Patients' Preferences for Antiretroviral Therapy Service in Northwest Ethiopia: A Discrete Choice Experiment.

Objective. We aim to evaluate patients' preferences for antiretroviral therapy (ART) to enhance shared decision making in clinical practice in Northwest Ethiopia. Methods. A discrete choice experiment approach was used among adult patients from 36 randomly selected public health facilities from February 6, 2023, to March 29, 2023. A literature review, qualitative work, ranking and rating surveys, and expert consultation were used to identify the attributes. Location, provider, frequency of visit, appointment modality, refill time, and cost of visit were the 6 ART service features chosen. Participants were given the option of choosing between 2 hypothetical differentiated ART delivery models. Mixed logit and latent class analysis were used. Results: Four hundred fifty-six patients completed the choice task. Respondents preferred to receive ART refills alone at health facilities by health care workers without having to have frequent visits and with reduced cost of visit. Overall, the participants valued the cost of the visit the most while they valued the timing of ART refill the least. Participants were willing to pay only for the attributes of frequency of visit and medication refill time. The latent class model with 3 classes provided the best model fit. Location, cost, and frequency were the most important attributes in class 1, class 2, and class 3, respectively. Income and marital status significantly predicted class membership. Conclusions. Respondents preferred to receive refills at health facilities, less frequent visits, individual appointments, service provision by health care workers, and reduced cost of visit. The cost attribute had the greatest impact on the choice of patients. Health care workers should consider the preferences of patients while providing ART services to meet patients' expectations and choices. Highlights: A discrete choice experiment was used to elicit patient preferences.People living with HIV preferred receiving medication refills at health facilities, less frequent visits, individual appointments, service delivery by health care workers, and lower visit costs.Health care workers should consider the preferences of patients while providing ART service to meet their expectations and choices.Scaling up differentiated HIV treatment services is crucial for patient-centered care.

Autonomy and freedom of choice: A mixed methods analysis of the endorsement of SRHR and its core principles by global agencies.

Based on an adapted version of the conceptual framework used by the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights (SRHR), this study sought to analyse to what extent seven global agencies, five of which belong to the UN family and the other two closely linked, incorporate women's autonomy and freedom of choice in accessing services into their SRHR policies, and how they operationalize these in their global SRHR programmes that target women and adolescent girls. Twenty-nine SRHR-related policy documents published in 2013-2020 and 17 independent evaluations of global SRHR programmes in the same period were analysed. They were found to fall short of considering women's individual autonomy and choice as the two core principles of SRHR. By ignoring autonomy and choice, global SRHR programmes missed the opportunity to incorporate activities that could enhance the emancipatory empowerment of women and girls to improve their sexual and reproductive wellbeing. The study identified concrete aspects on which global agencies, in view of their respective mandates, could have pronounced themselves more explicitly and might have been more effective in implementing SRHR programmes. In light of the international gender equality and women's empowerment discourse this suggests that donor countries could hold global agencies more accountable, bilaterally or jointly, for their SRHR performance, in particular their active endorsement and application of SRHR core principles.

Features of extreme PM 2.5 pollution and its influencing factors: evidence from China.

Extreme PM 2.5 pollution has become a significant environmental problem in China in recent years, which is hazardous to human health and daily life. Noticing the importance of investigating the causes of extreme PM 2.5 pollution, this paper classifies cities across China into eight categories (four groups plus two scenarios) based on the generalized extreme value (GEV) distribution using hourly station-level PM 2.5 concentration data, and a series of multi-choice models are employed to assess the probabilities that cities fall into different categories. Various factors such as precursor pollutants and socio-economic factors are considered after controlling for meteorological conditions in each model. It turns out that SO 2 concentration, NO 2 concentration, and population density are the top three factors contributing most to the log ratios. Moreover, in both left- and right-skewed cases, the influence of a one-unit increase of SO 2 concentration on the relative probability of cities falling into different groups shows an increasing trend, while those of NO 2 concentration show a decreasing trend. At the same time, the higher the extreme pollution level, the bigger the effect of SO 2 and NO 2 concentrations on the probability of cities falling into normalized scenarios. The multivariate logit model is used for prediction and policy simulations. In summary, by analyzing the influences of various factors and the heterogeneity of their influence patterns, this paper provides valuable insights in formulating effective emission reduction policies.

