adults from central Sweden in 2004, 2008, 2012, 2017 and 2022. The 30-49-year age group included between 5,500 and 12,200 respondents depending on the survey year. Trends in hours spent in domestic work and in experiencing domestic work as burdensome by gender and educational level were estimated by age-standardised proportions with corresponding 95% confidence intervals. Results Women reported spending more time in domestic work than men throughout every survey period from 2004 to 2022. For example, in 2022, 31% of women spent more than 20 hours per week in domestic work compared to 20% of men. Over time, hours spent in domestic work decreased in women whereas no trend was observed in men. Among women, educational level appeared to make no difference to prevalence of high domestic work time whereas, among men, it was consistently greater among those with higher educational levels. In general, women experienced domestic work as burdensome to a higher degree than men did. Conclusions As gender differences in unpaid labour/domestic work persist in Sweden, more effort is needed to implement social policies to increase men’s participation in domestic work, especially among men with low and middle educational levels, which has the potential to reduce gendered health inequities. Key messages • Amongst Swedish adults aged 30-49 years, the gender gap in unpaid labour has declined during the last two decades, but this is only due to women reducing their domestic work time. • For men, prevalence of high domestic work time was consistently greater among those with higher educational levels, whereas no difference was observed among women.

Patient preferences for ocular hypertension monitoring: a discrete choice experiment

Background/aimsTo elicit the preferences and calculate the willingness to pay (WTP) of patients with ocular hypertension (OHT) for eye monitoring services in the UK.MethodsPatients with OHT aged at least 18...

Adjustment of stem anteversion using tapered cone stem in total hip arthroplasty.

The aim of this study was to evaluate the suitability of the tapered cone stem in total hip arthroplasty (THA) in patients with excessive femoral anteversion and after femoral osteotomy. We included patients who underwent THA using Wagner Cone due to proximal femur anatomical abnormalities between August 2014 and January 2019 at a single institution. We investigated implant survival time using the endpoint of dislocation and revision, and compared the prevalence of prosthetic impingements between the Wagner Cone, a tapered cone stem, and the Taperloc, a tapered wedge stem, through simulation. We also collected Oxford Hip Score (OHS), visual analogue scale (VAS) satisfaction, and VAS pain by postal survey in August 2023 and explored variables associated with those scores. Of the 58 patients (62 hips), two (two hips) presented with dislocation or reoperation, and Kaplan-Meier analysis indicated a five-year survival rate of 96.7% (95% CI 92.4 to 100). Mean stem anteversion was 35.2° (SD 18.2°) for the Taperloc stem and 29.8° (SD 7.9°) for the Wagner Cone stem; mean reduction from Taperloc to Wagner Cone was 5.4° (SD 18.8°). Overall, 55 hips (52 patients) were simulated, and the prevalence of prosthetic impingement was lower for the Wagner Cone (5.5%, 3/55) compared with the Taperloc (20.0%, 11/55) stem, with an odds ratio of 0.20 (p = 0.038). Among the 33 respondents to the postal survey (36 hips), the mean scores were VAS pain 10.9, VAS satisfaction 86.9, and OHS 44.7. A multivariable analysis revealed that reduction of stem anteversion from Taperloc to Wagner Cone was more favourable for VAS pain (p = 0.029) and VAS satisfaction (p = 0.002). The mid-term survival rate for THA using the Wagner Cone stem was high, which may be supported by a reduction in prosthetic impingement. The reduction in excessive stem anteversion by using a tapered cone stem was associated with reduced pain and increased patient satisfaction.

Association Between Cancer Screening Patterns and Carer Literacy in Individuals With Cognitive Decline: An Observational Study.

