Questionnaire-based Tool Research Articles

Mixed-methods exploration of challenges to stoma care for ostomates in four low- and middle-income countries: STomacARe For Improvement reSearcH (STARFISH) study

Background Little is known about the challenges of stoma care and potential solutions for patients in low- and middle-income countries (LMICs). This study aimed to assess the outcomes and experience of care for patients with stomas in LMICs using a mixed methods approach. Methods A cross-sectional survey of hospitals assessed health system characteristics relevant to stoma care. A six-month retrospective audit collected data on all patients undergoing new stoma formation, and postoperative complications. Semi-structured interviews with stoma patients and informal caregivers, and key informant interviews with healthcare providers were conducted to gather information on experiences, challenges and coping strategies relating to stoma care. The results were triangulated to develop a questionnaire-based tool to assess patients’ and carers’ knowledge and attitudes towards stoma and stoma care. Results Six hospitals from the Philippines, Malawi, Nigeria and India participated in the study. Data from 446 patients demonstrated diversity case mix, outcomes and postoperative stoma counselling. Interview data from the Philippines highlighted the lack of knowledge on stoma care of the patients and carers, poor access to stoma care and resources and the lack of affordable stoma care supplies. Triangulating these inputs, a 33-item questionnaire was developed to facilitate task sharing of expert stoma care to non-expert nurses and caregivers. Conclusions This study highlighted gaps in capacity to provide stoma counselling and poor access to and affordability of stoma care supplies for patients in LMICs. This novel questionnaire can help close these gaps and improve care for new ostomates in resource limited settings. Registration The study is registered in the Philippine Health Research Registry PHRR No.210805-003783 (https://registry.healthresearch.ph/index.php/registry)

The New Zealand eating behavior questionnaire – Validation study for a novel assessment tool to describe actionable eating behavior traits

Individualised management of obesity remains challenging and, to date, most treatment is based on clinical judgement. This study aimed to develop and validate a novel questionnaire-based tool to identify three pre-defined eating behavior (EB) traits, emotional eating, reduced satiety (constant hunger) and reduced satiation (feasters) that may predict selective medication response given their targeted actions. We recruited 977 individuals from a tertiary academic diabetes clinic to participate in this two-phase validation study. Participants self-reported weight management activities and were asked to self-assess their EB characteristics. The initial questionnaire included 42 visual analogue scale questions. In Phase I, 729 participants completed the questionnaire, including Māori (11.8%) and Pacific peoples (19.3%). After random division of the study sample, Exploratory Factor Analysis (EFA) confirmed a three-factor model as the best fit. Stepwise removal of items with inadequate factor loading retained 27 of 42 items, which accounted for 96% of the variance. Confirmatory Factor Analysis (CFA), performed on the second half of the sample, demonstrated good model fit with the final 27-item questionnaire. Internal consistency was high for factor (α = 0.82–0.95) and demographic subgroups, and similar to those obtained in the EFA. Test-retest reliability in a subset of 399 participants who repeated the questionnaire after a four-week interval (Phase II) showed moderate to good reliability. Participants classified into one of three EB types based on the highest median score among the factors. Test-retest reliability was robust for emotional eaters (71.25%) and constant hunger (68.9%). The correlation between aggregate EB score (sum of three EB scores) and BMI was significant (Spearman rho = 0.314, P = .0005). The questionnaire reliably identified three distinct EB traits, which may be informative for precision medicine applications for obesity management.

