Proportion Willing Research Articles

Evaluating public acceptability of a potential Lyme disease vaccine using a population-based, cross-sectional survey in high incidence areas of the United States

BackgroundLyme disease incidence is increasing, despite current prevention options. New Lyme disease vaccine candidates are in development, however, investigation of the acceptability of a Lyme disease vaccine among potential consumers is needed prior to any vaccine coming to market. We conducted a population-based, cross-sectional study to estimate willingness to receive a potential Lyme disease vaccine and factors associated with willingness. MethodsThe web-based survey was administered to a random sample of Connecticut, Maryland, Minnesota, and New York residents June–July 2018. Survey-weighted descriptive statistics were conducted to estimate the proportion willing to receive a potential Lyme disease vaccine. Multivariable multinomial logistic regression models were used to quantify the association of sociodemographic characteristics and Lyme disease vaccine attitudes with willingness to be vaccinated. ResultsSurveys were completed by 3313 respondents (6% response rate). We estimated that 64% of residents were willing to receive a Lyme disease vaccine, while 30% were uncertain and 7% were unwilling. Compared to those who were willing, those who were uncertain were more likely to be parents, adults 45–65 years old, non-White, have less than a bachelor’s degree, or have safety concerns about a potential Lyme disease vaccine. Those who were unwilling were also more likely to be non-White, have less than a bachelor’s degree, or have safety concerns about a potential Lyme disease vaccine. In addition, the unwilling had low confidence in vaccines in general, had low perceived risk of contracting Lyme disease, and said they would not be influenced by a positive recommendation from a healthcare provider. DiscussionOverall, willingness to receive a Lyme disease vaccine was high. Effective communication by clinicians regarding safety and other vaccine parameters to those groups who are uncertain will be critical for increasing vaccine uptake and reducing Lyme disease incidence.

Trust in government, intention to vaccinate and COVID-19 vaccine hesitancy: A comparative survey of five large cities in the United States, United Kingdom, and Australia

BackgroundThere is widespread hesitancy towards COVID-19 vaccines in the United States, United Kingdom, and Australia. ObjectiveTo identify predictors of willingness to vaccinate against COVID-19 in five cities with varying COVID-19 incidence in the US, UK, and Australia. DesignOnline, cross-sectional survey of adults from Dynata’s research panel in July-September 2020. Participants, settingAdults aged 18 and over in Sydney, Melbourne, London, New York City, or Phoenix. Main outcomes and measuresWillingness to receive a COVID-19 vaccine; reason for vaccine intention. Statistical methodsTo identify predictors of intention to receive a COVID-19 vaccine, we used Poisson regression with robust error estimation to produce prevalence ratios. ResultsThe proportion willing to receive a COVID-19 vaccine was 70% in London, 71% NYC, 72% in Sydney, 76% in Phoenix, and 78% in Melbourne. Age was the only sociodemographic characteristic that predicted willingness to receive a COVID-19 vaccine in all five cities. In Sydney and Melbourne, participants with high confidence in their current government had greater willingness to receive the vaccine (PR = 1.24; 95% CI = 1.07–1.44 and PR = 1.38; 95% CI = 1.74–1.62), while participants with high confidence in their current government in NYC and Phoenix were less likely to be willing to receive the vaccine (PR = 0.78; 95% CI = 0.72–0.85 and PR = 0.85; 95% CI = 0.76–0.96). LimitationsConsumer panels can be subject to bias and may not be representative of the general population. ConclusionsSuccess for COVID-19 vaccination programs requires high levels of vaccine acceptance. Our data suggests more than 25% of adults may not be willing to receive a COVID-19 vaccine, but many of them were not explicitly anti-vaccination and thus may become more willing to vaccinate over time. Among the three countries surveyed, there appears to be cultural differences, political influences, and differing experiences with COVID-19 that may affect willingness to receive a COVID-19 vaccine.

Seroprevalence Study and Cross-Sectional Survey on COVID-19 for a Plan to Reopen the University of Alicante (Spain).

