The role of gene-environment interaction in the formation of risk attitudes.

Understanding the formation of risk preferences is crucial for elucidating the roots of economic, social, and health inequalities. However, this area remains inadequately explored. This study employs a risk preference measure directly linked to the labor market to examine whether previous experiences with high unemployment rates influence current risk decision-making among the elderly, and whether this impact varies by genotype. The findings indicate that individuals with low genetic predispositions for risk tolerance are more significantly influenced by historical fluctuations in unemployment rates than those with high genetic predispositions for risk tolerance. Consequently, this paper identifies genetic endowment as a crucial moderating factor that shapes how past experiences impact current decision-making processes. This disparity in how past experiences shape risk preferences based on genetic predisposition may further amplify inequalities in health, wealth, income, and other outcomes associated with risk preferences.

Patient preferences for the provision of NHS medicines helpline services: a discrete choice experiment.

Introduction: Patient medicines helpline services (PMHS) can reduce harm and improve medicines adherence and patient satisfaction after hospital discharge. There is little evidence of which PMHS attributes are most important to patients. This would enable PMHS providers to prioritise their limited resources to maximise patient benefit. Methods: Patient preferences for PMHS attributes were measured using a discrete choice experiment. Seven attributes were identified from past research, documentary analysis and stakeholder consultation. These were used to produce a D-efficient design with two blocks of ten choice sets incorporated into an online survey. Adults in the UK who took more than one medicine were eligible to complete the survey and were recruited via the Research for the Future database. Preferences were estimated using conditional logistic regression. Associations between participant characteristics and preferences were investigated with latent class models. Results: 460 participants completed the survey. The most valued attributes were weekend opening (willingness-to-pay, WTP: £11.20), evening opening (WTP: £8.89), and receiving an answer on the same day (WTP: £9.27). Alternative contact methods, immediate contact with a pharmacist and helpline location were valued less. Female gender and full-time work were associated with variation in preferences. For one latent class containing 27% of participants, PMHS location at the patient's hospital was the most valued attribute. Discussion: PMHS providers should prioritise extended opening hours and answering questions on the same day. Limitations include a non-representative sample in terms of ethnicity, education and geography, and the exclusion of people without internet access.

Artificial intelligence driven definition of food preference endotypes in UK Biobank volunteers is associated with distinctive health outcomes and blood based metabolomic and proteomic profiles.

BACKGROUND: Specific food preferences can determine an individual's dietary patterns and therefore, may be associated with certain health risks and benefits. METHODS: Using food preference questionnaire (FPQ) data from a subset comprising over 180,000 UK Biobank participants, we employed Latent Profile Analysis (LPA) approach to identify the main patterns or profiles among participants. blood biochemistry across groups/profiles was compared using the non-parametric Kruskal-Wallis test. We applied the Limma algorithm for differential abundance analysis on 168 metabolites and 2923 proteins, and utilized the Database for Annotation, Visualization and Integrated Discovery (DAVID) to identify enriched biological processes and pathways. Relative risks (RR) were calculated for chronic diseases and mental conditions per group, adjusting for sociodemographic factors. RESULTS: Based on their food preferences, three profiles were termed: the putative Health-conscious group (low preference for animal-based or sweet foods, and high preference for vegetables and fruits), the Omnivore group (high preference for all foods), and the putative Sweet-tooth group (high preference for sweet foods and sweetened beverages). The Health-conscious group exhibited lower risk of heart failure (RR = 0.86, 95%CI 0.79-0.93) and chronic kidney disease (RR = 0.69, 95%CI 0.65-0.74) compared to the two other groups. The Sweet-tooth group had greater risk of depression (RR = 1.27, 95%CI 1.21-1.34), diabetes (RR = 1.15, 95%CI 1.01-1.31), and stroke (RR = 1.22, 95%CI 1.15-1.31) compared to the other two groups. Cancer (overall) relative risk showed little difference across the Health-conscious, Omnivore, and Sweet-tooth groups with RR of 0.98 (95%CI 0.96-1.01), 1.00 (95%CI 0.98-1.03), and 1.01 (95%CI 0.98-1.04), respectively. The Health-conscious group was associated with lower levels of inflammatory biomarkers (e.g., C-reactive Protein) which are also known to be elevated in those with common metabolic diseases (e.g., cardiovascular disease). Other markers modulated in the Health-conscious group, ketone bodies, insulin-like growth factor-binding protein (IGFBP), and Growth Hormone 1 were more abundant, while leptin was less abundant. Further, the IGFBP pathway, which influences IGF1 activity, may be significantly enhanced by dietary choices. CONCLUSIONS: These observations align with previous findings from studies focusing on weight loss interventions, which include a reduction in leptin levels. Overall, the Health-conscious group, with preference to healthier food options, has better health outcomes, compared to Sweet-tooth and Omnivore groups.