Willingness of Voluntary Counseling and Testing Among Long Distance Truck Drivers: A Window of Opportunity in Control of Retroviral Disease

Objective: To evaluate the factors influencing the practice of voluntary counselling and testing among long-distance truck drivers as it affects the spread of retroviral disease.
 Design: This was a quantitative cross-sectional study conducted in the major bus terminals in Enugu State, Nigeria. A questionnaire-based tool was used to collect data from a population of adult bus drivers.
 Setting: It was conducted at the 3 main motor parks in Enugu metropolis from January 2019 – March 2020. 
 Participants: 500 long-distance truck drivers aged 19-65 years.
 Intervention: The knowledge and practices of the participants were assessed using a semi-structured interview guide. They were interviewed on various aspects of HIV/AIDS.
 Main Outcome Measures: Knowledge and practices. On Knowledge and practice performance scale rating; < 50% is poor, 50 -75% is fair, and > 75% is good.
 Results: Among the five hundred (500) long-distance truck drivers (LDTD) studied 68.0% showed a fair knowledge of HIV/AIDS. The prevalent high-risk behaviour was multiple sexual partners (73.2%). The practice of voluntary counselling and testing was poor, as (17.0%) had practised it; however, their risk perception was high at (76.0%). Fortunately, there was also a high willingness to screen 302 (60.4%) which was significantly higher in those with a tertiary level of education (100%) and the married participants (75.8 %) (χ2=174.4, p < 0.01).
 Conclusion: There was a high-risk perception in this study population with a high willingness to be tested. We hereby recommend regular screening service at the motor packs of truck drivers in Enugu State.

The Periodic Risk Evaluation: A new tool to link Medicaid-enrolled autistic adults to services and support

BackgroundThe Periodic Risk Evaluation (PRE) is a new questionnaire-based tool to identify autistic adults enrolled in Medicaid programs who are at risk for adverse outcomes including mental health and medical conditions, law enforcement interaction, stressful life events, substance use, presence of natural supports, and suboptimal living conditions. The PRE is completed by direct service providers and informs case conceptualization to drive changes in needed supports. MethodThe PRE was tested in a sample of 674 autistic adults with a mean age of 31 years across a large, northeastern state. A random forest model was developed to predict complex case status using the PRE items. Sensitivity, specificity, positive predictive value, and negative predictive value for different PRE score cutoffs were evaluated as the performance measures of interest. Expert clinical assessment, the gold standard for case status, identified 131 individuals (19.4 %) as complex cases in need of modified services and supports. ResultsThe final PRE model identified complex cases in unseen data with 75.5 % accuracy, 71.9 % sensitivity, 76.3 % specificity, 41.8 % positive predictive value, and 92.0 % negative predictive value. ConclusionsThe PRE may be a useful tool for triaging service needs and delivery to adults on the spectrum. The use of the PRE in the Medicaid system is critical because Medicaid is among the only insurers available during the transition to and throughout adulthood for autistic individuals. Adequate planning and assessment of risk can assist direct support staff in triaging and mitigating risk to minimize adverse outcomes.

Business model innovation or Business model imitation – That is the question

ABSTRACT This paper explores the phenomenon of intra-industry Business Model (BM) imitation through the concept of BM configurations and sheds light on how it relates to BM innovation. The analysis focuses on similarities and deviations of BM configurations among 80 companies operating in the industry sector related to Phantom Limb Pain (PLP). Leveraging a questionnaire-based mapping tool, the results show that companies operating within the area of PLP treatment apply relatively similar BM configurations. This indicates that companies mostly imitate the successful BMs of their main competitors in the industry as a whole and in their specific sub-groups, thus potentially ignoring the opportunity to also compete on a BM level. The contribution brought by the paper is twofold. First, it adds to the research stream on BM configurations by showing that this concept can be used not only to analyze and foster cross-industry BM imitation, but also to explore and examine intra-industry BM imitation (or differentiation). Second, the article contributes to the research stream on intra-industry BM imitation by going beyond prior anecdotal evidence and empirically testing the existence of the phenomenon of intra-industry BM imitation and hence, the potential innovation space on a BM level.