The implementation of strategies to mitigate possible cases of COVID-19 were addressed at the University of Alicante for the safe reopening of the 2020/2021 academic year. To discover the prevalence of immunity against SARS-CoV-2, a study was designed using a rapid immunoassay test (carried out between 6 and 22 July 2020), and in addition a cross-sectional survey was conducted on risk factors, symptoms, predisposition for becoming vaccinated, and sources of information about COVID-19. A random sample, stratified by students, faculty, and administrative staff, was selected. The seroprevalence found was 2.64% (39/1479; 95% CI 1.8–3.4), and the adjusted seroprevalence was 2.89% (95% CI 2.1–3.7). The average age of the students was 23.2 years old, and 47.6 years old for staff. In relation to COVID-19, the following was found: 17.7% pauci-symptomatic, 1.3% symptomatic, 5.5% contact with cases, 4.9% confined, and 0.3% PCR positive. More than 90% complied with preventive measures. The proportion willing to receive the COVID-19 vaccine was 91%. Their sources of information were the Internet (74%) and television (70.1%). They requested that the university offer information (45.1%), training (27%), and provide Personal Protective Equipment (PPE) (26.3%). Lastly, 87.9% would repeat the test. A plan was established that included the follow-up of cases and contacts, random sample testing, training courses, bimodal teaching, a specific website, and the distribution of PPE.

Risk of disease and willingness to vaccinate in the United States: Apopulation-based survey.

Vaccination complacency occurs when perceived risks of vaccine-preventable diseases are sufficiently low so that vaccination is no longer perceived as a necessary precaution. Disease outbreaks can once again increase perceptions of risk, thereby decrease vaccine complacency, and in turn decrease vaccine hesitancy. It is not well understood, however, how change in perceived risk translates into change in vaccine hesitancy. We advance the concept of vaccine propensity, which relates a change in willingness to vaccinate with a change in perceived risk of infection-holding fixed other considerations such as vaccine confidence and convenience. We used an original survey instrument that presents 7 vaccine-preventable "new" diseases to gather demographically diverse sample data from the United States in 2018 (N = 2,411). Our survey was conducted online between January 25, 2018, and February 2, 2018, and was structured in 3 parts. First, we collected information concerning the places participants live and visit in a typical week. Second, participants were presented with one of 7 hypothetical disease outbreaks and asked how they would respond. Third, we collected sociodemographic information. The survey was designed to match population parameters in the US on 5 major dimensions: age, sex, income, race, and census region. We also were able to closely match education. The aggregate demographic details for study participants were a mean age of 43.80 years, 47% male and 53% female, 38.5% with a college degree, and 24% nonwhite. We found an overall change of at least 30% in proportion willing to vaccinate as risk of infection increases. When considering morbidity information, the proportion willing to vaccinate went from 0.476 (0.449-0.503) at 0 local cases of disease to 0.871 (0.852-0.888) at 100 local cases (upper and lower 95% confidence intervals). When considering mortality information, the proportion went from 0.526 (0.494-0.557) at 0 local cases of disease to 0.916 (0.897-0.931) at 100 local cases. In addition, we ffound that the risk of mortality invokes a larger proportion willing to vaccinate than mere morbidity (P = 0.0002), that older populations are more willing than younger (P<0.0001), that the highest income bracket (>$90,000) is more willing than all others (P = 0.0001), that men are more willing than women (P = 0.0011), and that the proportion willing to vaccinate is related to both ideology and the level of risk (P = 0.004). Limitations of this study include that it does not consider how other factors (such as social influence) interact with local case counts in people's vaccine decision-making, it cannot determine whether different degrees of severity in morbidity or mortality failed to be statistically significant because of survey design or because participants use heuristically driven decision-making that glosses over degrees, and the study does not capture the part of the US that is not online. In this study, we found that different degrees of risk (in terms of local cases of disease) correspond with different proportions of populations willing to vaccinate. We also identified several sociodemographic aspects of vaccine propensity. Understanding how vaccine propensity is affected by sociodemographic factors is invaluable for predicting where outbreaks are more likely to occur and their expected size, even with the resulting cascade of changing vaccination rates and the respective feedback on potential outbreaks.