Understanding author choices in the current conservation publishing landscape.

Conservation literature addresses a broad spectrum of interdisciplinary questions and benefits. Conservation science benefits most when a diverse range of authors are represented, particularly those from countries where much conservation work is focused. In other disciplines, it is well known that barriers and biases exist in the academic publishing sphere, which can affect research dissemination and an author's career development. We used a discrete choice experiment to determine how 7 journal attributes affect authors' choices of where to publish in conservation. We targeted authors directly by contacting authors published in 18 target journals and indirectly via communication channels for conservation organizations. We only included respondents who had previously published in a conservation-related journal. We used a multinomial logit model and a latent class model to investigate preferences for all respondents and distinct subpopulations. We identified 3 demographic groups across 1038 respondents (older authors from predominantly middle-income countries, younger authors from predominantly middle-income countries, and younger authors from high-income countries) who had published in conservation journals. Each group exhibited different publishing preferences. Only 2 attributes showed a consistent response across groups: cost to publish negatively affected journal choice, including authors in high-income countries, and authors had a consistent preference for double-blind review. Authors from middle-income countries were willing to pay more for society-owned journals, unlike authors from high-income countries. Journals with a broad geographical scope that were open access and that had relatively high impact factors were preferred by 2 of the 3 demographic groups. However, journal scope and open access were more important in dictating journal choice than impact factor. Overall, different demographics had different preferences for journals and were limited in their selection based on attributes such as open access policy. However, the scarcity of respondents from low-income countries (2% of respondents) highlights the pervasive barriers to representation in conservation research. We recommend journals offer double-blind review, reduce or remove open access fees, investigate options for free editorial support, and better acknowledge the value of local-scale single-species studies. Academic societies in particular must reflect on how their journals support conservation and conservation professionals.

Comprensión de las elecciones de los autores en el entorno actual de publicaciones sobre la conservación Resumen La bibliografía sobre conservación aborda un amplio espectro de preguntas y beneficios interdisciplinarios. La mayor parte de ella representa una gama diversa de autores, sobre todo de países en los que se centra gran parte del trabajo de conservación. Es bien sabido que en otras disciplinas existen barreras y sesgos en el ámbito de la publicación académica que pueden afectar a la difusión de la investigación y al desarrollo de la carrera de un autor. Usamos un experimento de elección discreta para determinar cómo afectan siete atributos de las revistas sobre conservación en la elección de los autores sobre en cuál publicar. Nos dirigimos directamente a los autores y nos pusimos en contacto con quienes publicaban en 18 revistas objetivo e indirectamente a través de los canales de comunicación de las organizaciones de conservación. Sólo incluimos a los encuestados que habían publicado anteriormente en una revista relacionada con la conservación. Usamos un modelo logit multinominal y un modelo de clases latentes para investigar las preferencias de todos los encuestados y de las distintas subpoblaciones. Identificamos tres grupos demográficos entre los 1038 encuestados (autores de más edad de países con predominancia de ingresos medios, autores más jóvenes de países con predominancia de ingresos medios y autores más jóvenes de países con ingresos altos) que habían publicado en revistas de conservación. Cada grupo mostraba preferencias editoriales diferentes. Sólo dos atributos mostraron una respuesta coherente en todos los grupos: el costo de la publicación afectaba negativamente a la elección de la revista, incluidos los autores de países con ingresos altos, y los autores tenían una preferencia coherente por la revisión doble ciego. Los autores de países con ingresos medios están dispuestos a pagar más por las revistas pertenecientes a la sociedad, a diferencia de los autores de países de ingresos altos. Dos de los tres grupos demográficos prefieren las revistas de ámbito geográfico amplio, de acceso abierto y con un factor de impacto relativamente alto. Sin embargo, el alcance de la revista y el acceso abierto fueron más importantes que el factor de impacto. En general, los distintos grupos demográficos tenían preferencias diferentes en cuanto a las revistas y su selección se veía limitada por atributos como la política de acceso abierto. No obstante, la falta de encuestados procedentes de países con bajos ingresos (2% de los encuestados) destaca las barreras generalizadas para la representación en la investigación sobre conservación. Recomendamos que las revistas ofrezcan revisiones doble ciego, reduzcan o eliminen las tarifas de acceso abierto, investiguen opciones de apoyo editorial gratuito y reconozcan mejor el valor de los estudios de una sola especie a escala local. Las sociedades académicas, en particular, deben reflexionar sobre la forma en que sus revistas apoyan la conservación y a los profesionales de la conservación.

