Search

Charities that fundraise from the public can feel competing pressures to be as efficient as possible in their fundraising efforts and to accurately and ethically reflect their services and beneficiaries in their fundraising materials. At the same time, the number of donors giving to charity is in a long-term decline. These pressures may lead charitable managers to make tradeoffs when designing and implementing their fundraising programs. In this case study, two direct mail solicitations using different types of beneficiaries from one Canadian charity are examined to see how those trade-offs affect fundraising results. When aggregated, the differences between an out-group beneficiary profile and an in-group beneficiary profile appear subordinate to larger market-level externalities when all else is held equal. When disaggregated, there appears to be a change in donor behavior at the lower end of donation amounts in some markets and community types. The results of this study suggest that fundraiser tactics that narrow in on the preferences of a small segment of donors may be contributing to declining numbers of donors. [ABSTRACT FROM AUTHOR]

BACKGROUND: The COVID-19 pandemic increased demand for app-based platform-based couriers, creating job opportunities for individuals who have lost income because of COVID-19. Through various stages of lockdown, courier workers (e.g., delivering for Uber Eats, Amazon Flex, and Lyft) provide an essential service. At the same time, this form of work poses risks for exposure to the SARS-CoV-2 virus as these workers are highly mobile and in contact with many individuals. OBJECTIVE: To explore how platform-based couriers discuss risks associated with their work during periods of high (first wave, second wave, third wave/rise in concerns regarding variants) and low risk during the COVID-19 pandemic, 2020–2021. METHODS: We provide a narrative analysis of user posts (n = 2,866) on Reddit during periods of interest. RESULTS: Our analysis resulted in three central findings. First, we identified changing patterns in discourse as the pandemic went on. Second, we found that the theme of risk prevailed largely in the first wave, with dialogue dominated by tips and asking for advice about how to manage risk. Third, our findings reveal a growing polarization among users during the latter phases of the study. CONCLUSION: Polarization largely focused on acceptance (or not) of public health measures and the nature of their work as independent contractors and the role/responsibility of courier companies to offer protection. Our study is the first to document risks, from the perspectives of anonymous couriers who may be unwilling to share their honest opinions and thoughts through primary data collection where anonymity is not guaranteed. [ABSTRACT FROM AUTHOR]

Despite Robert M. Campbell's assertion that "an examination of contemporary postal matters would reveal much about the Canadian state" (Campbell, 1994, p. 6), the interest in postal history from social scientists has been short-lived. In Canada, this loss of interest coincided with the efforts to privatize Canada Post through the late 1980s–1990s (e.g., Campbell, 1994). This work is an attempt to reignite political analysis of Canada's postal system. Unlike previous analyses, however, we are most keenly interested in thinking with Indigenous and settler-colonial studies theorists about the role of postal services in the territorial project of settler-colonialism in Canada. We contend that the overarching omission of Canadian postal services from much of Canada's political history results in the exclusion of two key roles played by the post office in Canadian state formation: the first, that postal networks were essential to the proliferation of communications across the 'hinterlands' of the expanding nation-state and colonial interests. The second, and perhaps less widely studied, role of postal services in Canada's political history is that of territorialization and the production of distinctly Canadian space. We note that Canadian territorialization is specifically reinforced by the distinctly settler-colonial structures of Canadian colonization, which require an even more obvious physical demarcation of colonized territory and a colonial presence that extends beyond state administrators to encompass the public life of settlers more generally—and that the infrastructure of postal services provided a state mechanism through which to materialize territorial expansion and settler nationalism. [ABSTRACT FROM AUTHOR]