Willingness to pay for cataract surgery is much lower than actual costs in Zamfara state, northern Nigeria

ABSTRACTPurpose: Direct medical and non-medical costs incurred by those undergoing subsidised cataract surgery at Gusau eye clinic, Zamfara state, were recently determined. The aim of this study was to assess the willingness to pay for cataract surgery among adults with severe visual impairment or blindness from cataract in rural Zamfara and to compare this to actual costs.Methods: In three rural villages served by Gusau eye clinic, key informants helped identify 80 adults with bilateral severe visual impairment or blindness (<6/60), with cataract being the cause in at least one eye. The median amount participants were willing to pay for cataract surgery was determined. The proportion willing to pay actual costs of the (i) subsidised surgical fee (US$18.5), (ii) average non-medical expenses (US$25.2), and (iii) average total expenses (US$51.2) at Gusau eye clinic were calculated. Where participants would seek funds for surgery was determined.Results: Among 80 participants (38% women), most (n = 73, 91%) were willing to pay something, ranging from <US$1 to US$186 (median US$18.5, interquartile range 6.2–31.1). Approximately half of the participants (n = 41) were willing to pay US$18.5 (78% men), one-third (n = 26) were willing to pay US$25.2 (77% men); and 11% (n = 9) were willing to pay US$51.2 (all men). Only six participants (8%) already had the money to pay; one quarter (n = 20) would need to sell possessions to raise the funds.Conclusion: Willingness to pay for cataract surgery among adults with operable cataract in rural Zamfara state is far lower than current costs of undergoing surgery. People who were widowed—most of whom were women—were willing to pay least. Further financial support is required for cataract surgery to be universally accessible.

Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis.

Introduction: To facilitate provision of pre-exposure prophylaxis (PrEP) in low- and middle-income countries (LMIC), a better understanding of potential demand and user preferences is required. This review assessed awareness and willingness to use oral PrEP among men who have sex with men (MSM) in LMIC.Methods: Electronic literature search of Cochrane library, Embase, PubMed, PsychINFO, CINHAL, Web of Science, and Google Scholar was conducted between July and September 2016. Reference lists of relevant studies were searched, and three authors contacted for additional data. Non-peer reviewed publications were excluded. Studies were screened for inclusion, and relevant data abstracted, assessed for bias, and synthesized.Results: In total, 2186 records were identified, of which 23 studies involving 14,040 MSM from LMIC were included. The proportion of MSM who were aware of PrEP was low at 29.7% (95% CI: 16.9–44.3). However, the proportion willing to use PrEP was higher, at 64.4% (95% CI: 53.3–74.8). Proportions of MSM aware of PrEP was <50% in 11 studies and 50–70% in 3 studies, while willingness to use PrEP was <50% in 6 studies, 50–70% in 9 studies, and over 80% in 5 studies. Several factors affected willingness to use PrEP. At the individual domain, poor knowledge of PrEP, doubts about its effectiveness, fear of side effects, low perception of HIV risk, and the need to adhere or take medicines frequently reduced willingness to use PrEP, while PrEP education and motivation to maintain good health were facilitators of potential use. Demographic factors (education, age, and migration) influenced both awareness and willingness to use PrEP, but their effects were not consistent across studies. At the social domain, anticipated stigma from peers, partners, and family members related to sexual orientation, PrEP, or HIV status were barriers to potential use of PrEP, while partner, peer, and family support were facilitators of potential use. At the structural domain, concerns regarding attitudes of healthcare providers, quality assurance, data protection, and cost were determinants of potential use.Conclusions: This review found that despite low levels of awareness of PrEP, MSM in LMIC are willing to use it if they are supported appropriately to deal with a range of individual, social, and structural barriers.