Preferences for a Clostridioides difficile vaccine among adults in the United States.

INTRODUCTION: Clostridioides difficile (C.diff) infection (CDI) causes significant morbidity and mortality among older adults. Vaccines to prevent CDI are in development; however, data on the target population's preferences are needed to inform vaccination recommendations in the United States (US). This study assessed US adults' willingness to receive a C.diff vaccine and examined how vaccine attributes influence their choices. METHODS: A cross-sectional online survey with a discrete choice experiment (DCE) was conducted among US adults aged ≥50 years. DCE attributes included effectiveness, duration of protection, reduction in symptom severity, out-of-pocket (OOP) costs, number of doses, and side effects. The DCE included 11 choice tasks, each with two hypothetical vaccine profiles and an opt-out (i.e., no vaccine). Attribute-level preference weights were estimated using hierarchical Bayesian modeling. Attribute relative importance (RI) was compared between select subgroups. RESULTS: Of 1216 adults in the analyses, 29.9% reported they knew either 'a little' (20.7%) or 'a lot' (9.2%) about C.diff before the study. A C.diff vaccine was chosen 58.0% of the time (vs. opt-out) across choice tasks. It was estimated that up to 75.0% would choose a vaccine when OOP was $0. Those who were immunocompromised/high-risk for CDI (vs. not) more frequently chose a C.diff vaccine. Decreases in OOP costs (RI = 56.1), improvements in vaccine effectiveness (RI = 17.7), and reduction in symptom severity (RI = 10.3) were most important to vaccine choice. The rank ordering of attributes by importance was consistent across subgroups. CONCLUSION: OOP cost, improvements in vaccine effectiveness, and reduction in CDI severity were highly influential to vaccine selection. Most adults aged ≥50 years were receptive to a C.diff vaccine, especially with little-to-no OOP cost, suggesting that mandating insurance coverage of vaccination with no copayment may increase uptake. The limited awareness about C.diff among adults presents an opportunity for healthcare providers to educate their patients about CDI prevention.

Mounting an immune response reduces male attractiveness in a lizard.

Parasites impact host fitness and constitute an important selective pressure on the host's life history. According to parasite-mediated sexual selection, ornaments are presumed to honestly indicate immune capacity or resistance against parasites, and the chooser sex (typically females) obtains an advantage by selecting more ornamented, thus more immunocompetent mates. Therefore, signalers mounting an immune response must allocate resources from the sexual signal to the immune system, hence reducing the expression of the ornament and becoming less attractive to the choosing sex. Here, we test this idea in the lizard Psammodromus algirus. We inoculated a subsample of males with lipopolysaccharide (LPS) of the cell wall of Escherichia coli, while others served as sham controls. The inoculation of LPS decreased the proportion of ergosterol (pro-vitamin D2) in femoral secretions, and chemosensory tests showed that the scent of LPS-inoculated males was less attractive to females than the scent of control males. Given that ergosterol is a precursor of vitamin D, which has physiological functions as an immune modulator, immunocompromised males likely needed to divert vitamin D to the immune system, reducing the allocation of ergosterol to secretions. In this way, females could detect "sick" males, preferring the apparently healthy males. Overall, our study shows that mounting an immune response is costly in terms of reduced attractiveness. Moreover, we disentangle the underlying mechanism, which involves an honest signal based on vitamin D allocation.

Motivators and barriers for studying podiatry in Australia and New Zealand: A mixed methods study.

