Development and preliminary validation of a Greek-language outpatient satisfaction questionnaire with principal components and multi-trait analyses

BACKGROUND: In the recent years there is a growing interest in Greece concerning the measurement of the satisfaction of patients who are visiting the outpatient clinics of National Health System (NHS) general acute hospitals. The aim of this study is therefore to develop a patient satisfaction questionnaire and provide its preliminary validation. METHODS: A questionnaire in Greek has been developed by literature review, researchers' on the spot observation and interviews. Pretesting has been followed by telephone surveys in two short-term general NHS hospitals in Macedonia, Greece. A proportional stratified random sample of 285 subjects and a second random sample of 100 outpatients, drawn on March 2004, have been employed for the analysis. These have resulted in scale creation via Principal Components Analysis and psychometric testing for internal consistency, test-retest and interrater reliability as well as construct validity. RESULTS: Four summated scales have emerged regarding the pure outpatient component of the patients' visits, namely medical examination, hospital environment, comfort and appointment time. Cronbach's alpha coefficients and Pearson, Spearman and intraclass correlations indicate a high degree of scale reliability and validity. Two other scales -lab appointment time and lab experience- capture the apparently distinct yet complementary visitor experience related to the radiographic and laboratory tests. Psychometric tests are equally promising, however, some discriminant validity differences lack statistical significance. CONCLUSION: The instrument appears to be reliable and valid regarding the pure outpatient experience, whereas more research employing larger samples is required in order to establish the apparent psychometric properties of the complementary radiographic and laboratory-testing process, which is only relevant to about 25% of the subjects analysed here

Evaluation of methylation status of the eNOS promoter at birth in relation to childhood bone mineral content

Our previous work has shown associations between childhood adiposity and perinatal methylation status of several genes in umbilical cord tissue, including endothelial nitric oxide synthase (eNOS). There is increasing evidence that eNOS is important in bone metabolism; we therefore related the methylation status of the eNOS gene promoter in stored umbilical cord to childhood bone size and density in a group of 9-year-old children. We used Sequenom MassARRAY to assess the methylation status of two CpGs in the eNOS promoter, identified from our previous study, in stored umbilical cords of 66 children who formed part of a Southampton birth cohort and who had measurements of bone size and density at age 9 years (Lunar DPXL DXA instrument). Percentage methylation varied greatly between subjects. For one of the two CpGs, eNOS chr7:150315553 + , after taking account of age and sex, there were strong positive associations between methylation status and the child’s whole-body bone area (r = 0.28, P = 0.02), bone mineral content (r = 0.34, P = 0.005), and areal bone mineral density (r = 0.34, P = 0.005) at age 9 years. These associations were independent of previously documented maternal determinants of offspring bone mass. Our findings suggest an association between methylation status at birth of a specific CpG within the eNOS promoter and bone mineral content in childhood. This supports a role for eNOS in bone growth and metabolism and implies that its contribution may at least in part occur during early skeletal development

Pollination ecosystem services: A comprehensive review of economic values, research funding and policy actions

Economic valuation of crop pollination services, including potential monetary losses in agricultural production induced by insufficient pollination, is a strategy to quantify the impacts of this critical ecosystem service on food production, food security and the global economy, and to drive policy actions. We examined how the economic valuation of crop pollination services has been investigated across the ecological and economics literature and review estimates of monetary values of crop pollination services, as well as the investments (research funding/grants) and policy actions associated with pollinators and pollination. We documented an increase in the number of economic valuation studies on pollination services in the last two decades, with a substantial growth over the last five years, which represented 54% of all publications. However, we emphasize that there is a marked lack of data on regionally important commercial crops that are essential for the food security of many millions of people, particularly in developing countries. Estimated global values of the crop pollination service, adjusted for inflation in March/2020, range widely from US$195 billion to ~US$387 (US$267–657) billion annually — due to methodology, input data and a historical increase in production costs of pollinator-dependent crops. There is an increasing trend over time in the values of crop pollination service estimates for the full set of main globally-grown crops, although estimates for specific crops are widely variable at local to regional scales. Research funding on pollination/pollinators is mainly in developed countries, which have published all the reviewed policy papers on the economic value of crop pollination services. Although the valuation of pollination services, and associated economics and policy remain embryonic areas of research, animal-mediated pollination is clearly a high-value environmental service, which greatly strengthens conservation arguments worldwide