European Survey Research Articles

Labour market digitalization and social class: evidence of mobility and reproduction from a European survey of online platform workers

Abstract The type of work we do as adults is significantly influenced by our parents’ social class. However, digital technologies are transforming the way labour markets work. Candidates are screened using algorithmic decision-making systems. Skills are validated with online tests and feedback ratings. Communications take place online. Could these transformations undermine the advantages that have accrued to workers with privileged backgrounds or reproduce this privilege through digital divides? We examine this question with survey evidence from the online (remote) platform economy, a labour market segment where these digital transformations have progressed furthest (N = 1,001). The results reveal that online platform workers come predominantly from privileged class backgrounds, but we find less evidence of parental class shaping what types of online work they do. We conclude that digital transformations of labour markets may reproduce disparities in access to work but attenuate some class-based differences in the selection of workers by employers.

The current clinical practice for management of post-infarction ventricular septal rupture: a European survey.

Many historical and recent reports showed that post-infarction ventricular septal rupture (VSR) represents a life-threatening condition and the strategy to optimally manage it remains undefined. Therefore, disparate treatment policies among different centres with variable results are often described. We analysed data from European centres to capture the current clinical practice in VSR management. Thirty-nine centres belonging to eight European countries participated in a survey, filling a digital form of 38 questions from April to October 2022, to collect information about all the aspects of VSR treatment. Most centres encounter 1-5 VSR cases/year. Surgery remains the treatment of choice over percutaneous closure (71.8% vs. 28.2%). A delayed repair represents the preferred approach (87.2%). Haemodynamic conditions influence the management in almost all centres, although some try to achieve patients stabilization and delayed surgery even in cardiogenic shock. Although 33.3% of centres do not perform coronarography in unstable patients, revascularization approaches are widely variable. Most centres adopt mechanical circulatory support (MCS), mostly extracorporeal membrane oxygenation, especially pre-operatively to stabilize patients and achieve delayed repair. Post-operatively, such MCS are more often adopted in patients with ventricular dysfunction. In real-life, delayed surgery, regardless of the haemodynamic conditions, is the preferred strategy for VSR management in Europe. Extracorporeal membrane oxygenation is becoming the most frequently adopted MCS as bridge-to-operation. This survey provides a useful background to develop dedicated, prospective studies to strengthen the current evidence on VSR treatment and to help improving its currently unsatisfactory outcomes.

IMPACT-ALS: summary of results from a European survey of people living with ALS

Objective The IMPACT-ALS survey collected the experiences of people living with ALS (plwALS) across nine European countries. We aimed to better understand the functional burden of ALS to ensure the experiences of plwALS inform the development of person-centered therapies. Methods The content was informed by the US IMPACT-ALS survey, with adjustments relevant to the European population. Questionnaires consisted of four modules, each of which was pilot tested in advance of distribution. Data were captured using the Qualtrics software and were analyzed in SPSS. Results 857 respondents completed the survey, with a participation rate ranging from 0.2% to 6.3% across the nine participating countries. The majority were male and aged 55–74 years old. In the previous 2 weeks, symptoms experienced included weakness (81%), fatigue (61%), speech impairment (38%), pain (27%), and depression and other mood changes (23%). Eighty-two percent of respondents reported fears, of which the most common were leaving family too soon (68%) and death from respiratory failure (50%). Lifestyle changes since diagnosis were reported by 89% of respondents, with less time spent doing most daily activities but more time on the internet (81%), reading (56%) and communicating with family and friends (55%). Stopping progression of ALS was the most desired impact for a new therapy for 68% respondents. Conclusions The European IMPACT-ALS survey has generated insights into the complex experiences of plwALS. The data provide unique patient perspectives on common symptoms, fears, functional limitations, lifestyle changes, and wishes for future therapies that will enhance patient-centric care in ALS.

Novel, computational IgE-clustering in a population-based cross-sectional study: Mapping the allergy burden.