The Relationship between the Quality of Managers, the Internal Communication Level and the Institutional Visual Identity

This research analyses the relation between the constructs quality of managers and internal communication and the dependent variable belonging to the institutional visual identity within the Faculties of Physical Education and Sport, funded by the State Budget, in Romania. The data within this study come from a research based on the survey method, with a questionnaire-based tool, reprised from the scientific literature and validated through Alpha Cronbach’s coefficient, ensuring the internal reliability analysis of each construct: the quality of managers, the internal communication, belonging to the institutional visual identity. The research was carried out on a sample of 261 persons from a population of 452 teaching staff members within the faculties of physical education and sport, funded by the State Budget, in Romania. The research was carried out on two directions: one concerning the correlation between the quality of managers and belonging to the institutional visual identity; and the other concerning the correlation between the internal communication and the same belonging to the institutional visual identity.

Automatic Assessment of Technology Readiness Level Using LLDA-Helmholtz for Ranking University

<p class='IJASEITAbtract'>The assessment process of Technology Readiness Level using the questionnaire-based tool for Indonesian university's academic papers is considered to be labor-intensive. This paper introduces a new method of determining the TRL of an academic paper based on a text mining technique. The content of the research paper represented by their abstract published by university lecturers is justified to represent the technology maturity of research. Abstracts of papers were collected from the nine most reputable universities in Indonesia. By utilizing Labelled Latent Dirichlet Allocation, the abstracts were categorized into 1 of 9 levels of TRL. To determine the prior label of LLDA, we built a corpus of keywords representing each TRL level based on Bloom Taxonomy. Beforehand, Helmoltz principle was utilized to select the text feature. Since Bloom Taxonomy has only six levels, we split the keywords into 9 level. Afterward, the reputation score is calculated using our formula. Lastly, the university ranking is generated according to the extracted academic reputation score. To evaluate the proposed method, we compare our rank with QS’s. We calculate the ranking gap and Pearson correlation to evaluate the result. Helmholtz has successfully pruned 86% of features. The utilization of Helmholtz significantly improves the Pearson correlation of our proposed method. In short, the new insight of university ranking introduced in this work is promising. For all indicator experiments, LLDA-Helmholtz performed better results indicated by 0.95 Pearson correlation between two rankings, while for LLDA without Helmhotz, the correlation is 0.78.

The estimated age-group specific influenza vaccine coverage rates in Hong Kong and the impact of the school outreach vaccination program

ABSTRACT Previous studies have shown that seasonal influenza strikes annually causing millions to fall sick and several hundred thousand to die globally. Hence, universal vaccination is a public health aim to control influenza. The Hong Kong Government started to introduce the School Outreach Vaccination (SOV) program in 2018 to increase vaccination rates in children. This study looked at the impact this had on hospital admissions and estimated vaccination rates in the total population, using a questionnaire-based tool. The SOV program significantly increased vaccination coverage rates with a 1% increase associated with a reduction of 4.3 influenza-related hospital admissions of school-aged children. The estimation of vaccine coverage rates among the under 5-year olds (48.5%), primary school children (69.3%) and over 65-year olds (45.7%), through the questionnaire-based tool, was within the 95% confidence interval of the coverage rates published by the Center for Health Protection of the Hong Kong Government, 47.4%, 68.1% and 45.8%, respectively. Extension of the SOV program should be considered in secondary schools to increase the coverage rates in adolescents. The questionnaire survey may inform government how to achieve universal vaccination for specific age groups.

Comparison of a Voiding Diary With Clinical Management Tool As an Outpatient Screening Tool for Childhood Functional Voiding Disorders

To study the agreement of questionnaire-based assessment with voiding diary for differentiating primary mono-symptomatic nocturnal enuresis from voiding disorder in children. Children 5-12 years old with bedwetting after exclusion of secondary enuresis were enrolled and parents filled a clinical management tool (CMT) questionnaire and a 48-hours voiding diary. Point prevalence and agreement of classification as primary mono-symptomatic nocturnal enuresis or voiding disorder were compared. Of 1276 children screened, 143 (11.2%) reported enuresis. Of 100 (82 males) children finally analyzed, constipation and positive family history occurred in 14% and 37%, respectively. Questionnaire-based assessment and voiding diary identified 65% and 71%, respectively as voiding disorder [Cohen's kappa 0.542 (95%CI: 0.367-0.717)]. Discordance of classification was noted in 20%. Voiding diary identified additional 7% cases of voiding disorder. While CMT and voiding diary have moderate agreement, voiding diary should be used for cases screened negative by a questionnaire-based tool.