The incidence rates of dementia, mild cognitive impairment, and cancer increase with age, posing challenges to affected individuals and their families. However, there are currently no clear cancer screening guidelines for individuals with cognitive impairment. This study analyzed the impact of carer health literacy on screening behaviors in this population. We conducted a postal follow-up survey, associated with the National Center for Geriatrics and Gerontology-Life STORIES of People with Dementia, that targeted primary carers to assess their reports regarding patient attendance at regular cancer screenings recommended by the Japanese Ministry of Health, Labor and Welfare, over the preceding 2 years. Screening rates were compared between the memory clinic cohort and the national average, and the influence of carer health literacy level on screening was analyzed. Among the 826 total individuals analyzed, the memory clinic cohort exhibited lower breast cancer screening rates, at 11% among female patients aged 65-74 years versus the national average of 32%. Higher health literacy among carers was significantly associated with increased screening. For female patients, carers with high levels of communicative health literacy were more likely to ensure that patients attended screenings for gastric (adjusted odds ratio [AOR], 1.77; 95% confidence interval [CI], 1.03-3.04), colorectal (AOR, 1.70, 95% CI 1.08-2.70), and breast cancers (AOR, 3.08; 95% CI, 1.40-6.76). Among the male patients, high communicative health literacy was associated with increased lung cancer screening attendance (AOR, 1.82; 95% CI, 1.11-2.99). Our research highlights a notable gap in cancer screening attendance between individuals with cognitive impairment and the general population, potentially arising from the intricate nature of screening procedures and the extensive burden on carers. More informed decisions and increased screening rates can be achieved through patient-centric communication strategies that accommodate the cognitive abilities of patients, ensuring the comprehensibility and accessibility of health-related information.

The psychometric properties of the Pearlin Mastery Scale in persons living with restless legs syndrome.

Restless Legs Syndrome (RLS) is a neurological disorder characterized by an urge to move arms and legs, commonly combined with distress, pain and motor restlessness. It can cause fragmented sleep, daytime symptoms, and decreased quality of life. Pharmacological treatment can suppress symptoms, but not cure. When challenged with illness, people may turn to their inner psychological resources such as self-esteem and mastery. The Pearlin Mastery scale was developed to study stress and coping, is commonly used in people with chronic illnesses, however, not yet validated in people with RLS. The aim was to test reliability and construct validity of the Pearlin Mastery Scale in persons with RLS. A cross-sectional postal survey including the Pearlin Mastery Scale, Restless Legs Syndrome-6 Scale, Pittsburgh Sleep Quality Index and Patient Health Questionnaire was sent out to members (n = 1500) of the national RLS association and 788 (52.5%) agreed to participate. Data were analyzed using classical test theory, Confirmatory factor analysis and Rasch measurement theory analysis. Hypothesis testing for construct validity was done by bivariate correlation analyses. Most respondents were women (65%), retired (71%) and had a mean-age of 70.8 years (SD 11.4). The 7-item version of the Pearlin Mastery Scale showed poor fit to the one factor model. After omitting the two positively worded items (i.e., item 4 and 6), the 5-item version was found to be unidimensional, with satisfactory internal consistency. However, all items showed considerable ceiling effects. No measurement variance was seen regarding age-groups or sex. Higher level of mastery was moderately correlated with less depressive symptoms but only weakly correlated to RLS-related sleep problems. The 5-item version of the Pearlin Mastery Scale is suggested to be used in persons with RLS due to its acceptable psychometric properties. The instrument could be applied as an outcome measure for behavioral change interventions aiming to support mastery in RLS.

Finnish translation, validation, and reproducibility of BREAST-Q modules relevant to breast cancer treatment

Background and objective: Breast cancer and its treatments can have a marked impact on the patient health-related quality of life. The aim of this study was to produce and validate Finnish versions of the breast-conserving treatment, mastectomy and breast reconstruction modules of the BREAST-Q, a patient-reported outcome tool designed specifically for women undergoing treatment for breast cancer. Methods: The relevant BREAST-Q modules were translated to Finnish according to established guidelines. Altogether 777 preoperative women were recruited at the Breast Surgery Unit and the Plastic Surgery Unit of Helsinki University Hospital between December 2019 and March 2021. This included 541 patients scheduled for breast-conserving surgery, 86 for mastectomy, and 150 for breast reconstruction. Postoperative patients were recruited through a postal survey, approaching 500 women operated for breast cancer in 2017, including 250 women who had undergone breast-conserving surgery and 250 women who had undergone mastectomy, as well as 339 women who had undergone breast reconstruction between August 2017 and July 2019. The patients were invited to fill the BREAST-Q modules relevant to their treatment and the general health-related quality-of-life instrument SF-36. A repeat administration of the BREAST-Q was done 2 weeks later. Results: A total of 665 (41%) women participated in the study, 339 (44%) preoperatively and 326 (39%) postoperatively. The BREAST-Q subscales showed high internal consistency with most Cronbach’s alphas > 0.8. The repeatability of the subscales was excellent with most intra-class correlation coefficients > 0.75. Low or negligible correlation was observed between BREAST-Q subscales and SF-36 domains. Conclusions: The Finnish version of the BREAST-Q modules breast-conserving treatment, mastectomy, and breast reconstruction performs well in assessing the health-related quality of life of women undergoing surgery for breast cancer or breast reconstruction.