Even though the prevalence of allergies is increasing, population-based data are still scarce. As a read-out for chronic inflammatory information, new methods are needed to integrate individual biological measurements and lifestyle parameters to mitigate the consequences and costs of allergic burden for society. More than 480.000 data points were collected from 1462 Luxembourg adults during the representative, cross-sectional European Health Examination Survey, spanning health and lifestyle reports. Deep IgE-profiles based on unsupervised clustering were correlated with data of the health survey. 42.6% of the participants reported a physician-diagnosed allergy and 44% were found to be IgE-positive to at least one allergen or extract. The main sensitization sources were tree pollens followed by grass pollens and mites (52.4%, 51.8% and 40.3% of sensitized participants respectively), suggesting seasonal as well as perennial burden. The youngest group of participants (25-34years old) showed the highest burden of sensitization, with 18.2% of them having IgE to 10 or more allergen groups. Unsupervised clustering revealed that the biggest cluster of 24.4% of participants was also the one with the highest medical need, marked by their multi-sensitization to respiratory sources. Our novel approach to analyzing large biosample datasets together with health information allows the measurement of the chronic inflammatory disease burden in the general population and led to the identification of the most vulnerable groups in need of better medical care.

Exposure to farm environment and its correlations with total IgE, IL-13, and IL-33 serum levels in patients with atopy and asthma.

The aim of the study was to evaluate total immunoglobulin E (IgE), IL-13, and IL-33 serum level in people with bronchial asthma and atopy, and in healthy control group depending on their exposure to farm animals currently and in the first year of life. The study included 174 individuals living in rural areas and in a small town. Standardized questions from the International Study of Asthma and Allergy in Childhood and The European Community Respiratory Health Survey (ECRHS) questionnaires were used to define asthma. Atopic status was verified by skin prick tests. Rural exposure including contact with livestock was verified by adequate questionnaire. Total serum IgE, IL-13, and IL-33 levels were assessed by ELISA (enzyme-linked immunosorbent assay) tests. Participants with atopy and bronchial asthma were characterized by high level of immunoglobulin E. Tendency to lower serum IgE level was observed among people reporting present contact with farm animals. Also, among those having contact with livestock in their first year of life, the analogous tendency was noticed. No difference in serum IL-13 levels in participants with asthma and atopy, and controls was observed, and there was no effect of exposure on farm animals on the concentration of IL-13. The highest IL-33 level was found in the atopic group, and the lowest in the control group. Participants currently exposed to farm animals were predisposed to have lower IL-33 serum level. Exposure of farm animals currently and in first year of life may result in a lower level of total IgE. Correlation between IL-13 and IL-33 serum levels and contact with livestock was not confirmed.

Comfort with varying levels of human supervision in self-driving cars: Determining factors in Europe

While numerous studies have investigated attitudes towards self-driving cars in general, less research attention has been focused on individuals' comfort with the presence (or absence) of third-party human supervision of this automation, and its potential correlates. In the present study we perform a secondary analysis of pre-existing data from The European Commission’s Eurobarometer 92.1, a large-scale European survey ( n = 27565) of expectations and concerns of connected and automated driving. By comparing responses to three levels of human supervision in self-driving cars, we aim to identify changes in the importance of predictors of comfort with automation. We find considerable heterogeneity in both individual attitudes, as well as in country-level attitudes in our descriptive analysis. We find a trend of decreasing comfort as external human supervision is reduced, although this effect differs between countries. We then investigate potential drivers of self-reported comfort with varying levels of external human supervision in a regression framework. Gender differences get stronger with decreasing supervision, suggesting a possible resolution to conflicting evidence in previous studies. Following this, we fit an ordinal random forest model to derive variable importance metrics, which enable us to compare the changing role predictor variables might play in shaping self-reported comfort, depending on varying levels of third-party supervision. Data privacy is highlighted as an important variable, regardless of level of supervision. Our findings provide confirmation for previous literature in a large sample, while also uncovering a number of novel associations, providing guidance for future policy-making and research efforts.