BACKGROUND: Podiatry enrolments at Australian and New Zealand universities have decreased by 17.3% since 2015, which threatens the profession's sustainability and the health and wellbeing of Australian and New Zealand people and communities. Reasons for this decline remain unclear due to insufficient evidence on factors influencing career choices. The overarching aim of this study was to identify motivators and barriers for studying podiatry in Australia and New Zealand. METHODS: This study used a convergent mixed methods design. Students enrolled in (i) podiatry and (ii) relevant non-podiatry health, sport or science programs at nine Australian and one New Zealand university, were invited to participate in an online survey. First-year podiatry students were also invited to participate in an online workshop. Quantitative data were analysed using descriptive statistics and linear/logistic regression models. Three independent assessors used inductive thematic analysis for the qualitative data. RESULTS: Overall, 278 podiatry students (mean age 24.9 ± 8.5 years, 65.1% female) and 553 non-podiatry students (mean age 24.8 ± 8.2 years, 75.4% female; 32.2% from physiotherapy and 29.1% from occupational therapy) responded to the survey. Interest in a health-related career, wanting to make a difference to people's health, and opportunity to care for people from different backgrounds/age groups were key motivating factors among podiatry students. Barriers to studying podiatry were encountered by 28.1% of podiatry students. Thematic analysis identified seven themes concerning career choice, which are as follows: (i) awareness of profession and scope of practice; (ii) stereotypes and negative perceptions of the profession; (iii) awareness of career pathways; (iv) job prospects and earning potential; (v) working with people and building relationships; (vi) podiatry is not the first preference; and (vii) barriers which limit student enrolment. CONCLUSIONS: There are a variety of factors that motivate and influence students to study podiatry, however, altruistic reasons are most highly rated. Allied health students have limited understanding of the scope of practice and career opportunities in podiatry. Additionally, the podiatry profession often faces negative stereotypes. Further work is required to reverse the negative stereotypes and perceptions of podiatry and build knowledge of the profession's scope of practice, career pathways/opportunities, job prospects and earning potential.

Cannabis consumers' preferences for legal and illegal cannabis: evidence from a discrete choice experiment.

BACKGROUND: In U.S. states that legalized and commercialized recreational cannabis, cannabis sales in illegal markets are still sizable or even larger than those in legal markets. This study aimed to assess cannabis consumers' preferences for purchasing cannabis from legal and illegal markets and estimate the trade-offs under various policy scenarios. METHODS: 963 adults were recruited, who used cannabis in the past year and lived in a state with recreational cannabis legalization. In a discrete choice experiment, participants chose purchasing cannabis from a legal dispensary or an illegal dealer with varying levels in product attributes including quality, safety, accessibility, potency, and price. Mixed logit models were used to analyze preferences. RESULTS: The likelihood of choosing legal cannabis increased with a higher quality, the presence of lab test, a shorter distance to seller, a higher tetrahydrocannabinol level, and a lower price. The likelihood of choosing illegal cannabis increased with a higher quality, a shorter distance to seller, and a lower price. Among product attributes, quality and accessibility were perceived to be the most important for legal cannabis and price was perceived to be the most important for illegal cannabis. Policy simulations predicted that improving quality, ensuring safety, allowing delivery services, increasing dispensary density, and lowering prices/taxes of legal cannabis may reduce illegal cannabis market share. CONCLUSIONS: In the U.S., cannabis consumers' preferences for illegal cannabis were associated with both legal and illegal cannabis product attributes. Policies regulating legal cannabis markets should consider potential spillover effects to illegal markets.

EXPRESS: When feedback backfires - Knowledge of results can impair cognitive strategy choice.

Frequently, problems can be solved in more than one way. In modern computerized environments, more ways than ever exist. Naturally, human problem solvers do not always decide for the best-performing strategy available. One underlying reason might be the inability to continuously and correctly monitor each strategy's performance. Here, we supported some of our participants' monitoring ability by providing written feedback regarding their speed and accuracy. Specifically, participants engaged in an object comparison task, which they were asked to solve with one of two strategies: an internal strategy (mental rotation) or an extended strategy (manual rotation). After receiving no feedback (30 participants), trialwise feedback (30 participants), or blockwise feedback (30 participants) in these no choice trials, all participants were asked to estimate their performance with both strategies and were then allowed to freely choose between strategies in choice trials. Results indicated that written feedback improves explicit performance estimates. However, results also indicated that such increased awareness does not guarantee improved strategy choice and that attending to written feedback might tamper with more adaptive ways inform the choice. Thus, we advise against prematurely implementing written feedback. While it might support adaptive strategy choice in certain environments, it did not in the present setup. We encourage further research that improves the understanding of how we monitor the performance of different cognitive strategies. Such understanding will help create interventions that support human problem solvers in making better choices in the future.