Leader Attention to Information and Sustainability Performance

In contemporary business practice, sustainability has emerged as a focal point for understanding value creation. This study examines how leader attention influences sustainability performance. Specifically, it investigates two dimensions of leader attention: search intensity, which pertains to the depth and thoroughness of exploration, and search selection, which involves the criteria used to prioritize sustainability issues. This study employed a quantitative approach utilizing a survey methodology. Data collection of 30 SMEs was conducted through a postal survey, targeting the Malaysian service sector listed in the directory of the Federation of Malaysian Manufacturers (FMM). Data is analyzed using PLS-SEM to investigate perceptions regarding leader attention towards corporate sustainability performance. Employing the ABV theory, the findings indicate that search intensity positively impacts both corporate financial and non-financial performance, highlighting the importance of comprehensive information-gathering and analysis processes. However, the study does not find a significant relationship between search selection and financial performance, suggesting a limited impact of specific information search strategies. These results underscore the pivotal role of leader attention in shaping organizational sustainability performance. The study contributes to understanding how leader attention enhances sustainability and provides valuable insights for organizations. Despite its contributions, future research could explore mechanisms through which search intensity influences financial outcomes and consider moderating factors across industries and regions. In conclusion, this research emphasizes the importance of data-driven decision-making and comprehensive information search processes for corporate financial and non-financial performance in today's information-rich environment.

“Defend your children, they can be taken by two gay men”: A scoping review of the conflating and diversionary discourses used in same-sex marriage debates

The use of direct popular votes such as plebiscites, referendums, and postal surveys to determine the right of same-sex couples to marry have proliferated in recent years, particularly across the Global North. By including the public in the decision-making process, serious debates have been fermented about the morality of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) rights. Based on a scoping review of the available English language literature, this paper maps the key findings from 24 peer reviewed studies to offer a cross-national analysis of conflating and diversionary discourses used by pro- and anti-SSM advocates. This paper finds that despite ostensibly being about LGBTQ + sexual rights, these debates commonly conflate SSM with other unsubstantiated ‘threats’, categorised here as operating across the global, national, and individual levels. The findings suggest that SSM debates consistently conflated the issue with international human rights discourses, alongside notions of ‘race’, gender, family, and reproduction as a strategy to garner public opinion. This study reveals a complex network of discourses where the rights of LGBTQ + people are continuously harnessed for political agendas extending beyond the specific efforts to legislate SSM. This paper concludes with the limitations of this review and possible directions for future research.

‘I presumed the pain would eventually get better by itself’; challenges with access to rehabilitation for upper limb dysfunction after breast cancer treatment - Descriptive and qualitative findings from a cross-sectional survey

PurposeSixty percent of breast cancer patients develop persistent upper limb pain and dysfunction, but only limited knowledge exists about how these symptoms relate to rehabilitation access. MethodsA postal survey was sent to patients treated at a London University Teaching Hospital (2018–2020). Data were collected on pain (Pain Detect), shoulder function (Disability of Shoulder Arm and Hand (DASH)), quality-of-life (QoL) (EQ-5D-5L), and clinical characteristics, including treatment and access to rehabilitation. The free-text section invited patients’ comments on upper limb symptoms and management strategies, which were analysed thematically. Quantitative data were analysed descriptively, and the medians were examined with Mann-Whitley U-Tests or Kruskal-Wallis Test. ResultsOf 511 patients surveyed, 162 (32 %) questionnaires were returned and analysed. Respondents’ mean age was 62 years (SD 11.3). The majority had Sentinel Node Biopsy 71 % (116/162) and mastectomy 61 % (99/162). 73 % (119/162) reported pain. Mean (SD) Pain Detect and DASH Score were respectively 11.07 (7) and 21.7 (21.5), with 51 % recording significant shoulder dysfunction, and only 28 % reporting access to rehabilitation. Individuals with neuropathic pain had significantly higher median (range) DASH score 60.8 (35.8, 75.0) p = 0.000. Median DASH score for sedentary individuals was significantly higher 22.9 (7.9, 31.8) p = 0.0009.Free-text analysis revealed persistent, progressive symptoms, mixed attitudes towards exercise and variations in access to rehabilitation and support. ConclusionTwo years following surgery many patients reported significant upper limb symptoms which adversely impact on QoL. However, approximately two thirds did not access potentially beneficial rehabilitation treatments. There is a need to improve pathways of care.