Breast cancer screening and its associating factors among hungarian women aged 45–65: a cross-sectional study based on the European health interview surveys from 2009 to 2019

BackgroundIn 2020, globally 685,000 people died, and 2.3 million women were diagnosed with breast cancer. The main cause of cancer deaths among women is breast cancer, which account for 15.5% of all cancer deaths. Most of these could have been avoided with timely diagnosis.The aim of our study was to determine the proportion of breast screening participation in Hungary, and to identify possible factors that may influence breast screening attendance.MethodsOur data were gathered from the cross-sectional European Health Interview Surveys conducted in Hungary in 2009, 2014, and 2019. In terms of categorical characteristics, Pearson’s chi-square test was performed to evaluate the differences between people who have attended breast screening within two years and who have only attended more than two years ago. To determine the factors that may have an impact on the uptake of screening, generalized linear model with logit link function regarding binomial probability distribution was executed.ResultsThe responses of 2626 women between the age 45-65 were included in our study. In 2009 85% (n=741), in 2014 90% (n=851) and in 2019 87% (n=699) of the respondents claimed to have ever attended a breast screening in their life. In 2009 68% (n=594), in 2014 66% (n=630) and in 2019 64% (n=515) said that they have taken part in breast screening within two years (p=0.331). From 2014 to 2019 (AOR=0.72 [0.57-0.89]) the chance of attending breast screening was decreasing. We observed that both secondary (AOR=1.97 [1.60-2.44]) and tertiary educational level (AOR=2.23 [1.67-3.00]), higher perceived income (AOR=1.54 [1.25-1.90]), and more frequent meeting with the doctor (AOR=1.77 [1.39-2.27]) and with the specialist (AOR=1.88 [1.54-2.28]) appeared as protective factors of breast screening attendance.ConclusionsOur results show that the lifetime prevalence of breast screening participation is high, however the recommended biennial rate is relatively low. To increase the participation rate, various initiatives would be needed, especially for women in identified risk groups, which are lower educational level, lower perceived income, and less frequent meeting with the doctor and with the specialist.

How do geriatricians evaluate decision-making ability for older adults with cognitive impairment? Results from an European survey.

The assessment of decision-making ability of older adults with cognitive impairment is a complex challenge that geriatricians often face in relation to risk-taking situations (driving, aging in place, financial decisions, etc.). However, there are no clear and consensual practice guidelines. An overview of current practices and needs seemed necessary. We co-created and conducted an online survey to describe practice and knowledge, among European geriatricians. The survey was structured in 3 parts: a description of the professional's practice regarding cognitive impairment, a specific questionnaire about everyday risky decision-making evaluation and an investigation of the clinician's knowledge about relevant ethical and legal recommendations. Each part consisted of both multiple choice and open questions, analyzed through descriptive statistics and qualitative analysis methods. Based on the responses of 123 geriatricians across Europe, our survey showed that clinical interview is the cornerstone of geriatric assessment of decision-making ability of patients with mild to moderate dementia. When faced with risk-taking dilemma situations, geriatricians tend to favor a context of safety above autonomy, but they can support risky decision-making if it is consistent with the patient's previous lifestyle, depending on the degree of risk to self and others, on the decision-making ability assessed, and if there is some form of shared decision-making. Assessing decision-making ability is challenging for geriatricians, who in our study relied more on their clinical interview and global cognitive tests than more in-depth evaluations. Supporting independent decision-making, when associated with risk-taking, requires better detection and anticipation shared with the patient environment.

Which Occupations Did People Engage in during Lockdown? A European Cross-Sectional Descriptive Survey by Generation.