Patient considerations of social media account management after death.

PURPOSE: Social media is widely used but few studies have examined how patients with advanced cancer want their accounts managed after death. The objective of this study was to determine the proportion of our patients with advanced cancer who have discussed the post-mortem management of their social media accounts with their family or friends. METHODS: This was a cross-sectional survey in which patients with advanced cancer at an outpatient Supportive Care Clinic at a tertiary cancer center completed a novel survey on social media use that assessed patients' social media use practices, attitudes and preferences, and reactions to the survey. RESULTS: Of 117 patients, 72 (61.5%) were women, and the mean age was 56.4 years old. We found that 24 (21%) of our patients have discussed their preferences for management of their social media accounts after death. Patients with a lower annual income were significantly more likely to report having such conversations (p = 0.0036). Completing the survey motivated 76 patients (67%) to discuss their social media accounts and 82 patients (71.3%) to explore how social media will be managed after their death. Half of our study participants reported social media as an important source of coping. CONCLUSION: Few patients have had conversations on the management of their accounts after death, although more were interested in exploring their options further. More research is needed to examine the role of social media as a digital legacy and a coping tool for patients with advanced cancer.

Gender preferences for multiple attributes of soil and water conservation in Northern Rwanda.

Despite the dominance of female labor in agricultural production, female-controlled farm plots have lower efficiency compared to plot managed by male-headed households, which indicates a huge gender disparity in agricultural productivity. Overlooking gender preferences when designing interventions that promote the conservation of soil and water resources might face challenges in adoption and could result in ineffective policies to close the gender gap. This study seeks to analyze gender-specific preferences regarding attributes of soil and water conservation (SWC) in northern Rwanda. A best-worst survey was conducted among 653 respondents, comprising 253 males and 400 females, representing 422 households surveyed between September and December 2019. The analysis of BWS data involved assessing attribute-level relative importance, Pearson correlation, and maximum difference scaling using multinomial logit (MNL). Findings from attribute-level importance analysis revealed significant gender-based disparities in preferences across three important SWC attribute scenarios: the high scenario (between 65 % and 100 %), the moderate scenario (between 50 % and 65 %), and the basic scenario (with <50 % relative importance). The study identified heterogeneity in preferences regarding the relative importance of SWC attribute levels. Pearson correlation analysis revealed substantial synergies among attribute levels linked to land consolidation, improved land tenure, and joint SWC decision-making between genders. Additionally, the study identified trade-offs among multiple levels of SWC attributes, including households' SWC decision-making and physical and structural measures. The results from MNL regression show that both males and females exhibit positive preferences for multiple levels of SWC attributes, but show negative preferences when it comes to household decisions involving multiple SWC strategies. The study highlights the importance of equal opportunities for males and females' participation in agricultural transformation through the adoption of SWC technologies as a fundamental step towards sustainable agricultural intensification. It advocates for gender transformational approaches to incentivize the scaling up of SWC practices and promote packages with lower uptake rates. Additionally, the study suggests enhancing knowledge and extension education in SWC to better understand diverse needs and preferences of female farmers.

Virtual Service Delivery in Mental Health and Substance Use Care: A Systematic Review of Preference Elicitation Studies.