Background: Evidence supporting early palliative care is based on trials of specialised palliative care, but a more sustainable model might involve mainly primary providers. Aim: The aim of this study was to compare the characteristics of physicians providing primary and specialised palliative care, their attitudes towards early palliative care and their perception of having sufficient resources for its provision. Design: Survey distributed by mail and e-mail. Specialised providers were defined as both receiving palliative care referrals from other physicians and not providing palliative care only for their own patients. Setting/participants: A total of 531 physicians providing palliative care in Canada (71% participation) participated in the study. Results: Of the participants, 257 (48.4%) provided specialised and 274 (51.6%) primary care. Specialists were more likely to have palliative care training (71.8% vs 35.2%), work in urban areas (94.1% vs 75.6%), academic centres (47.8% vs 26.0%) and on teams (82.4% vs 16.8%), and to provide mainly cancer care (84.4% vs 65.1%) (all p < 0.001). Despite strongly favouring early palliative care, only half in each group agreed they had resources to deliver it; agreement was stronger among family physicians, those working on teams and those with greater availability of community and psychosocial support. Primary providers were more likely to agree that renaming the specialty 'supportive care' would increase patient comfort with early palliative care referral (47.4% vs 35.5%, p < 0.001). Conclusion: Despite strongly favouring the concept, both specialists and primary providers lack resources to deliver early palliative care; its provision may be facilitated by team-based care with appropriate support. Opinions differ regarding the value of renaming palliative care. [ABSTRACT FROM AUTHOR]

Fracture liaison services (FLS), implemented in different ways and countries, are reported to be a cost-effective or even a cost-saving secondary fracture prevention strategy. This presumed favorable cost-benefit relationship is encouraging and lends support to expanded implementation of FLS per International Osteoporosis Foundation Best Practice Standards. This study summarizes the economic impact and cost-effectiveness of FLS implemented to reduce subsequent fractures in individuals with osteoporosis. This systematic review identified studies reporting economic outcomes for FLS in osteoporotic patients aged 50 and older through a comprehensive search of MEDLINE, EMBASE, Cochrane Central, and PubMed of studies published January, 2000 to December, 2016. Grey literature (e.g., Google scholar, conference abstracts/posters) were also hand searched through February 2017. Two independent reviewers screened titles and abstracts and conducted full-text review on qualified articles. All disagreements were resolved by discussion between reviewers to reach consensus or by a third reviewer. In total, 23 qualified studies that evaluated the economic aspects of FLS were included: 16 cost-effectiveness studies, 2 cost-benefit analyses, and 5 studies of cost savings. Patient populations varied (prior fragility fracture, non-vertebral fracture, hip fracture, wrist fracture), and FLS strategies ranged from mail-based interventions to comprehensive nurse/physician-coordinated programs. Cost-effectiveness studies were conducted in Canada, Australia, USA, UK, Japan, Taiwan, and Sweden. FLS was cost-effective in comparisons with usual care or no treatment, regardless of the program intensity or the country in which the FLS was implemented (cost/QALY from $3023-$28,800 US dollars (USD) in Japan to $14,513-$112,877 USD in USA. Several studies documented cost savings. FLS, implemented in different ways and countries, are reported to be cost-effective or even cost-saving. This presumed favorable cost-benefit relationship is encouraging and lends support to expanded implementation of FLS per International Osteoporosis Foundation Best Practice Standards. [ABSTRACT FROM AUTHOR]

This article contributes to the established strand of literature on post and postal service by providing a quadratic framework under which national postal markets are analyzed and compared from efficiency, profitability, and quality of service standpoints. Sample countries are grouped into four market models based on two attributes of market structure and ownership. The question of which governance-operation postal model performs best is then answered. The policy insight offered by this paper expects to guide the advancement of national posts towards an optimal future design that best meets their specific needs and preferences. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction: This paper briefly describes the use of Canada Post Unaddressed Admail and a geographic information system (GIS) for survey distribution to a specific target population in a large, sparsely populated geographic area, and the effectiveness of this approach. Methods: Surveys were sent as Unaddressed Admail via Canada Post to a target population of people livingwithin 5 km of awind turbine in southwestern Ontario. Results: The overall response rate from 8 wind farms (in 8 counties) was 8.1%. Conclusion: This approach has the potential to save time and money, but low response rates are common, distribution is not precise and there is potential for selection bias. Despite these flaws, Unaddressed Admail is worth consideration for delivery of information, study-recruitment materials and surveys to rural, remote and specific target populations. [ABSTRACT FROM AUTHOR]