Comparing the Self-Reported Acceptability of Discrete Choice Experiment and Best-Worst Scaling: An Empirical Study in Patients with Type 2 Diabetes Mellitus.

Purpose: Discrete choice experiment (DCE) and profile case (case 2) best-worst scaling (BWS) present uncertainties regarding the acceptability of quantifying individual healthcare preferences, which may adversely affect the validity of responses and impede the reflection of true healthcare preferences. This study aimed to assess the acceptability of these two methods from the perspective of patients with type 2 diabetes mellitus (T2DM) and examine their association with specific characteristics of the target population. Patients and Methods: This cross-sectional study was based on a nationally representative survey; data were collected using a multistage stratified cluster-sampling procedure between September 2021 and January 2022. Eligible adults with confirmed T2DM voluntarily participated in this study. Participants completed both the DCE and case 2 BWS (BWS-2) choice tasks in random order and provided self-reported assessments of acceptability, including task completion difficulty, comprehension of task complexity, and response preference. Logistic regression and random forest models were used to identify variables associated with acceptability. Results: In total, 3286 patients with T2DM were included in the study. Respondents indicated there was no statistically significant difference in completion difficulty between the DCE and BWS-2, although the DCE scores were slightly higher (3.07 ± 0.68 vs 3.03 ± 0.67, P = 0.06). However, 1979 (60.2%) respondents found the DCE easier to comprehend. No significant preferences were observed between the two methods (1638 (49.8%) vs 1648 (50.2%)). Sociodemographic factors, such as residence, monthly out-of-pocket costs, and illness duration were significantly associated with comprehension complexity and response preference. Conclusion: This study yielded contrasting results to most of previous studies, suggesting that DCE may be less cognitively demanding and more suitable for patients with T2DM from the perspective of self-reported acceptability of DCE and BWS. This study promotes a focus on patient acceptability in quantifying individual healthcare preferences to inform tailored optimal stated-preference method for a target population.

Stated preference methodologies such as the discrete choice experiment (DCE) and case 2 best-worst scaling (BWS-2) are gaining popularity as methods for quantifying individual preferences in healthcare. However, the acceptability of the two methods to participants must be considered in practice to reduce cognitive burden and ensure the validity of preference elicitation.DCE was perceived to be less cognitively burdensome than BWS-2. In contrast to patients who thought that DCE was more acceptable, BWS-2 was more accepted by rural patients, patients who lived with the disease for a longer period, and those who had lower monthly out-of-pocket costs.These findings demonstrate potential differences in the acceptability of DCE and BWS-2 for patients with type 2 diabetes mellitus. To improve efficiency, it would be useful for researchers to consider the optimal stated preference method for identifying target populations according to sociodemographic and disease-related characteristics.

How can we measure resource quality when resources differ in many ways? Deconstructing shelter quality in a social fish.

Resource quality is an important concept in ecology and evolution that attempts to capture the fitness benefits a resource affords to an organism. Yet "quality" is a multivariate concept, potentially affected by many variables pertaining to the resource, its surroundings, and the resource chooser. Researchers often use a small number of proxy variables to simplify their estimation of resource quality, but without vetting their proxies against a wider set of potential quality estimators this approach risks overlooking potentially important characteristics that can explain patterns of resource use in their study systems. Here we used Neolamprologus multifasciatus, a group-living cichlid fish that utilizes empty snail shells as shelter resources, to examine how shells were used by, and partitioned among, group members in relation to a range of attributes, including shell size, intactness, texture, spatial position, and usage by heterospecifics. This approach generated a comprehensive picture of what characteristics contribute to the attractiveness and quality of each shell resource, confirming the importance of two previously proposed shell characteristics, size and intactness, but highlighting the influences of other unexplored variables, including shell spatial position and usage by heterospecifics. We also present a generally applicable "resource attractiveness index" as a means to estimate resource quality based on resource choice data. This index incorporates information from any number of resource characteristics and is of particular use when researchers wish to quantify resource value, but many characteristics jointly contribute to the value and attractiveness of the resource.