Mental health and substance use disorders affect the lives of many people worldwide. Prevention and treatment of these conditions is important for optimal health and wellbeing, yet service access barriers are common. Virtual models of care may help to reduce barriers to receiving care. However, to facilitate uptake and use of virtual services, they need to appeal to patients and clinicians. This systematic review aimed to synthesise preference elicitation studies to determine what features of virtual mental health and substance use care are preferred by service users and service providers. Following the PRISMA guidelines for systematic reviews, we searched PubMed, PsycINFO, EconLit, MEDLINE, CINAHL, Academic Search Ultimate, and ProQuest Central for all available studies from database inception until May 2023. The Mixed Methods Appraisal Tool was used to assess the methodological quality of included studies. Nineteen studies met the eligibility criteria. However, none examined preferences for elements of different models of virtual care. Across the included studies, we identified 41 unique features that mapped to four themes of mental health and substance use care ('service', 'treatment', 'clinician' and 'additional supports'). Participant preferences were for individual, in-person, effective, flexible, and low-cost treatment. These preferences varied based on demographic factors, such as culture, gender, and participant type (e.g., patients, clinicians, general population). A user-centred approach should be adopted when designing and implementing mental health and substance use services. While preferences for features of mental health and substance use services more broadly are known, preferences for different models of virtual care remain unexplored. Future research should examine what features of virtual services would lead to optimal uptake and use across different users and stakeholders.

Time preference shifts in medical decision-making after serious illness.

This study explores the impact of serious illnesses, such as cancer, on patients' time preferences in medical decision-making. Specifically, we assess how patients value extending their lifespan by one year under varying survival prognoses through three experimental studies. The findings reveal that patients exhibit a higher Subjective Discount Rates (SDR) in their medical decisions after a serious illness diagnosis. Notably, this difference in individual health also affects the time preferences of their family members. Additionally, the subjective contextual setting of the illness can also increase an individual's SDR levels. The research highlights a tendency for patients and families facing a potential short life expectancy to focus more on immediate concerns, leading to potentially shortsighted and irrational medical choices. This behavior often results in regret during the end-of-life stage. These insights are vital for healthcare professionals in optimizing treatment plans and for policymakers in understanding patient behaviors more comprehensively. The study emphasizes the need for considering psychological and behavioral changes in patients grappling with severe health challenges.

Bayesian model of tilling wheat confronting climatic and sustainability challenges.

Conventional farming poses threats to sustainable agriculture in growing food demands and increasing flooding risks. This research introduces a Bayesian Belief Network (BBN) to address these concerns. The model explores tillage adaptation for flood management in soils with varying organic carbon (OC) contents for winter wheat production. Three real soils, emphasizing texture and soil water properties, were sourced from the NETMAP soilscape of the Pang catchment area in Berkshire, United Kingdom. Modified with OC content at four levels (1, 3, 5, 7%), they were modeled alongside relevant variables in a BBN. The Decision Support System for Agrotechnology Transfer (DSSAT) simulated datasets across 48 cropping seasons to parameterize the BBN. The study compared tillage effects on wheat yield, surface runoff, and GHG-CO2 emissions, categorizing model parameters (from lower to higher bands) based on statistical data distribution. Results revealed that NT outperformed CT in the highest parametric category, comparing probabilistic estimates with reduced GHG-CO2 emissions from "7.34 to 7.31%" and cumulative runoff from "8.52 to 8.50%," while yield increased from "7.46 to 7.56%." Conversely, CT exhibited increased emissions from "7.34 to 7.36%" and cumulative runoff from "8.52 to 8.55%," along with reduced yield from "7.46 to 7.35%." The BBN model effectively captured uncertainties, offering posterior probability distributions reflecting conditional relationships across variables and offered decision choice for NT favoring soil carbon stocks in winter wheat (highest among soils "NT.OC-7%PDPG8," e.g., 286,634 kg/ha) over CT (lowest in "CT.OC-3.9%PDPG8," e.g., 5,894 kg/ha). On average, NT released minimum GHG- CO2 emissions to "3,985 kgCO2eqv/ha," while CT emitted "7,415 kgCO2eqv/ha." Conversely, NT emitted "8,747 kgCO2eqv/ha" for maximum emissions, while CT emitted "15,356 kgCO2eqv/ha." NT resulted in lower surface runoff against CT in all soils and limits runoff generations naturally for flood alleviation with the potential for customized improvement. The study recommends the model for extensive assessments of various spatiotemporal conditions. The research findings align with sustainable development goals, e.g., SDG12 and SDG13 for responsible production and climate actions, respectively, as defined by the Agriculture and Food Organization of the United Nations.