Canada Post's lettermail volumes are plummeting, largely due to the explosion of electronic communication, with no evident sign of stabilizing. E-commerce parcel deliveries are on the rise, but not nearly at the rate necessary to offset the decline in lettermail, and there are many private courier companies competing for that business. Meanwhile, even as the number of Canadian home addresses continues to increase, Canada Post's plan to end the remnants of door-to-door home delivery, had to be halted in light of the new Liberal government's promise to maintain the service. The extraordinary disruption that electronic media has caused to the model of stateowned postal services, with their mandate to provide universal delivery, may seem dire. And the threat is indeed urgent. But there are solutions to help Canada Post remain healthy in reforms that have occurred to postal systems elsewhere. [ABSTRACT FROM AUTHOR]

In December 2013, Canada Post announced they would be converting approximately five million households from door-to-door mail delivery to community mailboxes (CMB). The decision was made to address decreasing letter mail volume and operating losses experienced by the crown corporation. The CMBs will be phased in over the five years mainly in urban areas across the country. The decision to convert to CMBs makes Canada the only among the G8 countries to end home delivery of mail. As a result, no research exists on the implications of the change. Particular concern has been raised over how the conversion will affect older adults. One area that needs examination is the consequences of the CMBs delivery model on fall rates among older adults in the winter. Falls are common among seniors, with 20-30% community dwelling older adults falling each year. The risk of falling is increased in the winter when there is snow and ice on the ground. Injuries dues to falls consume a great deal of healthcare resources. The purpose of this scoping literature review was to determine: What are the implications for the elderly population of Canada Post's decision to convert home delivery of mail to community mailbox delivery? Specifically, the review focused on how the conversion may impact fall rates among older adults in the winter. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this study was to explore the integration of the nurse practitioner role in Canadian nursing homes to enable its full potential to be realised for resident and family care. The objective was to determine nurse practitioners' patterns of work activities. Background Nurse practitioners were introduced in Canadian nursing homes a decade ago on a pilot basis. In recent years, government and nursing home sector interest in the role has grown along with the need for data to inform planning efforts. Design The study used a sequential mixed methods design using a national survey followed by case studies. Methods A national survey of nurse practitioners included demographic items and the EverCare Nurse Practitioner Role and Activity Scale. Following the survey, case studies were conducted in four nursing homes. Data were collected using individual and focus group interviews, document reviews and field notes. Results Twenty-three of a target population of 26 nurse practitioners responded to the survey, two-thirds of whom provided services in nursing homes with one site and the remainder in nursing homes with as many as four sites. On average, nurse practitioners performed activities in communicator, clinician, care manager/coordinator and coach/educator subscales at least three to four times per week and activities in the collaborator subscale once a week. Of the 43 activities, nurse practitioners performed daily, most were in the clinician and communicator subscales. Case study interviews involved 150 participants. Findings complemented those of the survey and identified additional leadership activities. Conclusion Nurse practitioners undertake a range of primary health care and advanced practice activities which they adapt to meet the unique needs of nursing homes. Relevance to clinical practice Knowledge of work patterns enables nursing homes to implement the full range of nurse practitioner roles and activities to enhance resident and family care. [ABSTRACT FROM AUTHOR]

The article focuses on the development and assessment of the Multiligament Quality of Life questionnaire, which was designed to gather information related to treatment outcomes of patient with multiligament knee injuries. Topics discussed include the theoretical framework, design and procedure observed in creating the quality of life questionnaire and the findings and benefits presented by using the questionnaire to evaluate multiligament knee injuries.