Performance validity in a presurgical epilepsy population.

Objective: This study examined the performance validity test (PVT) pass/fail rate in a sample of presurgical epilepsy candidates; assessed whether performance validity was associated with reduced performance across cognitive domains; investigated the relationship between performance validity and self-report mood questionnaires; and assessed whether PVT performance was associated with demographic or clinical factors (i.e. sex, race/ethnicity, age, years of education, reported history of special education, seizure longevity, and number of anti-seizure medications). Methods: One hundred and eighty-three presurgical epilepsy candidates were examined. Each patient's assessment battery included a stand-alone performance validity measure and two embedded validity measures. Results: PVT failure rate in this sample (10%) was associated with reduced performance on all neurocognitive measures: Full Scale IQ (FSIQ; r = -0.26), CVLT-II Total Learning (r = -0.36) and Long Delay Free Recall (LDFR; r = -0.38), BVMT-R Delayed Recall (r = -0.28), and Wisconsin Card Sorting Test (Categories Completed; r = -0.32). In addition, PVT failure rate was associated with elevated scores on the Beck Anxiety Inventory (r = .22) but not on the Beck Depression Inventory (BDI-II; r = .14). Correlations that were significant at the α = 0.05 level maintained significance following post hoc Bonferroni correction. The valid and invalid groups did not differ significantly in sex, race/ethnicity, age, years of education, reported history of special education, seizure longevity, and number of anti-seizure medications. Conclusions: Results from this study suggest that PVT performance was not impacted by demographic or clinical factors and therefore may be a reliable indicator of performance validity in a presurgical epilepsy sample.

Assessment of demand for male contraceptives: A multi-country study.

BACKGROUND: As of 2019, high unmet contraceptive needs in low- and middle-income countries result in nearly half of all pregnancies being unintended. Additional male contraceptive options could help, but gaps remain in assessing demand for them. As the development of novel male contraceptives progresses, addressing these gaps would help inform policy and scientific direction. OBJECTIVES: Measure consumer demand for novel male contraceptives and identify product attributes associated with men's preferences. MATERIALS & METHODS: A cross-sectional, probability-based-sample survey was conducted with 12,435 sexually active, fertile cisgender, heterosexual men aged 18-60 years, and 9,122 of their female partners in Bangladesh, Vietnam, Kenya, Nigeria, DR Congo, and Côte d'Ivoire from May 2021 to October 2022. The survey was also conducted in the United States among 3,243 of these men in April 2022. A follow-up with 3,070 men in May 2023 assessed potential changes in demand after the Supreme Court's Dobbs v. Jackson Women's Health Organization decision. The surveys assessed contraceptive use, perceptions, and sociodemographic characteristics, and a discrete choice experiment evaluated preferences for 11 potential product attributes. Data from female partners in the six LMICs indicated their interest and trust in male partners' contraceptive use. RESULTS: On average, 61% of men showed interest in trying novel male contraceptives in their first year of availability, ranging from 39% and 49% (pre- and post-Dobbs) in the United States to 76% in Nigeria and Bangladesh. Form of administration and time of use drove men's product preferences. Female partners' interest and trust in male contraceptive use were high across geographies. DISCUSSION: This study reveals strong latent demand for novel male contraceptives, highlighting the potential for novel male methods to meet unmet needs, and female partners' trust in men to use them. CONCLUSION: High demand for novel male contraceptives among men and their partners exists, supporting investment in their development.

[The demographic, social and professional factors affecting choice of employment place and labor motivation of general practitioners and districts therapists].

The article considers social, demographic and professional factors determining choice by general practitioners and district therapists of place of employment and their professional motivation. The special questionnaire was developed to be applied in sociological survey. The sampling included general practitioners and district therapists of outpatient medical organizations of the Health Department and the private health care sector of Moscow. The final analysis included 399 questionnaires. It is established that possibility of job combining depends on number of children physician has. The significance of conditions for career growth increases with physician age and availability of adult children. The opportunities for research and education activities are of great value for physicians of private health sector who obtained higher education in Russia and having adult children. The preferred management style of line manager and model of communication with patient are affected by level of workload, working conditions and income level. The preferences regarding type of organizational culture are affected by place of birth. For physicians who graduated from Russian universities, significant factor of non-material incitement is possibility of additional rest. The physicians of older age working in private health sector more often consider career advancement as professional development goal. The factors influencing choice of place of employment and professional motivation in general practitioners and district therapists are summarized. The proposals for attracting, retaining and stimulating physicians are formulated.