Consumer preference and willingness-to-pay for formal recycling of electric vehicle batteries: A discrete choice experiment in China.

The burgeoning electric vehicle (EV) market poses a substantial challenge to battery recycling systems, yet understanding EV battery recycling behavior from the demand side remains limited. Previous studies have analyzed perceptual or attitudinal factors, neglecting the observable attributes of EV battery recycling. To this end, we proposed a discrete choice model to investigate the differences between formal and informal recycling behaviors, identifying consumer preferences and willingness to pay. By analyzing 1190 sample data collected from Chongqing, China, we find that: (1) The formal recycling market exhibits greater sensitivity to prices compared to the informal recycling market. (2) The formal recycling market favors recycling by EV battery producers, whereas the informal recycling market shows the least preference for recycling by automobile producers. (3) Door-to-door recycling services are the most effective in facilitating the transition from informal to formal recycling markets for EV batteries. (4) Capacity subsidy policies outperform one-time fixed subsidy policies in incentivizing formal recycling. (5) The formal recycling market for EV batteries necessitates "traceability to the recycling outlet", as opposed to being untraceable. (6) The high-awareness group exhibits greater sensitivity to government policies compared to those with lower environmental concerns and less knowledge of EV battery recycling.

Preferences for coordinated care for rare diseases: discrete choice experiment.

BACKGROUND: Evidence suggests that coordination of care for people affected by rare diseases is poor. In order to improve the way that care is coordinated it is necessary to understand the preferences of people affected by these conditions, and providers. The aim of this study was to examine patient, parent and carer, and health care professional preferences for different attributes of care coordination for people affected by rare diseases. We conducted a discrete choice experiment using online surveys. There were no restrictions on participants in terms of rare conditions, demographic factors other than age, or geographical location within the UK. Choice scenarios were based on the following attributes: annual cost of attending appointments; access to health records; access to clinical expertise; support of a care coordinator; access to a specialist centre; and, the existence of a documented plan for emergency care. Data were analysed using alternative-specific conditional logit regression models. RESULTS: Valid responses were obtained from 996 individuals (528 patients, 280 carers, 188 health care professionals) between August and December 2019. All attributes significantly influenced the type of service respondents preferred. Patients, carers and health professionals' preferences for care coordination were influenced by: the cost of attending appointments; access to health records; clinical expertise; role of care coordinators; access to specialist centres; and the existence of plan for emergency care. There were no statistically significant differences in the preferences between patients and carers. Preferences of health professionals differed to those of patients and carers. Both patients and carers selected responses which granted them a greater degree of autonomy in relation to the role of care coordinators, whereas health professionals preferred services where care coordinators had more autonomy. Health care professionals also expressed a stronger preference for a documented formal emergency plan to be in place. CONCLUSIONS: The findings highlight that people value better coordinated care, in line with policy documents emphasising commitments to coordinated care for people affected by rare diseases. This study highlights the factors that could be included in service provision as ways of improving the coordination of care for people affected by rare diseases.

Understanding the seasonal dietary patterns of the golden jackal (Canis aureus) for conservation implications in the Hirpora Wildlife Sanctuary, Western Himalayas.

Background: Wild canids form an important component of the ecosystem but are generally less studied and least prioritized for conservation. Diet is fundamental for effective management and exhibits the role of a species in an ecosystem. Golden jackal (Canis aureus, Linnaeus, 1758), a medium-sized canid species is known for opportunistic and omnivorous foraging behavior. Methods: This research investigates the feeding ecology of golden jackals within the Hirpora Wildlife Sanctuary, Western Himalayas. From August 2020 to July 2022, trails (n = 9; 1.5-5.5 km) were walked seasonally (once per month) to collect fecal samples (n = 128) for investigation of seasonal diet composition and dietary niche breadth and biomass consumption of prey items by golden jackal. The association between the coefficient of digestibility value and food items was assessed using the Pearson correlation. We also conducted PCA to understand contribution of major dietary items. Results: Scat analysis revealed that jackals feed on both animal and plant matter. Animal matter constituted most of the diet, encompassing small mammals and domestic livestock, insects, and birds. Rodents emerge as the dominant dietary item, maintaining consistent prevalence year-round. Livestock carrion, notably domestic sheep formed a significant component across all seasons, with maximal consumption observed in summer. Notably absent from the jackals' diet were traces of threatened mountain ungulates. Domestic sheep emerged as the primary contributor (33.4 %) to the overall biomass consumed, highlighting the jackals' interaction with human-associated food resources. The research unveils an overall dietary niche breadth of 0.38, indicating a low degree of dietary diversity. Seasonal analysis indicates heightened dietary overlap in the autumn-summer transition, with rodents, domestic sheep, and birds being major contributors to this overlap. Conclusion: The findings underscore the adaptability of golden jackals to diverse food resources in a seasonal environment. This study provides foundational insights into the dietary ecology of jackal crucial for its conservation and management strategies in the ecologically fragile ecosystem. The finding gives a hint at the role jackals can play in regulating rodent populations and contributing to environmental cleanliness by scavenging.