HIV testing is mandatory for individuals wishing to immigrate to Canada. Since the Designated Medical Practitioners (DMPs) who perform these tests may have varying experience in HIV and time constraints in their clinical practices, there may be variability in the quality of pre- and posttest counseling provided. We surveyed DMPs regarding HIV testing, counseling, and immigration inadmissibility. A 16-item survey was mailed to all DMPs across Canada (N= 203). The survey inquired about DMP characteristics, knowledge of HIV, attitudes and practices regarding inadmissibility and counseling, and interest in continuing medical education. There were a total of 83 respondents (41%). Participants frequently rated their knowledge of HIV diagnostics, cultural competency, and HIV/AIDS service organizations as “fair” (40%, 43%, and 44%, respectively). About 25%, 46%, and 11% of the respondents agreed/strongly agreed with the statements “HIV infected individuals pose a danger to public health and safety,” “HIV-positive immigrants cause excessive demand on the healthcare system,” and “HIV seropositivity is a reasonable ground for denial into Canada,” respectively. Language was cited as a barrier to counseling, which focused on transmission risks (46% discussed this as “always” or “often”) more than coping and social support (37%). There was a high level of interest (47%) in continuing medical education in this area. There are areas for improvement regarding DMPs' knowledge, attitudes, and practices about HIV infection, counseling, and immigration criteria. Continuing medical education and support for DMPs to facilitate practice changes could benefit newcomers who test positive through the immigration process. [ABSTRACT FROM AUTHOR]

In this study, we tested a structural equation model to examine work environment factors related to changes in job satisfaction of oncology nurses between 2004 and 2006. Relational leadership and good physician/nurse relationships consistently influenced perceptions of enough RNs to provide quality care, and freedom to make patient care decisions, which, in turn, directly influenced nurses' job satisfaction over time. Supervisor support in resolving conflict and the ability to influence patient care outcomes were significant influences on job satisfaction in 2004, whereas, in 2006, a clear philosophy of nursing had a greater significant influence. Several factors that influence job satisfaction of oncology nurses in Canada have changed over time, which may reflect changes in work environments and work life. These findings suggest opportunities to modify work conditions that could improve nurses' job satisfaction and work life. [ABSTRACT FROM AUTHOR]

A total of 41 questionnaires were returned from 64 respondents who consented to receive a questionnaire through the mail. Almost all valued the opportunity to receive consultation to address their fertility concerns and discuss fertility preservation options. Psychological stress, time pressure, and costs were identified as main factors affecting respondents’ decision to proceed with in-vitro fertilization to cryopreserve oocytes or embryos. About one third indicated that the discussion of fertility matters was initiated by themselves, their friends, and families rather than their health care providers. The findings have identified several major barriers encountered by female cancer patients when seeking fertility preservation services. [ABSTRACT FROM PUBLISHER]

Abstract: Background: Previous studies indicate that new graduate nurses’ first year of work is both stressful and difficult. The turnover rate of this group is particularly high. There is a need to increase our understanding of why new graduate nurses intend to leave their current employer. Objectives: The purpose of this study is to examine what proportion of new graduate nurses intends to leave their current position and to examine the relationship between transition programs, empowerment, work environment and intent to leave. Design: Survey data was collected with new graduate nurses over a 5-year period, beginning in 2004 and ending in 2008. A total of 348 new graduate nurses were surveyed in eastern Canada. Results: The results showed that 49.6% of the new graduate nurses did not intend to leave their current employer, whereas 4.9% were definitely planning to leave and 45.5% expressed different levels of uncertainty. Regression analysis indicated that a component of the work environment, foundations for quality nursing care, and a component of psychological empowerment, goal internalization explained, 24% of the variance of intent to leave. Conclusion: This study provides a more comprehensive understanding of factors that influence intent to leave. It also supports the importance of a good working environment for the retention of new graduate nurses. [Copyright &y& Elsevier]