A prospective randomized trial on the use of Coca-Cola Zero(®) vs water for polyethylene glycol bowel preparation before colonoscopy.

The study aimed to determine whether Coca-Cola (Coke) Zero is a safe and effective solvent for polyethylene glycol (PEG). Between December 2013 and April 2014, 209 healthy adults (115 men, 95 women) scheduled for elective colonoscopy were randomized to use either Coke Zero (n=100) or drinking water (n=109) with PEG as bowel preparation. Each patient received two sachets of PEG to dissolve in 2l of solvent, to be completed 6h before colonoscopy. Serum electrolytes were measured before and after preparation. Bowel cleanliness and colonoscopy findings were recorded. Palatability of solution, adverse effects, time taken to complete and willingness to repeat the preparation were documented via questionnaire. Mean palatability scores in the Coke Zero group were significantly better compared with the control group (2.31±0.61 vs 2.51±0.63, P=0.019), with a higher proportion willing to use the same preparation again (55% vs 43%). The mean time taken to complete the PEG + Coke Zero solution was significantly faster (74±29min vs 86±31min, P=0.0035). The quality of bowel cleansing was also significantly better in the Coke Zero group (P=0.0297). There was no difference in the frequency of adverse events (P=0.759) or the polyp detection rate (32% vs 31.2%). Consumption of either preparation did not significantly affect electrolyte levels or hydration status. Coke Zero is a useful alternative solvent for PEG. It is well tolerated, more palatable, leads to quicker consumption of the bowel preparation and results in better quality cleansing.

Knowledge and attitudes about Ebola vaccine among the general population in Sierra Leone

BackgroundClinical trials of Ebola vaccine are ongoing. Before it becomes commercially available, understanding the Ebola vaccine-related knowledge and attitude of the general population is imperative to developing an effective vaccine coverage strategy. MethodsWe conducted a survey including 400 participants from general communities of the West Area Rural District, Sierra Leone. Knowledge and attitudes about Ebola vaccine were investigated, and the determinants of having knowledge and a positive attitude toward accepting vaccination were identified. ResultsOver half (55.8%) of the participants were aware of Ebola vaccine. About 60% of the participants were willing to be study subjects if the Ebola vaccine clinical trial were conducted in their communities. Most of the participants (72.5%) were willing to take Ebola vaccination if it was free of charge. Given that the vaccination was not free, the proportion willing to pay a fee to take the vaccination declined dramatically to 26.6%. Using a forward step-wise logistic model, monthly salary was identified as the single determinant (OR for every 100,000 Leones increase: 1.17, 95%CI: 1.04–1.31) for awareness of Ebola vaccine, which was identified as the determinant (OR: 1.88, 95%CI: 1.17–3.02) for free vaccination uptake willingness. The combination of monthly salary, monthly average income of family members and their interaction was found to be associated with charged vaccination uptake willingness. DiscussionMeasures are still needed to promote the Ebola vaccine awareness and knowledge updating. Free or low-priced vaccine could increase the vaccination acceptability of the general community population significantly.

Analysis of factors that may be essential in the decision to fly on fully autonomous passenger airliners

SummaryThis research investigates factors that influence opinion in the decision to fly on fully autonomous passenger airliners primarily from the perspective of aviation and technology professionals. Bayesian statistical inference and a two‐level fractional factorial survey are used to sample passengers' views on fully autonomous airliners. Eight trust, safety, and cost factors are incorporated into a vignette set in the future. Factors include automation levels, safety records, liability guarantees, airline integrity, and service disruptions. Dependent variables exist in five post‐vignette questions and essentially ask “Would you” or “Would you not” be willing to fly on a fully autonomous airliner? Sixteen versions of the vignette, each with unique trust, safety, and cost levels, present varying (unknown) degrees of influence to the survey respondents. For every demographic, the research shows a 99% statistically significant difference between the “prior” and “posterior” sampled population proportions willing to fly. The most significant positive influence involves integrity characteristics of the airline, while the most negative influence relates to life insurance liability guarantees. Research from 2003 suggested that this mode of travel would be acceptable to only 10.5% of respondents. When the 2003 research is used as a Bayesian prior probability, the resulting posterior probability for the demographics sampled can be modeled as a beta distribution, indicating 95% probability that the sampled proportion of the population willing to fly is between 33.2% and 36.4%. After adjusting for age and profession demographics to match the US population, the 95% probability bounds on the proportion willing to fly are 31.35% and 34.15%. Copyright © 2015 John Wiley &amp; Sons, Ltd.