Secular trends in frailty among community-dwelling 75-95-year-old cohorts over three decades in Helsinki, Finland.

Frailty Index (FI) reflects health, functioning and well-being of older people. It is valuable to compare how frailty has changed over time in ageing cohorts. This study aims to examine trends in frailty among 75-95-year-old men and women over three decades. The Helsinki Ageing Study started in 1989 and includes repeated cross-sectional postal surveys every 10 years examining community-dwelling cohorts of older people (75, 80, 85, 90 and 95years). FI comprises the same 36 items in each cohort. The mean FI was 0.22 (SD 0.12), 0.25 (SD 0.15), 0.26 (SD 0.15) and 0.23 (SD 0.15) in 1989, 1999, 2009 and 2019, respectively (P for linearity for crude values .11). Adjusted for age and sex, the four cohorts differed in their frailty the 2019 cohort having the lowest FI. This sex-adjusted difference was seen among 75-, 80-, 85- and 90-year-olds but not among 95-year-olds. FI decreased more among men than women (P for cohort <.001, P for sex <.01, P for interaction = .19). The prevalence of frailty among community-dwelling individuals aged 75, 80, 85 and 90years-but not among those aged 95years-has significantly decreased over the last decades. This positive trend may have important implications for health policies in societies with increasing longevity.

Perioperative pathways for children with neurodevelopmental conditions and behaviours that challenge: An evaluation of parent experiences for service improvement.

To elicit experiences of parents of children with neurodevelopmental conditions using a new perioperative pathway. Parents of children accessing an adapted perioperative clinical pathway in a tertiary children's hospital between July 2019 and December 2020 were invited to participate. A mixed method study was conducted comprising a short survey questionnaire followed by telephonic interviews. From 67 postal surveys sent out, 20 were completed. Six out of 20 parents participated in phone interviews and one parent submitted written prose. Parents were positive about their experiences. Six themes emerged: Negative past experiences (highlighting the need for adapted perioperative pathways); Reasonable adjustments (improving child and parent's hospital journey); Facilitating communication, convenience and collaboration; Parent's satisfaction and relief; Barriers to overcome and Areas in need of improvement were discussed. Parents of children with neurodevelopmental conditions report great satisfaction and relief from their experiences of a more efficient, streamlined and stress-free way for their child to have tests or procedures done. Parents report improved communication, convenience and collaboration with staff resulted in timely, safe and high-quality care.

P-495 Are open-identity oocyte and sperm donors ready for the release of their identity to offspring conceived with their gametes? Follow-up 14-17 years post-donation