Tools and Strategies to Integrate Multi-Domain Information for Personalized Decision-Making in Oncological Care Pathways: A Scoping Review.

Introduction: There is a growing interest in personalized decision-making in oncology. According to the Integrated Oncological Decision-Making Model (IODM), decisions should be based on information from three domains: (1) medical technical information, (2) patients' general health status and (3) patients' preferences and goals. Little is known about what kind of tool/strategy is used to collect the information, by whom this is collected (nurse, clinician) when this is collected (moment in the care pathway), and how this information should be collected and integrated within decision-making in oncological care pathways, and what its impact is. Methods: We searched PUBMED, Embase and Web of Science in October 2023 for studies looking at tools to collect and integrate information from the three domains of the IODM. We extracted data on the content and implementation of these tools, and on decision and patient outcomes. Results: The search yielded 2576 publications, of which only seven studies described collection of information from all three domains (inclusion criteria). In the seven included studies, information on the three domains was collected through dialogue, questionnaires, and assessments (what) by a nurse (2 out of 7 studies) or by other members of the Multi-Disciplinary Team (by whom) (5 out of 7 studies). Members of the Multi-Disciplinary Team subsequently integrated the information (5 out 7 studies) during their meeting (when), with patients and family attending this meeting in 2 studies (how). In terms of decision outcomes, 5 out of 7 studies compared the treatment recommendations before and after implementation of the tools, showing a modification of the treatment plan in 3% to 53% of cases. The limited data on patient outcomes suggest positive effects on well-being and fewer complications (3 out of 7 studies). Conclusion: The seven studies identified that integrated information from the three IODM domains into treatment decision-making lacked comprehensive information regarding the strategies, process, timing and individuals involved in implementing the tools. Nevertheless, the few studies that looked at patient outcomes showed promising findings.

Beyond the stethoscope: ageism in white coats and resident physicians' preferences for elderly patient care.

BACKGROUND: The global increase in life expectancy has significantly raised the elderly population. In Türkiye, the proportion of individuals aged 65 and over rose from 8.8% in 2018 to 10.2% in 2023. This demographic shift necessitates the planning of social and health services for the elderly. Ageism affects elderly health negatively and is prevalent in healthcare settings. This study aimed to determine the prevalence of ageism among resident physicians at Pamukkale University Hospital and identify factors influencing their preferences for providing healthcare to elderly patients. METHODS: This cross-sectional study was conducted at Pamukkale University Hospital between 6 June and 16 June, 2024. A total of 448 resident physicians were selected through simple random sampling. Data were collected using a self-administered questionnaire, which included sociodemographic information, factors affecting ageism, and the Fraboni Scale of Ageism (FSA). Descriptive statistics, Chi-square tests, and logistic regression were used to evaluate factors influencing healthcare preferences. RESULTS: The FSA score averaged 71.89 ± 7.87, indicating a 20.1% (95% CI:16.48-24.10) prevalence of age discrimination among resident physicians. Logistic regression analysis revealed that male participants (odds ratio (OR) = 1.519, P = 0.042), those with moderate to very poor perceived knowledge of elderly health (OR = 2.418, P < 0.001), and higher FSA scores (OR = 1.046, P < 0.001) were more likely to prefer not providing healthcare services to elderly patients. CONCLUSIONS: Ageism among resident physicians is prevalent, impacting their willingness to provide care to elderly patients. Gender, perceived knowledge, and ageist attitudes influence their preferences for providing healthcare to elderly patients. Addressing these factors is crucial for improving healthcare services for the elderly.