Who gets targeted for vote-buying? Evidence from an augmented list experiment in Turkey

Understanding the dynamics of vote-buying is essential for improving accountability in elections in developing democracies. While list experiments are useful for attenuating social desirability bias associated with measuring vote-buying, they are not conducive to multivariate analyses, and the question of what types of individuals are targeted is left inadequately explored. We overcome this limitation by combining a population-based list experiment with an estimator (LISTIT) that allows for multivariate analyses in an efficient manner. Our analysis suggests that in the 2011 parliamentary elections in Turkey over one-third of the electorate was targeted for vote-buying, which is more than double the proportion willing to admit when asked directly. Additionally, we find that strong partisans of the ruling Justice and Development Party (Adalet ve Kalkınma Partisi), less-educated individuals, and urban residents are significantly more likely to be targeted for vote-buying. We present compelling evidence for the hypotheses that parties target their core supporters and socio-economically vulnerable individuals. The strength of our evidence derives from the use of original data on vote-buying that has been collected in an unobtrusive manner and analyzed at the level of individuals.

Can mass education and a television campaign change the attitudes towards cardiopulmonary resuscitation in a rural community?

BackgroundSurvival after out-of-hospital cardiac arrest (OHCA) is improved when bystanders provide Basic Life Support (BLS). However, bystander BLS does not occur frequently. The aim of this study was to assess the effects on attitudes regarding different aspects of resuscitation of a one-year targeted media campaign and widespread education in a rural Danish community. Specifically, we investigated if the proportion willing to provide BLS and deploy an automated external defibrillator (AED) increased.MethodsBLS and AED courses were offered and the local television station had broadcasts about resuscitation in this study community. A telephone enquiry assessed the attitudes towards different aspects of resuscitation among randomly selected citizens before (2008) and after the project (2009).ResultsFor responses from 2008 (n = 824) to 2009 (n = 815), there was a significant increase in the proportions who had participated in a BLS course within the past 5 years, from 34% to 49% (p = 0.0001), the number willing to use an AED on a stranger (p < 0.0001), confident at providing chest compressions (p = 0.03), and confident at providing mouth-to-mouth ventilations (MMV) (p = 0.048). There was no significant change in the proportions willing to provide chest compressions (p = 0.15), MMV (p = 0.23) or confident at recognizing a cardiac arrest (p = 0.09). The most frequently reported reason for not being willing to provide chest compressions, MMV and use an AED was insecurity about how to perform the task.ConclusionA targeted media campaign and widespread education can significantly increase the willingness to use an AED, and the confidence in providing chest compressions and MMV. The willingness to provide chest compressions and MMV may be less influenced by a targeted campaign.

Willingness to use and pay for options of care for community-dwelling older people in rural Vietnam