The primary objective was to describe the occupations people engaged in more frequently during lockdown than before the coronavirus disease 2019 pandemic as a function of generation. The secondary objectives were to (i) describe the levels of importance, performance, and satisfaction for these occupations and (ii) identify factors affecting the levels of importance, performance, and satisfaction. We conducted an online, cross-sectional survey of young adults (YAs, aged 18-39), middle-aged adults (MAs, aged 40-59), and older adults (OAs, aged 60 or over). 2534 participants (YAs: 47%, MAs: 33%, and OAs: 20%) cited 4500 occupations. The occupations in which people most engaged were leisure occupations (67%), followed by productive occupations (31%) and then self-care (2%) occupations. YAs gave a median (interquartile range) importance score of 8 (6; 9) to leisure, 8 (7; 10) to productivity, and 8 (7; 10) to self-care. MAs gave a median importance score of 8 (6; 10) to leisure, 8 (7; 10) to productivity, and 8 (7; 10) to self-care. OAs gave a median importance score of 8 (7; 10) to leisure, 8 (7; 9) to productivity, and 9 (8; 10) to self-care. In a pre-/postlockdown comparison, the changes in performance scores among YAs were +5 (3; 6) for leisure, +4 (2; 5) for productivity, and +4 (3; 6) for self-care. Among MAs, these changes were, respectively, +4 (3; 6), +3 (2; 5), and +4.5 (3; 6). Among OAs, these changes were, respectively, +3 (1; 5) for leisure, +3 (2; 5) for productivity, and +2 (0; 4) for self-care. The changes in satisfaction scores among YAs were +3 (0; 5) for leisure, +3 (0; 5) for productivity, and +3 (1; 6) for self-care. Among MAs, these changes were, respectively, +3 (0; 5), +2 (0; 4), and +5 (0; 6). Among OAs, these changes were, respectively, +2 (0; 4), +2 (0; 4), and +2 (0; 4). Lockdown led to stronger engagements in quiet leisure and alternative forms of socialization. Occupational therapists may have a role in helping community-dwelling people to balance and structure their new daily routine.

Inappropriate hospital admission as a risk factor for the subsequent development of adverse events: a cross-sectional study

BackgroundAll health overuse implies an unnecessary risk of patients suffering adverse events (AEs). However, this hypothesis has not been corroborated by direct estimates for inappropriate hospital admission (IHA). The objectives of the study were the following: (1) to analyze the association between IHA and the development of subsequent AEs; (2) to explore the distinct clinical and economic implications of AEs subsequent IHA compared to appropriate admissions.MethodsAn observational cross-sectional study was conducted on hospitalized patients in May 2019 in a high-complexity hospital in Madrid, Spain. The Appropriateness Evaluation Protocol was used to measure IHA, and the methodologies of the Harvard Medical Practice Study and the European Point Prevalence Survey of Healthcare-associated Infections were used to detect and characterize AEs. The association between IHA and the subsequent.ResultsA total of 558 patients in the hospital ward were studied. IHA increased the risk of subsequent occurrence of AEs (OR [95% CI]: 3.54 [1.87 to 6.69], versus appropriate) and doubled the mean AEs per patient (coefficient [95% CI]: 0.19 [0.08 to 0.30] increase, versus appropriate) after adjusting for confounders. IHA was a predictive variable of subsequent AEs and the number of AEs per patient. AEs developed after IHA were associated with scheduled admissions (78.9% of AEs, versus 27.9% after appropriate admissions; p < 0.001). Compared with AEs developed after appropriate admissions, AEs after IHA added 2.4 additional days of stay in the intensive care unit and incurred an extra cost of €166,324.9 for the studied sample.ConclusionsPatients with IHA have a higher risk of subsequent occurrence of AE. Due to the multifactorial nature of AEs, IHA is a possible contributing factor. AEs developed after IHA are associated with scheduled admissions, prolonged ICU stays, and resulted in significant cost overruns.