Sustainability considerations are not influencing meat consumption in the US.

The consumption of animal-source foods, and particularly red meat from ruminants, is a major contributor to greenhouse gas emissions, freshwater use, and loss of biodiversity. Reducing red meat consumption has been identified as a key strategy to mitigate climate change; however, little is known about how to effectively intervene to promote its reduction in the United States (US). This study aimed to examine meat (red, unprocessed, and poultry) and seafood consumption patterns, the factors influencing their consumption (including a reduction in their consumption over time), and how these differed based on socioeconomic variables. The study was conducted through an online survey with a representative sample of the US population (n = 1224) in 2021 using KnowledgePanel®. Overall, we found that most participants reported consuming red meat (78%), processed meat (74%), or poultry (79%) 1-4 times per week, with several differences in consumption patterns based on socio-demographic characteristics. A substantial proportion of the population reported reducing their red (70%) and processed meat (64%) consumption over the previous year, which was much higher than those that reported reducing poultry (34%) or seafood (26%). Key factors influencing red meat reduction were health and price, while environmental sustainability and animal welfare were less important, particularly among certain socio-demographic groups. These findings can help provide insight into how best to frame messaging campaigns aimed at shifting red meat consumption in the US to support climate change mitigation. Focusing on the factors that resonate more with consumers is more likely to lead to shifts in consumption patterns.

Low public awareness opens up new opportunities for highlighting milk as an iodine dietary source.

This international survey provides insights into public awareness of the importance of iodine as an essential trace mineral in human health along with knowledge of iodine dietary sources. The online questionnaire included sociodemographic aspects and dietary iodine consumer awareness on 7-point Likert-type questions. A total of 4,704 questionnaires from 16 countries were considered. Answers were analyzed through a multiple regression linear model including country, gender, age, education level, and employment status as fixed effects. Respondents were moderately aware of the importance of fish (4.86) and seafood (4.90) as dietary iodine sources, but less aware of milk as a primary iodine source (3.32). Respondent awareness varied considerably across countries. Age, education level, and employment status only modified their perception when asked about fish and seafood as a source of iodine, with elderly respondents, those highly educated and of working age being more aware of their relevance as dietary iodine sources. Respondent knowledge did not vary by age, education level, employment status, or gender when asked about cereals, vegetables and fruits, meat and milk as iodine-rich food sources. Consequently, labeling milk and dairy products as an iodine-rich food source should be considered. Public authorities can consider the results from this survey in promotional campaigns to improve the awareness of different iodine sources and their beneficial effect on health.

The influence of individual factors on the career preferences and specialty choices of final-year nursing students.

BACKGROUND: Statistical evidence shows that nursing students prefer a professional career in hospital settings, leading to a lack of career interest in non-hospital settings such as community and residential aged care facilities. The lack of preference for non-hospital settings has persisted over several decades and presents a need for different approaches that may reveal new information to better understand the individual factors that influence specialty choices and preferences from the students' viewpoints. PURPOSE: The aims of this study were to (1) explore individual factors that impact the nursing specialty choices of final-year nursing students and (2) explore how these factors influence the final-year nursing students' career decision-making process. METHOD: A narrative inquiry approach using semi-structured interviews was carried out with purposively sampled nursing students (n = 12) who had undertaken a final-year clinical placement(s). Data was analysed using two main steps. First, the interviews were restoried and then analysed using the three-dimensional framework. Subsequently, thematic analysis was applied to generate themes. RESULTS: Data analysis generated three main themes: demographic factors, social factors, and career goals. Participants' characteristics and interactions with other individuals and systems influenced their nursing specialty preferences and professional career plans. CONCLUSION: Nursing students' career interests are influenced by individual factors external to their nursing education, such as their age, gender, and life experiences. These student characteristics and experiences facilitated or inhibited a career in some nursing specialties, with the students gauging their ability to practice in a specialty during their CPs. Nursing education should expose and inform students about the core skills, career opportunities, and how to advance their careers in the different nursing specialties. Most importantly, final-year students may need formal career guidance to encourage nursing students' positive attitudes and career interests in different nursing specialties and make realistic career decisions.