Rerouting the Dissection of the Infratemporal and Submandibular Regions.

IntroductionTeaching and learning in anatomy are necessarily dependent on cadaveric dissection. Skillful dissection is the tool which helps in proper visualization of structures in a cadaver. Proper understanding about the course of lingual nerve, hypoglossal nerve, nerve to mylohyoid, and relations between structures present in infratemporal and submandibular regions is important for medical students. The aim of this study is to describe a modified technique of dissection and evaluate medical students' and teachers’ response to this approach.MethodsThe comparative observational study was conducted bilaterally on six adult cadavers. We compared the method of dissection given in standard textbooks with the modified method introduced. The validity and reliability of the newer method of dissection for teaching purpose was assessed by first-year undergraduate medical students using a questionnaire-based tool and feedback from postgraduate students and senior residents.ResultsThe modified method was described as less time consuming, easy to perform, and allowed extensive exploration of the structures in the infratemporal and submandibular regions.ConclusionsProper understanding of the course and relations between structures present in infratemporal and submandibular regions is important for medical students.The modified approach to infratemporal and submandibular regions will facilitate better understanding of the human anatomy.

Diabetes mellitus risk among Jordanians in a dental setting: a cross-sectional study

Dental offices can be useful to screen and identify patients at risk of developing diabetes mellitus (DM) using risk prediction tools. The Finnish Diabetes Risk Score (FINDRISC) is a validated, questionnaire-based tool used to predict the 10-year risk of developing type II DM. To determine the 10-year DM risk among Jordanians using the FINDRISC questionnaire in a dental setting. Participants attending two university dental teaching centres between March 2017 and February 2018 were interviewed using an Arabic translated version of the FINDRISC questionnaire. Anthropometrics including weight, height, waist circumference (WC) and body mass index (BMI) were recorded. Random capillary blood glucose level was measured for each participant. Statistical analysis was done using Chi-square and independent t-tests. A total of 1,247 (436 males and 811 females) participants were included. As defined by BMI, 1,012 (81.2%) participants were either overweight or obese. Abdominal adiposity as determined by WC was seen in 738 (59.2%) participants. The mean (± SD) FINDRISC score for females (11.3±4.3) was significantly higher (P=0.001) than males (10.4±4.9). After age adjustment, more females were in the high-risk categories (FINDRISC ≥ 15) compared with males. This trend was seen among all age groups, but was statistically significant in the older age groups; 55-64 years (P=0.037) and ≥ 65years (P=0.004). In a developing Middle Eastern country such as Jordan, almost half of Jordanians attending university dental clinics are at a moderate to high risk of developing type II DM in 10 years. The risk of DM should be considered in dental patients, particularly older females.

Accuracy of Trained Community-based Rehabilitation Volunteers in Identification and Appropriate Referral of Adults with Perceived Visual Disability in an Urban-slum Setting in Southern India

ABSTRACT Purpose The integration of primary eyecare into existing primary healthcare systems requires simple yet effective tools that do not overburden the grass-root level worker. The objective of this study was to test the accuracy of a questionnaire-based tool administered by trained community-based rehabilitation volunteers (CBRVs) in identifying persons with visual disability, proportions accessing referral pathway and barriers to uptake of eyecare services. Methods CBRVs working in the urban-slum service area of a teaching hospital were trained in administering a questionnaire-based tool derived from the World Health Organization (WHO) “Training in the community for people with disabilities” to a responsible adult member of the household. Post-training, they screened and referred adults with perceived visual problems. This tool was tested against two reference standards: (i) history of visual disability elicited by ophthalmologist; (ii) pre-set visual acuity and diagnosis criteria. Results Ten CBRVs screened 950 individuals of whom 805 (84.7%) were examined by an optometrist and ophthalmologist. Sensitivity and specificity of this method were 75% (95% CI 72–78%), 95.8% (95% CI 94–98%) respectively, using history and 60.2% (95% CI 57–63%), 91.8% (95% CI 90–94%) using clinical criteria as reference standard. Referral pathway was used by 91/221 (41.2%) referred individuals. The commonest barriers to accessing eye care were ‘did not feel the need’ (32.2%) and ‘busy with work/household responsibilities’ (30.2%). Conclusions This questionnaire-based tool administered by grass-root level health workers to a responsible adult member of the family may be a promising screening method for identification and appropriate referral of persons with visual disability in the community.