BackgroundThe proportion of people in Vietnam who are 60 years and over has increased rapidly. The emigration of young people and impact of other socioeconomic changes leave more elderly on their own and with less family support. This study assesses the willingness to use and pay for different models of care for community-dwelling elderly in rural Vietnam.MethodsIn 2007, people aged 60 and older and their family representatives, living in 2,240 households, were randomly selected from the FilaBavi Demographic Surveillance Site. They were interviewed using structured questionnaires to assess dependence in activities of daily living (ADLs), willingness to use and to pay for day care centres, mobile care teams, and nursing centres. Respondent socioeconomic characteristics were extracted from the FilaBavi repeated census. Percentages of those willing to use models and the average amount (with 95% confidence intervals) they are willing to pay were estimated. Multivariate analyses were performed to measure the relationship of willingness to use services with ADL index and socioeconomic factors. Four focus group discussions were conducted to explore people's perspectives on the use of services. The first discussion group was with the elderly. The second discussion group was with their household members. Two other discussion groups included community association representatives, one at the communal level and another at the village level.ResultsUse of mobile team care is the most requested service. The fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than do the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require that services be free-of-charge is two to three times higher than the proportion willing to pay full cost. Households are willing to pay more than the elderly for day care and nursing centres. The elderly are more willing to pay for mobile teams than are their households. Age group, sex, literacy, marital status, living arrangement, living area, working status, poverty, household wealth and dependence in ADLs are factors related to willingness to use services.ConclusionsCommunity-centric elderly care will be used and partly paid for by individuals if it is provided by the government or associations. Capacity building for health professional networks and informal caregivers is essential for developing formal care models. Additional support is needed for the most vulnerable elderly to access services.

WILL WOMEN DIAGNOSED WITH BREAST CANCER PROVIDE BIOLOGICAL SAMPLES FOR FUTURE RESEARCH PURPOSES?

Background and Aims: Biological samples are often used to assess exposures in case control studies of cancer risk. Little is known about the response rates for biological sample provision, especially in younger age groups, and how these are affected by other demographic or lifestyle variables. A population based study of breast cancer patients was conducted to estimate these rates and to obtain information on the recruitment of friend/colleague controls. Methods: Breast cancer cases diagnosed April-May 2010 were recruited to determine the proportion willing to provide biological samples (morning or 24 hour urine, saliva, blood) and contact information for similarly aged women for control recruitment. Cases (n=417) were women 25-74 years of age identified through the Ontario Cancer Registry and 67% (n=278) of those completed a mailed questionnaire. Results: Women indicated they were willing to provide blood samples, by visiting a clinic (62%) or having a nurse visit the home (61%). They also were willing to provide saliva samples (73%) and morning (66%) or 24-hr urine samples (52%). Compared to older women, younger women (•45) were consistently more likely to agree to provide any biological samples and were 3.1 times (OR) more likely to report they would collect a morning urine sample (95% CL: 1.15-8.35). Only 26% of cases indicated they would be willing to give contact information for similarly aged women (controls) to provide samples in future studies. Educated women were more likely to agree to provide biological samples, and women who consumed alcohol were more likely to agree to provide contact information than non-drinkers. Ethnicity, income, body mass index, and smoking status did not influence these results. Conclusions: Reasonable response rates for biological sample collection can be expected in future case controls studies of breast cancer (especially among younger women), however, other methods of control selection must be devised.

Public opinion of a stroke clinical trial using exception from informed consent

BackgroundAcute stroke is a leading cause of morbidity and mortality. Clinical trials in stroke are challenging because victims often do not have the capacity to provide informed consent, excluding those patients most likely to benefit from the research.AimWe evaluated patient willingness to participate in a hypothetical acute stroke trial using an exception from informed consent.MethodsConsecutive patients presenting to four emergency departments (EDs) underwent structured interviews regarding a hypothetical stroke trial using an exception from informed consent.ResultsOf 461 (72% of eligible) participants, 55% (95% CI, 50%–59%) were willing to be enrolled in the hypothetical study without giving informed consent. After multivariable analysis, independent predictors of willingness to enroll included Catholic religion (OR 1.57, 95% CI 1.17–2.10) and belief that current therapy offers a >50% chance of full recovery (OR 1.29, 95% CI 1.05–1.57). There was no difference between the proportion willing to enroll in a cardiac arrest study vs. a stroke study (55% vs. 55%, p = 0.83)ConclusionsFifty-five percent of ED patients would be willing to be enrolled in a stroke trial using exception from informed consent.

