Local Ties as Self-Reported Constraints to Internal Migration in Spain

The internal migration literature has identified various factors that deter migration and encourage staying, but has been less concerned with people’s own reports about what makes it difficult for them to migrate or makes them want to stay. We explore factors that make it difficult to change the place of residence—from here on denoted as constraints—reported in the Spanish survey on Attitudes and Expectations of Spatial Mobility in the Labour Force (N = 3892). These constraints were uniquely asked from all respondents through an open-ended question, regardless of their migration intentions. We find that many self-reported constraints correspond to factors that have previously been associated with decreased migration propensities. In order of frequency, respondents reported ties to family and friends, ties to their residential environment, financial limitations, and ties to work as constraints to migration. Our results further show that the likelihood of mentioning ties to family and friends as constraints decreased with age, was higher for women than for men and for people who lived close to most of their social network than for those who did not. Mentioning ties to the residential environment as constraints was positively associated with being partnered, and also with living in one’s birthplace. People who were unemployed were less likely to mention ties to work and were more likely to report financial limitations as constraints than people who had a permanent contract—whereas being self-employed was positively associated with mentioning ties to the residential environment

The price of mobility

This paper addresses the question concerning the price of geographic mobility in various labour market and migration scenarios. Pivotal points are expected mobility premiums which are sufficient to tip the scales in favour of moving to a geographically distinct location. These premiums are first derived within a theoretical model, accounting not only for location-specific amenity levels or labour market conditions, but also for heterogeneous personality traits and preferences. Derived hypotheses demonstrate that—in presence of heterogeneous psychic costs or adjustment capabilities—expected mobility premiums can remain distinctly positive even in an unemployment scenario. Furthermore, adjustment capabilities are to a large extent related to earlier mobility experiences, implying that labour mobility is partially learnable

Multi-criteria decision analysis of breast cancer control in low- and middle- income countries: development of a rating tool for policy makers

Contains fulltext : 137483.pdf (publisher's version ) (Open Access)BACKGROUND: The objective of this study was to develop a rating tool for policy makers to prioritize breast cancer interventions in low- and middle- income countries (LMICs), based on a simple multi-criteria decision analysis (MCDA) approach. The definition and identification of criteria play a key role in MCDA, and our rating tool could be used as part of a broader priority setting exercise in a local setting. This tool may contribute to a more transparent priority-setting process and fairer decision-making in future breast cancer policy development. METHODS: First, an expert panel (n = 5) discussed key considerations for tool development. A literature review followed to inventory all relevant criteria and construct an initial set of criteria. A Delphi study was then performed and questionnaires used to discuss a final list of criteria with clear definitions and potential scoring scales. For this Delphi study, multiple breast cancer policy and priority-setting experts from different LMICs were selected and invited by the World Health Organization. Fifteen international experts participated in all three Delphi rounds to assess and evaluate each criterion. RESULTS: This study resulted in a preliminary rating tool for assessing breast cancer interventions in LMICs. The tool consists of 10 carefully crafted criteria (effectiveness, quality of the evidence, magnitude of individual health impact, acceptability, cost-effectiveness, technical complexity, affordability, safety, geographical coverage, and accessibility), with clear definitions and potential scoring scales. CONCLUSIONS: This study describes the development of a rating tool to assess breast cancer interventions in LMICs. Our tool can offer supporting knowledge for the use or development of rating tools as part of a broader (MCDA based) priority setting exercise in local settings. Further steps for improving the tool are proposed and should lead to its useful adoption in LMICs

Potential impact of encounter patient decision aids on the patient-clinician dialogue: a qualitative study on Dutch and American medical specialists' experiences

OBJECTIVES: To examine the experiences among Dutch and American clinicians on the impact of using encounter patient decision aids (ePDAs) on their clinical practice, and subsequently to formulate recommendations for sustained ePDA use in clinical practice. DESIGN: Qualitative study using semi-structured interviews with clinicians who used 11 different ePDAs (applicable to their specialty) for 3 months after a short training. The verbatim transcribed interviews were coded with thematic analysis by six researchers via ATLAS.ti. SETTING: Nine hospitals in the Netherlands and two hospitals in the USA. PARTICIPANTS: Twenty-five clinicians were interviewed: 16 Dutch medical specialists from four different disciplines (gynaecologists, ear-nose-throat specialists, neurologists and orthopaedic surgeon), 5 American gynaecologists and 4 American gynaecology medical trainees. RESULTS: The interviews showed that the ePDA potentially impacted the patient-clinician dialogue in several ways. We identified six themes that illustrate this: that is, (1) communication style, for example, structuring the conversation; (2) the patient's role, for example, encouraging patients to ask more questions; (3) the clinician's role, for example, prompting clinicians to discuss more information; (4) workflow, for example, familiarity with the ePDA's content helped to integrate it into practice; (5) shared decision-making (SDM), for example, mixed experiences whether the ePDA contributed to SDM; and (6) content of the ePDA. Recommendations to possibly improve ePDA use based on the clinician's experiences: (1) add pictorial health information to the ePDA instead of text only and (2) instruct clinicians how to use the ePDA in a flexible (depending on their discipline and setting) and personalised way adapting the ePDA to the patients' needs (e.g., mark off irrelevant options). CONCLUSIONS: ePDAs contributed to the patient-clinician dialogue in several ways according to medical specialists. A flexible and personalised approach appeared appropriate to integrate the use of ePDAs into the clinician's workflow, and customise their use to individual patients' needs

The Psychophysiological Regulation of Pacing Behaviour and Performance Fatigability During Long-Distance Running with Locomotor Muscle Fatigue and Exercise-Induced Muscle Damage in Highly Trained Runners

Background Locomotor muscle fatigue (LMMF) and exercise-induced muscle damage (EIMD) are common conditions experienced during long-distance running due to the pooled effect of mechanical and metabolic strain on the locomotor muscles. However, little is known about the instant effects of combined LMMF and EIMD on pacing behaviour and performance during the decisive final stages of ‘real-world’ long-distance running events. Methods Twenty-two highly trained runners (11 females) completed two maximal self-paced 20-km treadmill time trials in a counterbalanced crossover design: (A) in a tapered condition and (B) with LMMF and EIMD. Indicators of muscle damage, muscle metabolic strain, and endocrinological stress were assessed to investigate the physiological effects, and a three-dimensional framework of perceived fatigability was applied to investigate the perceptual effects of running with LMMF and EIMD on performance fatigability. Results LMMF and EIMD caused restrictions in work capacity and medium increases in blood leucocyte and neutrophil count, interleukin-6, and cortisol concentrations, collectively constituting a physiological milieu likely not conducive to high performance. LMMF and EIMD further caused large increases in perceived physical strain and large decreases in valence as well as large increases and decreases in action crisis and flow state, respectively. Conclusions Under the constraint of amplified physical duress, findings are suggestive of heuristic and rational antecedents in the goal disengagement process. Dynamic changes in physiological and perceptual effects of LMMF and EIMD are hypothesised to underpin the observed alterations in pacing behaviour and performance fatigability during long-distance running. The applied three-dimensional framework provides a more comprehensive understanding of strain-perception-thinking-action coupling in centrally regulated and goal-directed exercise behaviour