Abstract Study question What attitudes and needs do open-identity oocyte and sperm donors have regarding potential future contact with adult offspring from their donation? Summary answer Most oocyte and sperm donors had positive attitudes towards being contacted by offspring and wanted some guidance, but one in ten was negative towards contact. What is known already The number of donor-conceived persons (DCPs) requesting identifying information about their donor is expected to rise as large groups conceived with gametes from open-identity donors are reaching adulthood. Men and women donating within open-identity programs must accept that their identity may be released to offspring from their donation, but they have no obligation to engage in any contact. In Sweden, donors can contact the clinic to obtain information about the number of offspring from their donation, but no There is limited knowledge about open-identity donors’ attitudes about potential contact with DCPs and their need for guidance about handling such contacts. Study design, size, duration The present study is part of the prospective longitudinal Swedish Study on Gamete Donation and concerns the fifth wave of data collection conducted in 2021-2022, which included 215 donors (87% response). Following exclusion of known/directed donors (n = 22) and those who stated knowing that their donation had not resulted in a child (n = 24) the present study sample included 100 oocyte donors and 91 sperm donors. Participants/materials, setting, methods The Swedish Study on Gamete Donation used consecutive recruitment of new donors at all fertility clinics providing gamete donation during a three-year period (2005-2008). Participants were requested to complete postal surveys at five time points. The present study concerns data collected 14-17 years post-donation and includes study-specific items on donors’ attitudes and needs regarding potential future contact with DCPs. Data analysis with Pearson’s chi-square statistic and multinominal logistic regression. Main results and the role of chance At 14-17 years post-donation, most of the 100 oocyte and 91 sperm donors were living with a partner (65%) and had children of their own (77%). Among participants, about half had obtained information from the clinic that their donation had resulted in child(ren) and remaining donors had no information about the results of their donation. Most donors had positive attitudes towards being approached by offspring from their donation (71%) while remaining were neutral (19%) or negative (10%). Donors who were ignorant about any donor offspring were three times more likely to be negative towards contact compared to being positive (OR 3.26; CI 1.05-10.11), when controlling for sociodemographic variables. The majority of donors wanted to receive guidance on how to handle potential future contact with DCPs (59%), and this wish was not significantly related to their gender, educational level or presence of own children. The vast majority of donors wanted to be notified by the clinic when a DCP requests identifying information about them (93%). Furthermore, most donors supported that clinic staff enquires about their stance towards contact with DCPs and would like to convey that they are open to contact (80%). Limitations, reasons for caution The present study concerns a national cohort of women and men who donated oocytes and sperm in the context of the Swedish legislation mandating open-identity donation, which limits the generalizability of our findings to other groups and contexts. Wider implications of the findings A few years before potential release of their identity, most oocyte and sperm donors are positive towards being contacted by offspring from their donation, but many want guidance regarding handling such contacts. Open-identity donors should have access to information and counselling in preparation of potential contact with DCPs. Trial registration number not applicable

BT37 Can patients with psoriasis and eczema support their self-management by being involved in care decision making?

Abstract Eczema and psoriasis are often associated with psychological and metabolic comorbidities. They usually require long-term medical care. Currently, no intervention is available to regularly assess such patients’ needs and comorbidities and support their involvement in decision making and self-management. The objective of this study was to explore the acceptability and potential of a self-developed questionnaire (study tool) in addressing the needs, comorbidities and feedback of patients with psoriasis and eczema, to support their involvement in decision making and self-management of their chronic conditions. A mixed-methods study was conducted that included a postal survey on adult male and female patients with psoriasis and eczema. The study tool contained the Dermatology Life Quality Index and seven supplementary open-ended questions to capture patients’ views, feedback, comorbidities, coping status and needs. The survey was followed by semistructured face-to-face interviews with a sample of the patients who had participated in the survey. The final study involved sharing the research findings along with a prototype of the proposed online version of the study tool with a group of healthcare professionals. Of the 114 patients who participated in the postal survey, 108 (94.7%) expressed physical, metabolic and psychological comorbidities. Stress was identified as the dominant disease-triggering factor in 72 (63.2%) participants. Thirty-three (28.9%) participants reported that they could not cope with their chronic illness. Eighteen (15.8%) had anxiety, and 12 (10.5%) had depression and suicidal thoughts. Twenty-nine (25.4%) participants addressed their needs for support at home, and 16 (14.0%) of them asked for support at work. In the interviews, all the participants (22, 100%) welcomed the use of the study tool on a regular basis to support their needs and feedback. Nineteen (86%) of them preferred using an online version of the tool (portal system) as a convenient way of remote and interactive communication with the healthcare provider, particularly during the worsening of their skin condition. In the final study, the healthcare experts agreed that the proposed online version of the study tool (portal) would be a convenient platform for such patients to address their unmet needs, comorbidities and feedback. It can be designed to provide access to supportive services including links to patient information on skin diseases, local mental health services, patient forums and other relevant support groups and charities. In conclusion, the study tool has the potential to regularly engage and assess patients’ unmet needs, comorbidities and feedback. All the interviewees welcomed regular use of the study tool. The use of an online version of the tool can have the potential to fill important gaps in patient self-management and in health service improvement.