From attitudes to social networks: National gender-role attitudes and gender differences in late-life social relationships

Studies often find gender differences in social networks in later life, but are these findings universal, or do they differ in various cultural contexts? To address this research gap, the current study examines the association between gender differences in social relationships and country-level gender-role attitudes. We combined data from the Survey of Health, Ageing and Retirement in Europe (SHARE) of individuals aged 50 years and older with country-level data on gender-role attitudes from the European Values Survey (EVS) for 15 European countries. We estimated a series of multivariate hierarchical regression models that predicted the size of the personal social network, its emotional closeness, and the proportion of the spouse, children, and friends in the network. The results indicated gender differences in social network characteristics. Women reported larger social networks and were more likely to have larger proportions of children and friends but smaller proportions of the spouse in their social networks. The magnitude of gender differences was associated with country-level gender-role attitudes. In countries with more egalitarian gender-role attitudes, women had larger networks with a larger proportion of friends compared to men. In countries with more traditional gender-role attitudes, women had larger proportions of their children and spouse in their social networks and had emotionally closer networks. Our findings suggest that the societal context and opportunity structures for social interactions play an important role in shaping the structure of women’s and men’s social relationships in later life.

Changes in attitudes toward alcohol control policies in Lithuania: findings from two representative surveys in 2015 and 2020

ABSTRACT Background: A set of evidence‐based alcohol control policy measures was adopted in the period 2016–2020 in Lithuania. The present study fills a knowledge gap on how changes in alcohol control policy are associated with attitudes toward different alcohol policy measures. Objective: This study aims to explore whether support for key alcohol control policy measures in Lithuania declined following implementation of alcohol control measures. Methods: Data came from the Standard European Alcohol Survey. Two representative surveys with the same questionnaire, were conducted in Lithuania in 2015 (N = 1513, 51.7% female, response rate was 38.9%) and 2020 (N = 1015, 50.6% female, response rate was 38.0%). Multi-stage stratified probability sampling was applied. Surveys were carried out using computer-assisted face-to-face interviews, descriptive statistics and multiple logistic regression analyses was applied. We used a binomial logistic regression analysis and the Pearson chi-square test. Results: There was a significant decline in a proportion of respondents who agreed that the number of alcohol selling places should be kept low (OR: 0.84, p = .032), alcohol prices should be kept high (OR: 0.83, p = .027), and the police should be allowed to randomly check whether the driver is sober (OR: 0.65, p < .001). The proportion of respondents who agree that individuals are responsible enough with their drinking significantly declined (OR: 0.76, p = .003). Conclusion: Support for restrictions on alcohol-selling points, increase in alcohol price, and random alcohol testing of drivers declined following the adoption of new alcohol control policy measures. Our findings might be beneficial for policy-makers planning alcohol control policies and information campaigns.

Contemporary European practice in transcatheter aortic valve implantation: results from the 2022 European TAVI Pathway Registry.

A steep rise in the use of transcatheter aortic valve implantation (TAVI) for the management of symptomatic severe aortic stenosis occurred. Minimalist TAVI procedures and streamlined patient pathways within experienced Heart Valve Centres are designed to overcome the challenges of ever-increasing procedural volume. The 2022 European TAVI Pathway Survey aims to describe contemporary TAVI practice across Europe. Between October and December 2022, TAVI operators from 32 European countries were invited to complete an online questionnaire regarding their current practice. Responses were available from 147 TAVI centres in 26 countries. In 2021, the participating centres performed a total number of 27,223 TAVI procedures, with a mean of 185 TAVI cases per centre (median 138; IQR 77-194). Treatment strategies are usually (87%) discussed at a dedicated Heart Team meeting. Transfemoral TAVI is performed with local anaesthesia only (33%), with associated conscious sedation (60%), or under general anaesthesia (7%). Primary vascular access is percutaneous transfemoral (99%) with secondary radial access (52%). After uncomplicated TAVI, patients are transferred to a high-, medium-, or low-care unit in 28%, 52%, and 20% of cases, respectively. Time to discharge is day 1 (12%), day 2 (31%), day 3 (29%), or day 4 or more (28%). Reported adoption of minimalist TAVI techniques is common among European TAVI centres, but rates of next-day discharge remain low. This survey highlights the significant progress made in refining TAVI treatment and pathways in recent years and identifies possible areas for further improvement.