Comparison of Multiple-Choice Question Formats in a First Year Medical Physiology Course.

The purpose of this study was to compare student performance and question discrimination of multiple-choice questions (MCQs) that followed a standard format (SF) versus those that do not follow a SF, termed here as non-standard format (NSF). Medical physiology exam results of approximately 500 first-year medical students collected over a five-year period (2020-2024) were used. Classical test theory item analysis indices, e.g. discrimination (D), point-biserial correlation (rpbis), distractor analysis for non-functional distractors (NFDs), and difficulty (p) were determined and compared across MCQ format types. The results presented here are the mean ± standard error of the mean (SEM). The analysis showed that D (0.278 ± 0.008 vs 0.228 ± 0.006) and rpbis (0.291 ± .006 vs 0.273 ± .006) were significantly higher for NSF questions compared to SF questions, indicating NSF questions provided more discriminatory power. In addition, the percentage of NFDs was lower for the NSF items compared to the SF ones (58.3 ± 0.019% vs 70.2 ± 0.015%). Also, the NSF questions proved to be more difficult relative to the SF questions (p = 0.741 ± 0.007 for NSF; p = 0.809 ± 0.006 for SF). Thus, the NSF questions discriminated better, had fewer NFDs, and were more difficult than SF questions. These data suggest that using the selected non-standard item writing questions can enhance the ability to discriminate higher performers from lower performers on MCQs as well as provide more rigour for exams.

Drivers and Barriers Influencing Adherence to the Mediterranean Diet: A Comparative Study across Five Countries.

Given the global decline in adherence to the Mediterranean Diet (MD), even within its native region, it is key to identify the factors influencing this trend to mitigate the negative health outcomes associated with westernized diets. To this end, 4025 individuals (49.6% women, 42.6 ± 14.2 y/o) from Greece, Italy, Morocco, Slovenia, and Tunisia remotely completed a series of measures assessing motives, attitudes, and psychosocial factors related to MD adherence, which was evaluated using the MEDAS questionnaire. The results suggested medium-to-low adherence across all countries, with the highest adherence in Italy and Morocco and the lowest in Slovenia. Structural equation modeling revealed that positive attitudes toward the healthiness of food were the strongest predictors of adherence, whereas picky eating was a significant negative predictor in all countries except Greece. Adherence to the MD was positively influenced by health motivations in Morocco and weight control in Slovenia and Greece, while sensory appeal negatively influenced adherence in Italy. Additionally, price and convenience were significant barriers in Tunisia and Greece, whereas a preference for local and seasonal foods promoted adherence in Morocco and Greece. Overall, our findings underscore the need for country-specific interventions and policies that address distinct local factors and motivations to ease favorable shifts in dietary patterns toward MD principles.

Sources of influence for choosing an operating department practitioner career: Findings from a questionnaire among students in England.

AIMS: The aim of this study was to explore the sources of influence which impact choosing an operating department practitioner career among current operating department practitioner students in England to inform recommendations for maximising recruitment and retention. METHODS: An online questionnaire was disseminated to allied health professional, inclusive of operating department practitioner, students in England in 2021. RESULTS: One hundred and fifty operating department practitioner students attending undergraduate courses completed the questionnaire. Personal influences, such as role models, were the key sources of influence for choosing an operating department practitioner career. Educational sources were the least influential. Gaining work experience or exposure to the theatre setting was perceived as key to address course attrition. Conducting one's own research was vital in learning more about the operating department practitioner role and influencing the decision to choose the profession. CONCLUSIONS: There are opportunities to utilise media and educational sources more effectively to influence individuals to choose an operating department practitioner career.

A study of patients' choice of medical treatment based on rational choice theory: a cross-sectional survey from China.

