Drivers of social acceptance of natural-resource management: A comparison of the public and professionals in California.

The social impacts of natural resource management are challenging to evaluate because their perceived benefits and costs vary across stakeholder groups. Nevertheless, ensuring social acceptance is essential to building public support for adaptive measures required for the sustainable management of ecosystems in a warming climate. Based on surveys with both members of the public and natural-resource professionals in California, we applied structural-equation modeling to examine how psychological factors impact individuals' attitudes toward management's capacity to reduce the impacts of disturbance events, including wildfires, smoke from wildfires, drought, water shortages, tree mortality, and utility failure. We found the members of the public more optimistic than natural-resource professionals, perceiving management capacity to be on average 3.04 points higher (of 10) and displaying higher levels of trust of the government on both the state (Δ = 11%) and federal levels (Δ = 19%). Personal experience with natural-resource events had a positive effect on perceived management in both the public (1.26) and the professional samples (5.05), whereas perceived future risk had a negative effect within both samples (professional = -0.91, public = -0.45). In addition, higher trust and perceived management effectiveness were also linked with higher perceptions of management capacity in the public sample (1.81 versus 1.24), which could affect the acceptance of management actions. Continued social acceptance in a period of increasing risk may depend on managers sharing personal experiences and risk perception when communicating with the public. The contemporary shift toward multibenefit aims is an important part of that message.

From fallow ground to common ground: Perspectives on future land uses in the San Joaquin valley under sustainable groundwater management.

Agriculture dominates California's San Joaquin Valley with over five million acres of farmland produces 400 different commodities ranging from nuts, tree fruits, vines, and row crops. During dry years agricultural production in the San Joaquin Valley uses about 53% of total applied water in the state. Implementation of California's Sustainable Groundwater Management Act (SGMA) will restrict groundwater pumping, likely reducing irrigated agricultural land use resulting in conversion to alternative land uses. To promote collaborative and inclusive efforts to repurpose agricultural land, California's legislature established a funding program administered by the Department of Conservation, the Multibenefit Land Repurposing Program (MLRP), in 2021. To ensure that land repurposing plans under the MLRP and SGMA represent San Joaquin Valley community needs this paper examines public perceptions of future land uses under SGMA through a phone survey. Respondents (n = 197) were recruited through a stratified random sample of mobile numbers registered within communities in the San Joaquin Valley classified as disadvantaged communities (DACs) (n = 32). Our results show that most respondents were somewhat (33%) or not at all (54%) familiar with SGMA, highlighting the need for outreach efforts to overcome barriers to representation, translation, and education about future water and land use decisions. Survey respondents identified secure water supplies (e.g., groundwater recharge) (35%) and less-water intensive agriculture (27%) as their top land use priorities to address groundwater overdraft under SGMA, indicating that the status quo for land use is preferred to alternative land uses. Preference for maintaining agriculture as primary land use (27%), we correlated with agricultural identity and lack of interest in community or global benefits such as schools and climate change mitigation. The findings from this study underscore the local variability in land use values and the importance to engaging local communities in land use decision-making, especially as they relate to changing current practices toward a more climate-resilient but agriculturally productive future with less land and less water.

Involvement that makes an impact on healthcare: Perceptions of the Swedish public.

AIM: 'Participation and influence in society' is the first of 11 objective domains in Swedish public health policy. The aim of this article is to investigate the views of the Swedish general population on the impact of a range of health participation activities, and whether these views were associated with sociodemographic characteristics. METHODS: The study utilizes a national representative survey of the Swedish population, aged 15 years and over ( n = 1500). RESULTS: Apart from voting in regional elections - which most of the respondents believed to be an influential way to make improvements in healthcare (74%) - respondents believed more in individual patient activities than activities associated with adopting a citizen role and acting collectively. A majority of respondents believed in the impact of replying to patient surveys (67%), making a complaint (61%), talking directly to staff (58%) or changing their healthcare provider (54%). Fewer believed in the impact of joining a patient organization (46%), taking part in a citizen council (35%) or joining a political party (34%). Beliefs in impact increased with educational attainment and decreased with age. CONCLUSIONS: The results suggest people have more confidence in the impact of participating as individual patients rather than collectively and as citizens. To ensure that activities enable 'participation and influence in society', complementary opportunities for collective involvement that also take into account under-represented voices such as those with a low level of education need to be developed.