Conditional macroeconomic survey forecasts: Revisions and errors

Using data from the European Central Bank's Survey of Professional Forecasters and ECB/Eurosystem staff projections, we analyze the role of ex-ante conditioning variables for macroeconomic forecasts. In particular, we test to which extent the updating and ex-post performance of predictions for inflation, real GDP growth and unemployment are related to beliefs about future oil prices, exchange rates, interest rates and wage growth. While oil price and exchange rate predictions are updated more frequently than macroeconomic forecasts, the opposite is true for interest rate and wage growth expectations. Beliefs about future inflation are closely associated with oil price expectations, whereas expected interest rates are related to predictions of output growth and unemployment. Exchange rate predictions also matter for macroeconomic forecasts, albeit less so than the other variables. With regard to forecast errors, wage growth and GDP growth closely comove, but only during the period when interest rates are at the effective zero lower bound.

Worksite Health Promotion and Work Performance: Both Awareness and Use Matter.

This work aimed to study whether being aware of the existence of worksite health promotion (WHP), using it, or both are related to employees' task and contextual performance. Multilevel cross-sectional data came from the European Sustainable Workforce Survey, with data from more than 11,000 employees in 259 organizations. Generalized structural equation modeling was used to examine two types of WHP: healthy menus and sports facilities. Awareness of healthy menus and sports facilities was positively associated with task and contextual performance. Healthy menus use was related to both higher task and contextual performance, whereas sports facilities use was only associated with contextual performance. The relation of WHP use was stronger for contextual than for task performance. Organizations should ensure that employees are aware of the availability of WHP as well as stimulate employees to make use of it.

Worsened self-rated health in the course of the COVID-19 pandemic among older adults in Europe.

Governments across Europe deployed non-pharmaceutical interventions to mitigate the spread of coronavirus disease 2019 (COVID-19), which not only showed clear benefits but also had negative consequences on peoples' health. Health inequalities increased, disproportionally affecting people with higher age or lower education. This study analyzed associations between social factors and worsened self-rated health of elderly people in the course of the COVID-19 pandemic, taking different stringencies of government mandates as well as infection rates into account. Data stem from the European SHARE survey. The main outcome was a binary indicator of worsened self-rated health. Analyses included data from two waves (2020 and 2021) during the pandemic (N = 48 356 participants, N = 96712 observations). Predictors were age, sex, education and living together with a partner, and two macro indicators that reflected the stringency of government response mandates and COVID-19 infection rates. Data were analyzed using logistic mixed-effects regression models. Older age [odds ratio (OR) 1.73, confidence interval (CI) 1.65-1.81] and female sex (OR 1.26, CI 1.20-1.32) were positively associated and higher education (OR 0.74, CI 0.70-0.79) was negatively associated with worsened self-rated health. Not living together with a partner showed higher odds of worsened self-rated health (OR 1.30, CI 1.24-1.36). Inequalities increased from 2020 to 2021. Associations between worsened self-rated health and government response mandates or infection rates were inconsistent. Self-rated health worsened in the course of the pandemic and health disparities increased. Possible future pandemics require targeted interventions to minimize adverse health outcomes, in particular among old, potentially isolated, and deprived people.

A Generalized Ordered Logit Model to Accommodate Multiple Rating Scales

Rating scales are ubiquitous in the social sciences, yet may present practical difficulties when response formats change over time or vary across surveys. To allow researchers to pool rating data across alternative question formats, the article provides a generalization of the ordered logit model that accommodates multiple scale formats in the measurement of a single rating construct. The resulting multiscale ordered logit model shares the interpretation as well as the proportional odds (or parallel lines) assumption with the standard ordered logit model. A further extension to relax the proportional odds assumption in the multiscale context is proposed, and the substitution of the logit with other convenient link functions is equally straightforward. The utility of the model is illustrated from an empirical analysis of the determinants of respondents’ confidence in democratic institutions that combines data from the European Social Survey, the General Social Survey, and the European and World Values Survey series.