OBJECTIVE: To describe how patients choose between primary care institutions (PCIs) and non-PCIs using rational choice theory from the perspective of survival rationality, economic rationality, and social rationality. METHODS: Multi-stage stratified sampling and convenience sampling were applied to select 1723 patients to conduct the questionnaire survey. Chi-square test and binary logistic regression were performed to analyze the factors associated with patients' choice of PCIs. RESULTS: In total 55.83% of 1723 patients would attend a PCIs for healthcare. The results of the univariate analysis revealed that patients who are female (58.46%, P = .015), suffering from chronic diseases (56.26%, P = .047), inpatients (67.58%, P < .001), Beijing (59.62%, P = .002), partial understanding of the family doctor contracting system (62.30%, P < .001), and not understanding of the medical alliance policy (58.04%, P = .031) had significantly higher probability of choosing PCIs. Logistic regression analysis showed that females were more unwilling to attend PCIs (odds ratio (OR) = 0.822, 95%CI: 0.676-0.999). Following survival rationality, patients without chronic diseases were more likely to attend PCIs (OR = 1.834, 95%CI: 1.029-3.268), and inpatients were more unlikely to attend PCIs (OR = 0.581, 95%CI: 0.437-0.774). From an economic rationality perspective, patients from the Fujian province were more likely to attend PCIs (OR = 1.424, 95%CI: 1.081-1.876). From a social rationality perspective, patients who partial understanding of the family doctor contracting system were more unlikely to attend PCIs (OR = 0.701, 95%CI: 0.551-0.892), and patients who partial and complete understanding of the medical alliance policy were more likely to attend PCIs (OR = 1.340, 95%CI: 1.064-1.687; OR = 1.485, 95%CI: 1.086-2.030). CONCLUSIONS: Survival, economic, and social rationality are involved in patients' choice to attend PCIs. Compared to survival rationality and social rationality, economic rationality showed a lower association with patients' choice to attend PCIs. Medical institutions are recommended to adopt a "patient health-centered" approach when providing medical services and further optimize the family doctor contracting system and construction of medical alliances.

BMI and explicit-implicit cues on food choice: The fake food buffet in the United Kingdom and Indonesia.

We examined whether people with high BMI sampled from two different countries were more susceptible to behavioural change via an implicit, rather than explicit, intervention. We measured BMI and used three types of cue interventions (implicit vs explicit healthy lifestyle cue vs neutral cue) to examine their impact on our participants' food choice using the Fake Food Buffet. Healthiness of the meal chosen was measured by the percentage of healthy food items in the meal. Portion size of their chosen meal was operationalised by the total number of food items chosen and its total calorie content was also estimated. Participants were recruited from the United Kingdom (N = 264) and Indonesia (N = 264). Our results indicated that while explicit food cues were overall more effective, implicit cues were a more effective strategy to change food choice behaviours among individuals with high BMI. Participants with high BMI were more likely to regulate the healthiness of their meal and less likely to regulate its portion size or calorie content. The efficacy of our healthy eating interventions was cross-culturally generalizable. Our study supports previous research that implicit cues of a healthy lifestyle might be a more effective behavioural change strategy for individuals with high BMI.

A picture is worth a thousand words: Framing of food choice options affects decision conflict and mid-fontal theta in food choice task.

In food choices, conflict arises when choosing between a healthy, but less tasty food item and a tasty, but less healthy food item. The underlying assumption is that people trade-off the health and taste properties of food items to reach a decision. To probe this assumption, we presented food items either as colored images (image condition, e.g. photograph of a granola bar) or as pre-matched percentages of taste and health values (text condition, e.g., 20% healthy and 80% tasty). We recorded choices, response times and electroencephalography activity to calculate mid-frontal theta power as a marker of conflict. At the behavioral level, we found higher response times for healthy compared to unhealthy choices, and for difficult compared to easy decisions in both conditions, indicating the experience of a decision conflict. At the neural level, mid-frontal theta power was higher for healthy choices than unhealthy choices and difficult choices compared to easy choices, but only in the image condition. Those results suggest that either conflict type and/or decision strategies differ between the image and text conditions. The present results can be helpful in understanding how dietary decisions can be influenced towards healthier food choices.