Survey participation among general practitioners: comparison between teaching physicians and a random sample

Objective Health scientists strive for a smooth recruitment of physicians for research projects like surveys. Teaching physicians are an easy to approach population that is already affiliated with a university by teaching students in their practice. How do response rates compare between a convenient online survey among teaching physicians and an elaborate postal survey in a random sample of unknown physicians? Data from the TMI-GP study on the use of memory tests in general practice were used. Results Physicians in the random sample responded to the postal survey more often than teaching physicians to the online survey (59.5% vs. 18.9%; odds ratio 7.06; 95% confidence interval 4.81–10.37; p < 0.001). Although it is unclear whether the sample, the survey mode (online vs. postal) or both account for this effect, it is noteworthy that even in such a convenience sample of known/committed physicians, an adequate response rate could not be reached without a tailored and elaborated survey technique. Responders in the two samples were comparable regarding a content-related item (use of memory tests; Χ2 (df = 1) = 3.07; p = 0.080).

Intention to Install Green Infrastructure Features in Private Residential Outdoor Space

Green infrastructure (GI) features in private residential outdoor space play a key role in expanding GI networks in cities and provide multiple co-benefits to people. However, little is known about residents' intended behavior concerning GI in private spaces. Resident homeowners in Toronto (Ontario, Canada) voluntarily participated in an anonymous postal survey (n = 533) containing questions related to likelihood to install additional GI features in their private outdoor space; experiences with this space, such as types of uses; and environmental concerns and knowledge. We describe the association between these factors and people's intention to install GI in private residential outdoor space. Factors such as environmental concerns and knowledge did not influence likelihood to install GI. However, experiences with private residential outdoor space, such as nature uses of this space, level of self-maintenance of this space, and previously installed GI features, were significant influences on the likelihood to install GI. These findings have important implications for managing GI initiatives and the adoption of GI in private residential spaces, such as orienting communication materials around uses of and experiences with outdoor space, having programs that generate direct experiences with GI features, and considering environmental equity in such programs.

Prevalence and severity of differing dimensions of breathlessness among elderly males in the population

Breathlessness is common in the general population. Existing data were obtained primarily with the uni-dimensional modified Medical Research Council (mMRC) breathlessness scale that does not assess intensities of unpleasantness nor physical, emotional, and affective dimensions. The aim of this research was to determine the prevalence and intensity of these dimensions of breathlessness in elderly males and any associations with their duration, change over time, and mMRC grade. We conducted a population-based, cross-sectional study of 73-year-old males in a county in southern Sweden. Breathlessness was self-reported at one time-point using a postal survey including the Dyspnoea-12 (D-12), the Multidimensional Dyspnoea profile (MDP), and the mMRC. Presence of an increased dimension score was defined as a score≥minimal clinically important difference for each dimension scale. Association with mMRC, recalled change since age 65, and duration of breathlessness were analysed with linear regression. Among 907 men, an increased dimension score was present in 17% (D-12 total score), 33% (MDP A1 unpleasantness), 19% (D-12 physical), 17% (MDP immediate perception), 10% (D-12 affective), and 17% (MDP emotional response). The unpleasantness and affective dimensions were strongly associated with mMRC ≥3. Higher MDP and D-12 scores were associated with worsening of breathlessness since age 65, and higher MDP A1 unpleasantness was associated with breathlessness of less than one year duration. Increased scores of several dimensions of breathlessness are prevalent in 73-year-old males and are positively correlated with mMRC scores, worsening of breathlessness after age 65, and duration of less than one year.

Exploring Understandings of Different Decommissioning Options for Offshore Oil and Gas Structures in the South Taranaki Bight of New Zealand