Who wants to be involved in health care decisions? Comparing preferences for individual and collective involvement in England and Sweden.

BACKGROUND: Patient and public involvement (PPI) is framed as positive for individuals, the health system, public health, as well as for communities and society as a whole. We investigated whether preferences for PPI differed between two countries with Beveridge type health systems-Sweden and England. We measured willingness to be involved in individual treatment decisions and in decisions about the organization and provision of local health and social care services. METHODS: This was a comparative cross-sectional study of the general population's preferences. Together, the two samples included 3125 respondents; 1625 in England and 1500 in Sweden. Country differences were analysed in a multinomial regression model controlling for gender, age and educational attainment. RESULTS: Overall, 68% of respondents wanted a passive patient role and 44% wanted to be involved in local decisions about organization and provision of services. In comparison with in Sweden, they were in England less likely to want a health professional such as a GP or consultant to make decisions about their treatment and also more likely to want to make their own decisions. They were also less likely to want to be involved in local service development decisions. An increased likelihood of wanting to be involved in organizational decision-making was associated with individuals wanting to make their own treatment decisions. Women were less likely to want health professionals to make decisions and more likely to want to be involved in organizational decisions. CONCLUSIONS: An effective health system that ensures public health must integrate an effective approach to PPI both in individual treatment decisions and shaping local health and social care priorities. To be effective, involvement activities must take in to account the variation in the desire for involvement and the implications that this has for equity. More work is needed to understand the relationship between the desire to be involved and actually being involved, but both appear related to judgements of the impact of involvement on health care decisions.

Radiotherapy in implant-based immediate breast reconstruction: risk factors, surgical outcomes, and patient-reported outcome measures in a large Swedish multicenter cohort.

The purpose of this large cohort study was to analyze the effects of prior and postoperative radiotherapy (RT) on surgical outcomes and patient-reported outcome measures (PROMs) in implant-based immediate breast reconstruction (IBR). All breast cancer patients (n = 725, of whom 29 had bilateral IBR) operated with implant-based IBR at four Stockholm hospitals from 2007 to 2011 were included. The median follow-up was 43 months. Three groups were compared: no RT (n = 386), prior RT (n = 64), and postoperative RT (n = 304). Outcomes were IBR failure (implant loss with or without secondary autologous reconstruction), unplanned reoperations, and PROMs, as measured by the BreastQ(®) questionnaire. IBR failure occurred in 22/386 (6 %) of non-irradiated cases, 16/64 (25 %) after prior and 45/304 (15 %) after postoperative RT (p < 0.001). Failure risk was higher after prior than postoperative RT (HR 9.28 vs. 3.08). Further risk factors were high BMI, less surgeon reconstructive experience, and postoperative infection, while the use of permanent implants lowered the risk of IBR failure. The estimated 5 years IBR failure rate was 10.4 % for non-irradiated, 28.2 % for previously and 25.2 % for postoperatively irradiated patients (p < 0.001). At least one unplanned reoperation occurred in 169/384 of non-irradiated (44 %), 42/64 (66 %) of previously, and 180/303 (59 %) of postoperatively irradiated breasts (p < 0.001). Further contributing factors were the use of one-stage expander and permanent implants, less surgeon reconstructive experience, and smoking. RT significantly impaired scores on all scales of the BreastQ(®). However, a clear majority of women in all groups would choose IBR again. Implant-based IBR remains a feasible option for women undergoing mastectomy as patient satisfaction levels are high. After prior RT, however, autologous alternatives should be considered.