TELEPHONE SCREENING FOR HAZARDOUS DRINKING AMONG INJURED PATIENTS SEEN IN ACUTE CARE CLINICS: FEASIBILITY STUDY

We evaluated the effectiveness of telephoning injured patients after discharge, compared with contacting them in the clinic during the acute care visit, for screening for hazardous drinking and eliciting willingness to participate in a lifestyle intervention trial. We conducted a quasi-randomized controlled trial among acutely injured adult patients in trauma and acute care clinics, assigning telephone and clinic screening strategies systematically by week. During telephone weeks, we mailed study information to patients identified from computerized records, then telephoned them. During clinic weeks, researchers recruited patients awaiting care. We screened for hazardous drinking using the AUDIT-C (Alcohol Use Disorders Identification Test-C). We examined the proportion of all injured adult patients who were screened, the proportion of screened patients with hazardous drinking (AUDIT-C score >or=4), and the proportion willing to participate in a (hypothetical) lifestyle intervention trial. Differences were analysed with non-linear mixed models using generalized estimating equations, controlling for age, sex, and facility. Levers and barriers to screening were explored through structured interviews with research staff. We enrolled 29% (469/1,609) of all injured adult patients and 76% of injured patients contacted and found to be eligible. Of screened patients, 23.1% screened positive for hazardous drinking. Telephone and clinic contact were equally effective for screening patients (OR = 1.05; 95% CI = 0.59-1.87), identifying hazardous drinking (OR=0.97; 95% CI = 0.54-1.74), and eliciting willingness to participate in an intervention trial (OR=1.49; 95% CI = 0.97-2.30). Clinic site modified results: telephone was more effective than clinic contact for screening urban patients (OR=1.99; 95% CI = 1.36-2.93), but less effective for screening suburban patients (OR = 0.70; 95% CI = 0.69-0.71). Barriers to clinic screening included lack of clinic staff support, time constraints, and difficulty recruiting elderly or acutely distressed patients. Barriers to telephone screening included erroneous contact information and failure to answer the telephone. Telephone screening is a feasible and efficient method for screening moderately injured adult patients for hazardous drinking, but characteristics of the clinical site (including personnel) influence its effectiveness. Trauma and acute care clinics are likely to be fruitful sites for identification of patients with hazardous drinking, whether for enrollment into brief intervention trials or treatment programmes.

The Effect of Triage‐applied Ottawa Ankle Rules on the Length of Stay in a Canadian Urgent Care Department: A Randomized Controlled Trial

To determine whether triage nurses ordering ankle or foot radiographs according to the Ottawa Ankle Rules (OAR) before physician evaluation decreases the length of stay for patients visiting an urgent care department. From July to September 2004, a randomized controlled trial of consecutive adult patients with ankle or foot twisting injuries who arrived at an urgent care department was conducted. Patients were included if their age was 18 years or older and their injury had occurred within seven days. They were excluded if there were neurovascular deficits, limb deformities, open fractures, or nonisolated ankle or foot injuries. Patients were randomly allocated to a roentgenogram-ordering clinical pathway (intervention) or to standard departmental care (control). Those assigned to the intervention group had triage nurses applying the OAR, and those with positive OAR were sent for roentgenograms before physician evaluation. Physicians were blinded to negative OAR nurse assessments. Investigators were blinded to group allocation. The primary outcome was the total mean length of stay (TLOS). The secondary outcomes were patient satisfaction (five-point ordinal scale) and the proportion willing to return to the site for future care. Two-independent sample t-test was used to analyze the TLOS. The Kruskal-Wallis test was used to analyze satisfaction ratings differences between groups. Fisher's exact test was used to analyze the willing-to-return outcome. This study had 80% power to detect an effect size of 25 minutes. Two hundred thirty-two patients were eligible; 130 patients gave consent and were enrolled. Three patients were then excluded, three were lost to follow-up, and one left without being seen. The intervention and control groups had mean TLOS of 73.0 minutes and 79.7 minutes, respectively. There was a statistically nonsignificant time difference of -6.7 minutes (95% CI = -20.9 to 7.4) between groups. There were no differences in patient satisfaction ratings (p-value = 0.343) or WOR (3.8%; 95% CI = -3.3% to 11.0%). The use of OAR and the ordering of roentgenograms by triage nurses before physician evaluation for twisting ankle or foot injuries does not decrease the length of stay in an urgent care department.