<p>The majority of the world’s offshore oil and gas structures will need to be decommissioned in upcoming decades as they near the end of their production phase. Once decommissioned, there are three main options available for the now-obsolete structures: complete removal, partial removal, and re-use. Since New Zealand has yet to decommission any offshore structures, there are no past examples or legislative precedent to guide the process. International case studies indicate that social acceptance is crucial to the successful implementation of these projects, so the aim of this thesis was to examine perceptions of different decommissioning options for offshore oil and gas structures in the South Taranaki Bight of New Zealand. Grounded in agenda-setting theory, Study 1 examined the prominence and portrayal of offshore decommissioning in the media. We found an exceedingly low coverage (N = 13) which indicates that the public are likely unaware of the issue. Within the limited sample, the themes 'disregarding decommissioning' and 'addressing decommissioning' were identified which, when combined, suggest that New Zealand is in the pre-planning stage of decommissioning and has yet to explore the options available. Using a postal survey (N = 154), Study 2 measured how the Taranaki community currently understood different decommissioning options, and explored whether and which familiarity variables, psychological constructs, and demographic variables could predict support for different options. The results confirmed a lack of knowledge and awareness (but high levels of interest) among the sample and revealed heterogeneity in which option was supported. Moreover, path analyses showed that awareness, knowledge, age, individualist worldviews, and egalitarian worldviews were significantly associated with support for different options. As will be discussed, these findings have significant implications for communication, engagement, and policy-making in both New Zealand and the international context.</p>

Exploring Understandings of Different Decommissioning Options for Offshore Oil and Gas Structures in the South Taranaki Bight of New Zealand

<p>The majority of the world’s offshore oil and gas structures will need to be decommissioned in upcoming decades as they near the end of their production phase. Once decommissioned, there are three main options available for the now-obsolete structures: complete removal, partial removal, and re-use. Since New Zealand has yet to decommission any offshore structures, there are no past examples or legislative precedent to guide the process. International case studies indicate that social acceptance is crucial to the successful implementation of these projects, so the aim of this thesis was to examine perceptions of different decommissioning options for offshore oil and gas structures in the South Taranaki Bight of New Zealand. Grounded in agenda-setting theory, Study 1 examined the prominence and portrayal of offshore decommissioning in the media. We found an exceedingly low coverage (N = 13) which indicates that the public are likely unaware of the issue. Within the limited sample, the themes 'disregarding decommissioning' and 'addressing decommissioning' were identified which, when combined, suggest that New Zealand is in the pre-planning stage of decommissioning and has yet to explore the options available. Using a postal survey (N = 154), Study 2 measured how the Taranaki community currently understood different decommissioning options, and explored whether and which familiarity variables, psychological constructs, and demographic variables could predict support for different options. The results confirmed a lack of knowledge and awareness (but high levels of interest) among the sample and revealed heterogeneity in which option was supported. Moreover, path analyses showed that awareness, knowledge, age, individualist worldviews, and egalitarian worldviews were significantly associated with support for different options. As will be discussed, these findings have significant implications for communication, engagement, and policy-making in both New Zealand and the international context.</p>

Improving postal survey response using behavioural science: a nested randomised control trial

Background Systematic reviews have identified effective strategies for increasing postal response rates to questionnaires; however, most studies have isolated single techniques, testing the effect of each one individually. Despite providing insight into explanatory mechanisms, this approach lacks ecological validity, given that multiple techniques are often combined in routine practice. Methods We used a two-armed parallel randomised controlled trial (n = 2702), nested within a cross-sectional health survey study, to evaluate whether using a pragmatic combination of behavioural science and evidenced-based techniques (e.g., personalisation, social norms messaging) in a study invitation letter increased response to the survey, when compared with a standard invitation letter. Participants and outcome assessors were blinded to group assignment. We tested this in a sample of women testing positive for human papillomavirus (HPV) at cervical cancer screening in England. Results Overall, 646 participants responded to the survey (response rate [RR] = 23.9%). Logistic regression revealed higher odds of response in the intervention arm (n = 357/1353, RR = 26.4%) compared with the control arm (n = 289/1349, RR = 21.4%), while adjusting for age, deprivation, clinical site, and clinical test result (aOR = 1.30, 95% CI: 1.09–1.55). Conclusion Applying easy-to-implement behavioural science and evidence-based methods to routine invitation letters improved postal response to a health-related survey, whilst adjusting for demographic characteristics. Our findings provide support for the pragmatic adoption of combined techniques in routine research to increase response to postal surveys. Trial registration ISRCTN, ISRCTN15113095. Registered 7 May 2019 – retrospectively registered.