Interdisciplinary Legal, Forensic and Pharmaceutical, Forensic and Chemical, Forensic and Narcological, Forensic and Toxicological, Criminal and Legal Study of the Illegal Trafficking of Amphetamine

Noted that the illegal circulation of amphetamine in the world is growing. A legal, forensic and pharmaceutical, forensic and chemical, forensic and narcological, forensic and toxicological, forensic and psychiatric, criminal and legal study of the illegal circulation and distribution of amphetamine and its derivatives in an interdisciplinary context was conducted. The classification and legal group of amphetamine has been established. The experience of the international anti-narcotic association on the impact of amphetamine on life, the state of the body, and side effects was studied. Forensic and pharmaceutical analysis of criminal offenses was conducted. The results of a European online survey on the circulation of prohibited psychoactive substances in 21 EU countries, 9 non-EU countries, including Ukraine, were studied. Types of illegal amphetamines were analyzed. Drugs with amphetamine for the pharmacotherapy of narcolepsy were given. Forensic and pharmaceutical practice was summarized. Amendments and additions to Part 3 of Art. 307 of the Criminal Code of Ukraine regarding the strengthening of criminal liability for illegal trafficking of amphetamine were proposed. The peculiarities of the toxicology of amphetamine in the human body were given. The algorithm of pharmacotherapy of amphetamine addiction was summarized.

Using advanced analytics to help identify women who are more likely to have a severe subjective experience of vulvovaginal atrophy: a modeling study

Objective To develop a model to identify women likely to be severely impacted by vulvovaginal atrophy (VVA), based on their experience of symptoms and non-clinical factors. Methods Multivariate statistics and machine-learning algorithms were used to develop models using data from a cross-sectional, observational, multinational European survey. A set of independent variables were chosen to assess subjective VVA severity and its impact on daily activities. Results A final composite model was selected that included three categories of variables: clinical severity, patient demographics/clinical characteristics and Day-to-Day Impact of Vaginal Aging (DIVA) variables related to emotion/mood, impact on lifestyle and frequency of sex. The model accurately classified 71% of women. Three DIVA variables (feeling bad about yourself, desire/interest in sex, physical comfort related to sitting) explained much of the variation in the dependent variable of the model. Over 90% of the impact of VVA relates to certain psychosocial and behavioral aspects that can be identified without the need to consider physical signs/symptoms. Conclusion Non-clinical factors can contribute significantly to the overall VVA burden. Questions used in developing the composite model could form the basis of an instrument to help screen women prior to clinical consultation and improve VVA management.

Perceptions of surgical difficulty in liver transplantation: A European survey and development of the Pitié-Salpêtrière classification

BackgroundSignificant variations exist regarding the definition of difficult liver transplantation. The study goals were to investigate how liver transplant surgeons evaluate the surgical difficulty of liver transplantation and to use the identified factors to classify liver transplantation difficulty. MethodsA Web-based online European survey was presented to liver transplant surgeons. The survey was divided into 3 parts: (1) participant demographics and practices; (2) various situations based on recipient, liver disease, tumor treatment, and technical factors; and (3) 8 real-life clinical vignettes with different levels of complexity. In part 3 of the survey, respondents were asked whether they would perform liver transplantation but were not aware that these patients eventually underwent liver transplantation. ResultsA total of 143 invites were sent out, and 97 (67.8%) participants completed the survey. Most participants considered previous spontaneous bacterial peritonitis, previous supra-mesocolic surgery, hypertrophy of segment I, and obesity to be recipient factors for high-difficulty liver transplantation. Most participants considered liver transplantation to be challenging in patients with Budd–Chiari syndrome, Kasai surgery, polycystic liver disease, diffuse portal vein thrombosis, and a history of open hepatectomy. The proportion of participants indicating that liver transplantation was warranted varied across the 8 cases, from 69% to 100%. Our classification of the surgical difficulty of liver transplantation employed these recipient-related, surgical history–related, and liver disease–related variables and 3 difficulty groups were identified: low, intermediate, and high difficulty groups. ConclusionThis survey provides an overview of the surgical difficulty of various situations in liver transplantation that could be useful for further benchmark and textbook outcome studies.