Learning needs assessment is an important stage of every educational process that aims to inform changes in practice and policy for continuing professional development. Professional competencies have been widely used as a basis for the development of learning needs assessment. The Canadian Community Health Nursing Standards of Practices (CCHN Standards) were released in 2003. However, it is not known whether community health nurses (CHNs) have the educational background to enable them to meet these standards. This article reports on the development of a learning needs assessment questionnaire for CHNs. Exploratory and confirmatory factor analyses were conducted to examine the consistency of factors underpinning the CCHN Standards. Also, validity and reliability of the questionnaire were evaluated using appropriate techniques. This process resulted in a valid and reliable CHN learning needs assessment questionnaire to measure learning needs of large groups of practitioners, where other forms of measurement cannot be feasibly conducted. [ABSTRACT FROM PUBLISHER]

How to reorganize the Swiss postal network? A case study of spatial decision making-support. This article presents a case study of spatial decision making-support in relation to the Swiss Post and its efforts to reorganize the postal network in eight Swiss cities. The first part of the article describes the methodology and highlights selected original elements used in the processing of geographic information (spatial analysis and multi-criteria analysis). The second part, more analytical, examines the process used to apply the method defined in the previous section. Based on a constructivist approach of decision-support, it explores the modes of interaction between available information and decision makers. The analysis shows that the decision maker is relatively difficult to identify since the decision making process includes a set of partial and dependent decisions that are taken by a diversity of people. In conclusion, geographic information played an important role, not only on the decision, but mainly in allowing decision makers to better understand spatial complexity [ABSTRACT FROM AUTHOR]

Abstract: To characterize the current availability and scope of pediatric neurogastroenterology and motility (PNGM) services in North America (NA), the NASPGHAN-NGM committee distributed a self-reporting survey through the NASPGHAN bulletin board and mailing listserv, to compile a list of NA centers offering PNGM services, PNGM training, and the types of diagnostic and therapeutic PNGM procedures and services. We received responses that 54 centers in NA offer some form of PNGM services. Previously, the NASPGHAN website had last updated information from 2015 listing 36 centers in the USA and 2 in Canada. The American Neurogastroenterology and Motility Society (ANMS) website had 16 PNGM centers listed in NA in 2021. Neither of these resources capture additional information regarding training, research, advanced diagnostics, and therapeutics, and all available PNGM services. Our data highlights the growth in the field of PNGM services, and the variability of their distribution throughout the continent., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

This paper situates the events surrounding the passing of the Postal Services Continuation Act in a social, political and historical context. The significance of the back-to-work legislation is discussed and the problems it presents for laborer are analyzed. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Public Policy is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Response rates to physician surveys are typically low. The objective of this study was to determine the effect of a prenotification letter on the response rate of a postal survey of emergency physicians., Design: This was a substudy of a national, cross-sectional postal survey sent to emergency physicians in Canada. We randomised participants to either receive a postal prenotification letter prior to the survey, or to no prenotification letter., Participants: A random sample of 500 emergency physicians in Canada. Participants were selected from the Canadian Medical Directory, a national medical directory which lists more than 99% of practising physicians in Canada., Interventions: Using computer-generated randomisation, physicians were randomised in a concealed fashion to receive a prenotification letter approximately 1 week prior to the survey, or to not receive a prenotification letter. All physicians received an unconditional incentive of a $3 coffee card with the survey instrument. In both groups, non-respondents were sent reminder surveys approximately every 14 days and a special contact using Xpresspost during the final contact attempt., Outcome: The primary outcome was the survey response rate., Results: 201 of 447 eligible physicians returned the survey (45.0%). Of 231 eligible physicians contacted in the prenotification group, 80 (34.6%) returned the survey and among 237 eligible physicians contacted in the no-prenotification group, 121 (51.1%) returned the survey (absolute difference in proportions 16.5%, 95% CI 2.5 to 30.5, p=0.01)., Conclusion: Inclusion of a prenotification letter resulted in a lower response rate in this postal survey of emergency physicians. Given the added costs, time and effort required to send a prenotification letter, this study suggests that it may be more effective to omit the prenotification letter in physician postal surveys., Competing Interests: Competing interests: MH receives a salary as Hospital Donation Physician from Trillium Gift of Life Network, Ontario’s organ donation organisation and JJP is supported by the Heart and Stroke Foundation of Ontario through a Mid-Career Award., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: We aim to describe the general characteristics of how the Canadian newspaper The Globe and Mail reports on opioid-related news, the opioid crisis and its victims, and explore how Canadians' perceptions of the opioid crisis could have developed over time from this reporting. The Globe and Mail has the highest circulation among Canadian newspapers and is Canada's newspaper of record., Methods: Reviewers performed independent, blinded bibliometric searches of all The Globe and Mail articles archived in the Canadian Periodicals Index Quarterly spanning an 18-year period (1 January 2000-1 June 2018) related to the keywords "opioids" or "drugs and opioids" and "opiates". Independently and in duplicate, reviewers manually extracted qualitative data from articles and identified emergent themes. Articles were screened independently by both reviewers based on the inclusion criteria. Conflicts were resolved by discussion and consensus. Social representation theory was used as a framework for describing how the opioid crisis is portrayed in Canada., Results: Our search yielded 650 relevant opioid articles. The number of articles peaked in 2009, 2012, and in 2016, coinciding with major developments in the epidemic. The language used in this discourse has evolved over the years and has slowly shifted towards less stigmatizing language. Content analysis of the articles revealed common social representations attributing responsibility to pharmaceutical companies, physicians, and foreign countries., Conclusions: The Globe and Mail's coverage of the opioid crisis is focused on basic social representations and attributed responsibility for the crisis to a few collectives. A shift toward coverage of the root causes of the opioid epidemic could positively influence the general public's perception of the opioid crisis and promote deeper understanding of the issue. Journalists face several obstacles to achieve greater focus and framing of the opioid crisis; a closer working relationship between the media and the research community is needed.