Willingness to pay for telemedicine assessed by the double-bounded dichotomous choice method

We investigated the willingness of patients with chronic heart failure (CHF) to pay for access to medical care via telemedicine, as an alternative to visits to a physician's office. Willingness to pay was estimated using a double-bounded dichotomous choice contingent valuation method. One hundred and twenty-six patients were surveyed after their discharge from a CHF-related hospital stay. As expected, willingness to pay was negatively related to price. When people are presented with a survey question about value, particularly when the good being valued is not traded in the market, the question itself can affect the person's perception of value. However, the survey results showed no evidence of such a 'framing' effect. We found that 55% of the patients would be willing to pay $20 to access telemedicine instead of travelling to the physician's office, for at least some of their care. When the price was raised to $40, the proportion willing to pay fell to 19%. This suggests that telemedicine may be close to being commercially feasible in the USA.

Potential Effect of Authorization Bias on Medical Record Research

To analyze the influence of recent changes in Minnesota statutes that generally require prior authorization for use of medical records for research from patients who received medical care after Jan. 1, 1997. In this Mayo Clinic Institutional Review Board-approved study, we obtained a stratified random sample of patients encountered at Mayo Clinic Rochester during the period 1994 through 1996 and estimated the proportion willing to provide the general authorization. On the basis of data from administrative files, we then compared demographic, diagnostic, and utilization characteristics for patients who provided authorization and those who did not. Overall, 3.2% (95% confidence interval, 2.4 to 4.0%) of the study subjects declined authorization. If patients not responding to requests for authorization were also considered to have refused, the overall refusal rate would be 20.7% (95% confidence interval, 18.5 to 22.9%). Women were somewhat more likely to refuse authorization than were men (4.0% versus 2.4%; P = 0.067), and patients younger than 60 years were more likely to refuse than were older patients (5.4% versus 1.2%; P<0.001). Patients residing more than 120 miles from Rochester were much less likely to decline authorization than were local residents (2.1% versus 5.8%; P = 0.001). Patients with prior diagnoses that might be considered more sensitive such as mental disorders, infectious diseases, and reproductive problems also were more likely to refuse authorization. These data demonstrate that laws requiring written authorization for research use of the medical record could result in substantial biases in etiologic and outcome studies, the direction and magnitude of which may vary from topic to topic. Clinicians should be prepared to enter the discussion to help inform patients and legislators of the potential hazards of laws that restrict access to medical records for research purposes.

The Price Elasticity of Mass Preferences

I compare the price elasticity of economic and political preferences. My central hypothesis is that willingness to pay, whether expressed verbally or through cash transactions, is more price-elastic for economic consumption goods than for public goods. I find that increases in price greatly diminish the proportion of people willing to pay for consumer goods, such as housing or hardback books; whereas the proportion willing to pay more in taxes to support a public good, such as environmental protection or shelter for the homeless, is much less responsive to changes in price. I conclude by discussing the theoretical and political implications of willingness to pay for public and private goods.

Fundamental Issues in the Teaching of Elementary School Mathematics

THE COMMITMENT OF OUR NATION to an intensive scientific and technological development puts heavy pressure on our schools and colleges to produce an increased number of graduates well trained to pursue trades, professions, and scientific or academic careers dependent upon mathematical skills and abilities. While this pressure is felt especially in high schools, colleges and universities, its effects are reaching the grade-schools as well. From the stream of students flowing through our educational system we must obtain a greater proportion willing to pursue mathematical studies to more or less advanced levels, and we must in particular guarantee that among the students leaving the grade-schools an increased number will have a taste and inclination for mathematics sufficiently strong for them to study further mathematics in high school. This necessitates an improvement and enrichment of the mathematical elements in grade-school education.