What’s in a label? Can use of a questionnaire-based tool identify patients that may benefit from antimicrobial allergy ‘de-labelling’

Background Being labelled as “allergic” to an antimicrobial (commonly penicillins) can lead to worse clinical outcomes and increase antimicrobial resistance. Unclear or inappropriate allergy documentation contributes to this issue so clarifying “allergy” status is important to optimise clinical outcomes. Methods The study was conducted at St Thomas’ Hospital, a large teaching hospital in London. An antimicrobial allergy assessment process, consisting of a researcher-developed and administered questionnaire, a review of patient medical records and categorisation of the drug allergy ‘label’, was applied to eligible patients from selected wards. Recommendations for allergy ‘de-labelling’ and referrals were given based on patient categorisation. Results Sixty assessments were completed during the study. Six patients (10%) were identified as unlikely to have a true allergy and could potentially be ‘de-labelled’. A further thirty-seven patients (61.7%) were identified as eligible for allergy referral and testing. The allergy ‘labels’ of twenty-seven patients (45%) led to them receiving second-line antibiotic therapy. Twenty-two patients (34.7%) had inconsistencies in their allergy documentation across the 3 main electronic clinical systems. Conclusion This study demonstrated that the use of a simple, standardized, pharmacy-led approach to antimicrobial allergy assessment could lead to some patients being 'de-labelled' outside of specialist allergy settings. The implementation of this approach could immediately bring about improvements in antimicrobial usage and patient outcome.

A Cross-sectional study on screening for knee osteoarthritis and associated factors in a rural area of India

Background: Osteoarthritis (OA) is a degenerative disease that worsens over time after fourth decade of life. It accounts for the decrease in activities of daily living in the elderly population. Hence, early diagnosis and treatment are essential to increase the quality of life. Objectives: The objective is to identify the high risk people for OA in a rural area and to find out the significant factors associated to OA among the rural population. Materials and Methods: Cross-sectional study among rural population with a convenient sample size of 100 in which 50 were male and 50 were female. Institutional ethics committee approval was taken. Informed written consent was obtained from the participants. Data collection procedure employed was Western Ontario and McMaster Universities (WOMAC) OA index. Statistical analysis was done by Epi-info statistical software package version 3.5.4 for data analysis. Results: According to WOMAC Index 38% of the subjects belonged to high risk and 62% belonged to low risk. Age group, gender, and family history were significantly associated with these scores. Conclusion: In a resource poor setting, questionnaire-based tool to detect high risk individuals for OA at an early stage is useful in reducing the morbidity.

Ethnic background and risk perception in construction workers: development and validation of an exploratory tool.