Why does community ownership foster greater acceptance of renewable projects? Investigating energy justice explanations

ABSTRACT The fact that community ownership increases the social acceptability of renewable energy projects is well established, but there is a lack of empirical evidence to explain why this is the case. This study examines whether energy justice factors (fair involvement, fair distribution of benefits and perceived impacts from wind turbines) can help explain this relationship, whether these factors are interrelated, and whether different ownership structures (community, shared or private ownership) change these associations. Using a postal survey of residents in Scotland (n = 320), the study employs a novel method, Multigroup-Structural Equation Modelling, to investigate these questions. This modelling reveals that acceptance of these projects was influenced by factors of energy justice (i.e. fair involvement, fair benefits and perceived impacts), but the influence from each factor depended on the ownership structure. Specifically, those near the community-owned project prioritised involvement, those near the privately-owned valued fair benefits, and those near the shared ownership prioritised both. By examining the relationships amongst energy justice factors, the real-life complexity of people’s responses to wind energy projects is revealed, whereby factors can have knock-on effects. Importantly, this study finds that the community and shared ownership projects fostered greater community acceptance than the privately-owned because they had more instances where fair involvement influenced other factors, which led to greater overall acceptance. Although community involvement may seem time-consuming, a more inclusive approach can prevent long-term issues caused by local opposition. Policy Highlights Community ownership of renewable energy projects leads to greater acceptance by local residents, as long as the projects meet their expectations. Energy justice plays a crucial role in acceptance of onshore wind energy projects, but residents prioritise different aspects depending on ownership. Policymakers and developers should take into account the preferences and concerns of local residents when designing renewable projects, especially in terms of fair involvement and fair distribution of benefits. Better support for communities and developers is essential if the Scottish Government want shared ownership offered on all new projects.

Clinical Value of Fine Needle Aspiration Cytology and Core Needle Biopsy in Head and Neck Pathology - A Nationwide Survey in Germany.

Fine-needle aspiration cytology (FNA) and core needle biopsy (CNB) of the thyroid gland, salivary glands, and lymph nodes are considered simple and rapid methods for minimally invasive tissue collection. We performed a postal survey to analyse the diagnostic value and complication rate of FNA and CNB in Germany. A questionnaire comprising 11 questions was sent to all 161 German ENT departments in September 2015. The response rate was 45%. In 33 of the 73 responding clinics neither FNA nor CNB were carried out. Of the 26 clinics that provided detailed reasons, the majority (n=18) cited a lack of expertise among the collaborating pathologists. Overall, FNA was used more often, regardless of the anatomical region investigated. The study was based on a total of 36,684 FNAs and 9,624 CNBs. The rate of estimated meaningful and correct findings was 63% (10%-90%) for FNA, and 83% (50%-100%) for CNB. In eight cases (<0.001%) a potential tumor cell spread was reported. This is the first nationwide survey in Germany to investigate the utility of FNA and CNB across different localizations in the head and neck region. This study revealed comparable results to the literature regarding the diagnostic value of FNA and CNB. Cell spreading was only observed in individual cases. The appraisal of needle biopsies in the head and neck area seems to be rather inhomogeneous in Germany.

Factors associated with readmission for community-onset pneumonia among older people: A retrospective study

BackgroundAlthough older individuals are prone to pneumonia relapse, little real-world evidence is available on the main factors contributing to pneumonia recurrence. This study assessed the impact of patients’ lifestyles on hospital readmission due to pneumonia recurrence. MethodsWe retrospectively included consecutive patients (aged ≥65 years) who were admitted for community-onset pneumonia. A binary or multiple-choice postal questionnaire survey on lifestyles after hospitalization was conducted to identify the factors associated with readmission due to pneumonia recurrence. ResultsOf 117 patients who responded to the questionnaires, 89 were included in the analyses after excluding 28 patients who died within 1 year of discharge. Twenty-four of 89 (27%) patients were readmitted to the hospital for pneumonia within 1 year of discharge. Multivariate analysis revealed that cerebrovascular disease (odds ratio [OR], 3.912; 95% confidence interval [CI], 1.104–13.861; p = 0.035) and need of assistance at mealtime (OR, 2.225; 95% CI, 1.182–4.186; p = 0.013) were significantly associated with readmission due to pneumonia recurrence. Oral care and mealtime body position were not associated with readmission. ConclusionsHost factors, not patients’ lifestyles such as oral care and body position, mainly contribute to the development of pneumonia among older people. These results should be considered risk factors for readmission by medical workers and family members.