Fragility fractures and prescriptions of medications for osteoporosis in patients with polymyalgia rheumatica: results from the PMR Cohort Study

Objectives Polymyalgia rheumatica (PMR) is a common indication for long-term glucocorticoid treatment leading to an increased risk of osteoporosis and fragility fractures. Guidelines recommend calcium and vitamin D for all patients, as well as anti-resorptive agents for high-risk patients. This study aimed to investigate falls and fragility fracture history and use of medications for osteoporosis in a PMR cohort. Methods 652 people with incident PMR responded to a postal survey. Self-reported data on falls, fragility fracture history and medication were collected at baseline. Follow up data on fragility fractures (hip, wrist, spine) and falls were collected at 12 and 24 months. Logistic regression was used to assess the association between baseline characteristics and fractures. Results Fewer than 50% of respondents received osteoporosis treatments, including supplements. 112 (17.2%) participants reported a fragility fracture at baseline, 72 participants reported a fracture at 12 months, whilst 62 reported a fracture at 24-months. Baseline history of falls was most strongly associated with fracture at 12 (OR 2.35; 95% CI 1.35, 4.12) and 24 months (1.91; 1.05, 3.49) when unadjusted for previous fractures. Conclusions Fracture reporting is common in people with PMR. To improve fracture prevention, falls assessment and interventions need to be considered. History of falls could help inform prescribing decisions around medications for osteoporosis. Future research should consider both pharmacological and non-pharmacological approaches to reducing fracture risk.

Potentials and current shortcomings in the cooperation between German centers for rare diseases and primary care physicians: results from the project TRANSLATE-NAMSE

Background The TRANSLATE-NAMSE project with the strengthening of the centers for rare diseases with their affiliation to the European Reference Networks was a major step towards the implementation of the German National Plan of Action for People with Rare Diseases establishing better care structures. As primary care physicians, general practitioners and pediatricians play a central role in the diagnosis of patients with rare disease, as it is usually them referring to specialists and rare disease centers. Therefore, the interface management between primary care physicians and the centers for rare diseases is of particular importance. Methods In a mixed-method-approach an anonymous postal survey of 1,500 randomly selected primary care physicians in Germany was conducted with focus on (1) knowledge about a center for rare diseases and how it works, (2) in case of cooperation, satisfaction with the services provided by centers, and (3) expectations and needs they have with regard to the centers. In addition, in-depth telephone interviews were conducted with physicians who had already referred patients to a center. Results In total, 248 physicians responded to the survey, and 15 primary care physicians were interviewed. We observed a wide lack of knowledge about the existence of (45.6% confirmed to know at least one center) about how to access rare disease centers (50.4% of those who know a center confirmed knowledge) and what the center specializes in. In case of cooperation the evaluation was mostly positive. Conclusion To improve medical care, the interplay between primary care physicians and rare disease centers needs to be strengthened. (1) To improve the communication, the objectives and functioning of the rare disease centers should become more visible. (2) Other projects dealing with the analysis and improvement of interface management between centers and primary care physicians, as described in the National Plan of Action for People with Rare Diseases, need to be implemented immediately. (3) If the project is evaluated positively, the structures of TRANSLATE-NAMSE should be introduced nationwide into the German health care system to ensure comprehensive, quality-assured care for people with rare diseases with special consideration of the key role of primary care physicians—also taking into account the financial expenditures of this new care model.

Euthanasia in advanced dementia; the view of the general practitioners in the Netherlands on a vignette case along the juridical and ethical dispute

Background In the Netherlands, euthanasia has been regulated by law since 2002. In the past decade, a growing number of persons with dementia requested for euthanasia, and more requests were granted. A euthanasia request from a patient with advanced dementia (PWAD) can have a major impact on a general practitioner (GP). We aimed to get insights in the views of Dutch GPs on euthanasia concerning this patient group. Methods A postal survey was sent to 894 Dutch GPs. Questions were asked about a case vignette about a PWAD who was not able to confirm previous wishes anymore. Quantitative data were analyzed with descriptive statistics. Results Of the 894 GPs approached, 422 (47.3%) completed the survey. One hundred seventy-eight GPs (42.2%) did not agree with the statement that an Advance Euthanasia Directive (AED) can replace an oral request if communication with the patient concerned has become impossible. About half of the respondents (209; 49.5%) did not agree that the family can initiate a euthanasia trajectory, 95 GPs (22.5%) would accept such a family initiative and 110 GPs (26.1%) would under certain conditions. Discussion In case of a PWAD, when confirming previous wishes is not possible anymore, about half of the Dutch GPs would not accept an AED to replace verbal or non-verbal conformation nor consider performing euthanasia; a minority would. Our study shows that, probably due to the public debate and changed professional guidelines, conflicting views have arisen among Dutch GPs about interpretation of moral, ethical values considering AED and PWADs.