Among occupational sectors, construction is still one of the branches with the highest reported numbers of work-related injuries and diseases, which can even lead to death and in many cases induce permanent health consequences. The vast majority of these occupational injuries and diseases are preventable; accordingly, an improvement in preventive strategies, also through a better knowledge of the main factors involved in these events, is one of the most important objectives for better occupational health and safety in the construction sector. Considering the individual factors associated with a higher risk of work-related adverse health effects in workers, an inadequate perception of occupational risks is among the most relevant issues. Risk perception can vary according to different cultural backgrounds, highly influenced by ethnicity, and it affects the relations between workers in the work environment, and the way by with they undergo the specific occupational tasks and manage risky situations frequently occurring on construction sites. Accordingly, the aim of the authors was to develop a new tool for the assessment of risk perception in construction workers with different ethnic backgrounds. A team of health and safety experts involved in the training of construction workers from various ethnic backgrounds and in different regions of Italy developed and validated a questionnaire-based tool for the evaluation of their risk perception. Furthermore, through a factor analysis, a reference model defining various dimensions of occupational risk perception, relevant for the different ethnicities, was identified. The final tool included 12 items aimed to assess the associations between the ethnic background and occupational risk perception of construction workers. The authors identified 4 relevant dimensions: behavioral control, work conditions, safety climate and personal attitude. The proposed tool should be considered to explore the appropriate ways for the development of effective preventive strategies for construction workers with different ethnic backgrounds in Italy. Int J Occup Med Environ Health. 2020;33(2):163-72.

P3B.19: The sensory profile of children with Intestinal Failure

Introduction: Sensory responses are shaped by a person’s experiences. A child’s sensory processing patterns may support and/or interfere with skill development and functional performance. Children with intestinal failure (IF) endure physical and psychological hardship from a young age that may impact sensory processing. We studied the sensory profile of children with IF. Methods:The Sensory Profile 2, a validated questionnaire-based tool, was used to evaluate processing patterns in the context of everyday life in children with IF (on home PN>3 months). An occupational therapist met with parents to apply the tool to a sample of children from two centres (Alberta Children’s Hospital, Canada, and Hopital Necker-Enfants Malades, France). The assessed sensory domains included: seeking, avoiding, sensitivity, registration, auditory, visual, touch, movement, body position, oral, conduct, emotional expression, and attentional responses. Individual scores were compared with normative data to determine z-scores. Results: Preliminary data for n=30 subjects, median age 5.0 (range 1.3, 14.6) years, included IF diagnoses of short bowel syndrome (n=18), chronic intestinal pseudo-obstruction (n=3) and other (n=9). A developmental diagnosis was noted in 7% of subjects. The sensory domains for which >20% of subjects had z-scores > +2.0 are listed in table 1. Compared to the normal reference data, 20% of the group avoided sensory input at higher rates, while 20% were “sensors” reacting more quickly and intensely to sensory input. Sensitivity to oral touch and taste were higher than average in almost half the children. Among 15–35 month olds, 27% rated with z-scores > +2.0 for general sensory. Among >3 year olds, 26% expressed strong emotional responses with sensory processing. Conclusions: Preliminary data suggests that a proportion of children with IF have sensory processing issues including oral sensory processing problems. Determining protective factors among those who do not develop oral sensitivity merits further study. Children with IF should undergo assessment of their sensory responses, and prevention strategies for sensory dysregulation in this population need to be developed.

Development and psychometric evaluation of a safety climate scale for vineyards

BackgroundThis study aimed to develop a questionnaire-based tool measuring the safety climate in vineyards and to assess its psychometric properties. MethodsA literature search was conducted to identify the dimensions and items that constitute the safety culture construct in various occupational sectors and to draft a conceptual framework. Content validity appraisal was performed by 16 farm managers or pesticide operators. The resulting preliminary conceptual framework consisted of 9 dimensions and 42 questions. Then, a telephone survey was conducted in the French Aquitaine (Bordeaux) region with 312 vineyard workers. Item-total correlation tests, Cronbach's alpha analysis and a principal component analysis were performed to confirm the unidimensionality of the scale under construction. Structural equation modeling (SEM) techniques were used to verify the model hypothesized from the exploratory analyses and to determine how well it fits the data. ResultsExploratory analyses resulted initially in a 9-dimension, 20-item safety climate questionnaire. Internal consistency proved good with a Cronbach's alpha equal to 0.81. The SEM approach suggested two dimension groupings for a better fit of the data (7 dimensions operationalized through the same 20 items). Internal model parameters showed that the more influential dimensions of safety climate were Management commitment, Communication and feedback, Rules and practices, and Knowledge (all standardized path coefficients ≥ 0.7). ConclusionsOwing to its good psychometric properties, we hope this score will help in drawing up relevant interventions aimed at improving safety culture, raising pesticide risk awareness, and hopefully inducing more sustainable practices in the medium-term future.