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.

DCE attribute development investigating public policy for the provision of medicinal cannabis.

Background: Defining attributes and attribute levels for a discrete choice experiment (DCE) poses a significant challenge for practitioners exploring preferences for new or unfamiliar products due to the dearth of available information and limits in stakeholder knowledge. This study outlines a comprehensive process for identifying attributes and levels in a DCE aimed at gauging public preferences for health policies related to medicinal cannabis (MC).Methods: A rigorous four-stage attribute development process was utilized and included i) the formulation of a preliminary attribute list from a scoping review and document analysis, ii) reduction of attributes via focus groups, iii) removal of inappropriate attributes using Delphi studies and research team knowledge, and iv) refinement of attribute language based on the feedback from think-aloud interviews.Results: A base attribute list formed from the scoping review and document analysis served as effective discussion stimuli in focus groups, especially for participants with limited subject knowledge. Structured focus group activities proved more effective than open-ended discussions in engaging naive participants. Delphi studies were found to be overcomplex for expert-led attribute prioritization. Think-aloud interviews during a pilot DCE were essential for assessing attribute language and clarity and understanding participants' decision-making processes.Conclusion: The development of DCE attributes measuring preferences for an unfamiliar health product requires a multi-method approach. Evaluating the outcomes from various methods of attribute development yielded a refined list of attributes that were significant to stakeholders, allowed for meaningful trade-offs, and were presented in language accessible to the target population.

Advance Care Planning in Nursing Homes: Comparing Characteristics and Outcomes of Participants and Non-Participants.

BACKGROUND: There is an increasing need to integrate Advance Care Planning (ACP) in nursing homes (NH) due to rapid aging and burden of multimorbidity. This study examines differences in the characteristics and outcomes of NH residents enrolled in a palliative care programme who have completed ACP and those who did not. METHOD: We conducted a retrospective cohort analysis of 294 deceased residents enrolled into a palliative programme from 8 nursing homes in Singapore. Comparison was made between residents who completed an ACP and those who did not. Treatment preferences and place of death preferences were examined and concordance to these preferences were analyzed. RESULTS: ACP completion rate was 81% in the cohort. Residents opting for comfort measures only had high concordance (92%) for their preferred place of death (PPOD). However, residents opting for limited intervention showed lower PPOD concordance (77%), with many dying in hospitals despite a preference for dying in the NH. Residents with ACP were significantly more likely to die in NH (68.2% vs. 36.4%) and had a longer median programme enrolment duration (131 vs. 53 days) compared to those who did not complete ACP. CONCLUSION: Despite high ACP completion rate in our cohort, challenges remain in aligning treatment preferences with actual care provided, particularly for residents opting for limited intervention. Future efforts should focus on increasing ACP participation and addressing systemic barriers to improve end-of-life care outcomes for NH residents.

A Genomic Counseling Model for Population-Based Sequencing: A Pre-Post Intervention Study.

BACKGROUND: Novel uses of genome sequencing (GS) present an opportunity for return of results to healthy individuals, prompting the need for scalable genetic counseling strategies. We evaluate the effectiveness of a genomic counseling model (GCM) and explore preferences for GS findings in the general population. METHODS: Participants (N=466) completed GS and our GCM (digital genomics platform and group-based webinar), and indicated results preferences. Surveys were administered pre- (T0) and post- (T1) GCM. Change in knowledge and decisional conflict (DC) were evaluated using paired-sample T and Wilcoxon tests. Factors influencing knowledge and results preferences were evaluated using linear and logistic regression models. RESULTS: Participants were 56% female, 58% white, and 53% ≥40 years of age. Mean knowledge scores increased (Limitations: 3.73 to 5.63; benefits: 3.73 to 5.48, p<0.0001) and DC decreased (-21.9, p<0.0001) at T1 versus T0. Eighty-six percent of participants wished to learn all GS findings at T1 vs 78% at T0 (p<0.0001). Older age, negative/mixed attitudes toward genetics, and greater DC were associated with change in preferences post-intervention. CONCLUSION: In a population-based cohort undergoing GS interested in learning GS findings, our GCM increased knowledge and reduced DC, illustrating the GCM's potential effectiveness for GS counseling in the general population.