End-of-life care in German and Dutch nursing homes: a cross-sectional study on nursing home staff’s perspective in 2022

BackgroundAs society ages, the need for nursing home care is steadily increasing and end-of-life care of nursing home residents has become increasingly more important. End-of-life care differs between Germany and the neighbouring Netherlands. For example, a much higher proportion of German compared to Dutch nursing home residents is hospitalized at the end of life. Therefore, the aim of this study was to evaluate end-of-life care in German and Dutch nursing homes.MethodsIn this cross-sectional study, a postal survey was sent to 600 randomly selected German and Dutch nursing homes each and addressed to the nursing staff management. Participants were asked to estimate the percentage of nursing home residents whose wishes for emergency situations (e.g. cardiopulmonary resuscitation) are known and to indicate whether facilities offer advanced care planning (ACP). They were also asked to estimate whether general practitioners (GPs)/elder care physicians (ECPs) and nursing home staff are usually well trained for end-of-life care. Finally, participants were asked to estimate the proportion of nursing home residents who die in hospital rather than in the nursing home and to rate overall end-of-life care provision.ResultsA total of 301 questionnaires were included in the analysis; 199 from German and 102 from Dutch nursing homes (response 33.2% and 17.0%). German participants estimated that 20.5% of residents die in the hospital in contrast to the Dutch estimation of 5.9%. In German nursing homes, ACP is offered less often (39.2% in Germany, 75.0% in the Netherlands) and significantly fewer wishes for emergency situations of residents were known than in Dutch nursing homes. GPs were considered less well-trained for end-of-life care in Germany. The most important measures to improve end-of-life care were comparable in both countries.ConclusionDifferences in (the delivery and knowledge of) end-of-life care between Germany and the Netherlands could be observed in this study. These could be due to structural differences (ECPs available 24/7 in the majority of Dutch nursing homes) and cultural differences (more discussion on quality of life versus life-sustaining treatments in the Netherlands). Due to these differences, a country-specific approach is necessary to improve end-of-life care.

Access to civil justice as a social determinant of health: a legal epidemiological cross-sectional study

BackgroundAlthough it is widely acknowledged that access to civil justice (ATJ) is a key social determinant of health (SDOH), the existing literature lacks empirical evidence supporting ATJ as a SDOH for specific dimensions of health.MethodsA legal epidemiological, cross-sectional, postal survey was conducted on n = 908 randomly sampled participants in Hong Kong in March 2023. Data collected were perceptions of the civil justice system, health, and sociodemographics. Perceived ATJ was assessed using a modified version of the Inaccessibility of Justice scale (IOJ) and Perceived Inequality of Justice scale (PIJ), i.e. the “modified IOJ-PIJ”, consisting of 12 of the original 13 items from both scales divided into two subdomains: “procedural fairness”, and “outcome neutrality”. For health data, quality of life was assessed using the Hong Kong version of the Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF(HK)), psychological distress (including symptoms of anxiety and depression) was assessed using the four-Item Patient Health Questionnaire (PHQ-4), and having comorbidities was assessed using Sangha’s Self-Administered Comorbidity Questionnaire (SCQ). Structural equation modelling (SEM) was used to investigate the relationships between perceived ATJ and the measured health outcomes.ResultsSEM demonstrated that both subdomains for ATJ had significantly negative associations (B < 0; p < 0.05) with all quality-of-life subdomains, except for between outcome neutrality with social relationships; both subdomains for ATJ had significantly positive association (B > 0; p < 0.05) with both anxiety and depression; and, after adjusting for age, only “procedural fairness” had significantly positive association (B > 0; p < 0.05) with having comorbidities.ConclusionThis study provided empirical evidence that ATJ is a SDOH for specific dimensions of health. The results of this study encourage laws, policies, and initiatives aimed at improving ATJ, as well as collaborative efforts from the legal and health sectors through health-justice partnerships, and from the broader community, to safeguard and promote public health by strengthening ATJ.