A novel tool to predict youth who will show recommended usage of diabetes technologies.

Controversy exists regarding which individuals will benefit most from commencement of diabetes technologies such as continuous subcutaneous insulin infusion (CSII) or continuous glucose monitoring systems (CGMS), such as 'real-time' sensor-augmented pumping (SAP). Because higher usage correlates with haemoglobin A1c (HbA1c) achieved, we aimed to predict future usage of technologies using a questionnaire-based tool. The tool was distributed to two groups of youth with type 1 diabetes; group A (n = 50; mean age 12 ± 2.5 yr) which subsequently commenced 'real-time' CGMS and group B (n = 47; mean age 13 ± 3 yr) which commenced CSII utilisation. For the CGMS group, recommended usage was ≥5 days (70%) per week [≥70% = high usage (HU); <70% = low usage (LU)], assessed at 3 months. In the CSII group, HU was quantified as entering ≥5 blood sugars per day to the pump and LU as <5 blood sugars per day, at 6 months from initiation. Binary logistic regression with forward stepwise conditional was used to utilise tool scales and calculate an applied formula. Of the CGMS group, using gender, baseline HbA1c, and two subscales of the tool generated a formula which predicted both high and low usage with 92% accuracy. Twelve (24%) showed HU vs. 38 who exhibited LU at 3 months. Of the CSII group, 32 (68%) exhibited HU vs. 15 who exhibited LU at 6 months. Four tool items plus gender predicted HU/LU with 95% accuracy. This pilot study resulted in successful prediction of individuals who will and those who will not go on to show recommended usage of CSII and CGMS.

Enabler for Safety Improvements in Air Traffic Control

Air traffic control activities demand a high level of safety performance. Methods for identifying and monitoring work and situational factors to enable safety performance improvements are rare. This paper reports on the development of such a questionnaire-based tool for the Swedish air navigation services provider. Results from interviews specified eight aspects to be assessed by the questionnaire: safety culture, commitment to safety, organizational climate, psychosocial work environment, leadership, communication, employee participation, and areas of conflict. The questionnaire functioned well in a pilot study. The study proved the relevance of the items and yielded responses identifying organizational system weaknesses and potential latent conditions regarding risk and safety. Key enablers for success of the tool were found to be management commitment and involvement of all organizational levels.

A study of owner observed behavioural and lifestyle changes in cats with musculoskeletal disease before and after analgesic therapy.

This study describes the use of a simple questionnaire-based tool to identify behavioural/lifestyle changes that are associated with chronic pain in the cat. These changes were grouped into four behavioural domains (mobility, activity, grooming and temperament). Twenty-three cats with chronic musculoskeletal pain as determined by clinical examination were included. The owners of these cats were asked to complete a questionnaire before and 28 days after the start of analgesic treatment (meloxicam). This included a global assessment of changes in behaviour and assessment of the degree of behavioural change observed within each of the defined domains. The attending veterinary surgeon was independently asked to provide a global score before and after treatment. Both owners and veterinary surgeons reported significant changes in behaviour/lifestyle after analgesic therapy. There was no difference between the owners and veterinary surgeons global assessments at baseline but there was at day 28 (P=0.02). The owners' scores decreased from a median of 5 at baseline to 3 at 28 days (P=0.0004) while the median veterinary surgeon scores decreased from 5 to 2 at 28 days (P<0.0001). There was a statistically significant reduction in the owners' scores for each of the four domains with the greatest reduction occurring in the activity category (P=0.0001). This study shows that owner assessment of changes in their cat's behaviour/lifestyle is an important method of identifying chronic pain in their pets.