Background: Quitting smoking is the most effective way of reducing the risk of cancer among smokers. One way of helping people stop smoking is to provide them with free Nicotine Replacement Therapy (NRT), such as when NRT is sent to people by postal mail as part of a mass distribution initiative. Our previous research indicated that there may be a substantial impact on increasing quit rates of a mailed NRT intervention in rural areas. The current research seeks to confirm this finding and to understand the social determinants of health driving these anticipated large effects., Methods/design: Telephone numbers will be randomly selected from across rural regions of Canada in order to recruit adult smokers interested in completing a smoking survey and willing to be interviewed again in 6 months. The survey will ask participants about their smoking history, demographic characteristics, and a hypothetical question: would they be interested in receiving nicotine patches if they were provided to them free of charge? Half of the smokers interested in receiving nicotine patches will be selected by chance and offered the NRT package. The other half of smokers will not be offered the nicotine patches. In addition, the municipality where each participant lives will be identified and, once the relevant general population data becomes available, attempts will be made to link participant data to relevant municipal characteristics (e.g., smoking rates, availability of health services). Characteristics of the participants and the municipalities in which they live will be used to explain why the nicotine patch intervention may have a larger impact in some rural regions compared to others., Discussion: The findings from the proposed RCT are timely and of high relevance as the distribution of nicotine patches has substantial potential to combat the public health problem of cigarette related cancer, other diseases, and premature death from tobacco use. Targeting such tobacco cessation initiatives to rural regions may substantially increase the impact of this intervention, helping to optimize the use of limited prevention resources while aiming to save the maximum number of lives., Clinical Trials Registration: ClinicalTrials.gov NCT04606797 , October, 27, 2020.

Objective: The incidence of thyroid cancer (TC) is known to be very high in the Greater Toronto Area of Ontario, Canada. We performed a pilot survey study examining Toronto-area family physician (FP) perspectives on thyroid neoplasm evaluation (i.e. thyroid nodules [TNs] or thyroid cancer [TC]) in this region, to explore for potential factors leading to overdiagnosis. Methods: We performed a cross-sectional mail-out written survey of a random sample of 300 FPs in active practice in the Greater Toronto Area (Markham and Brampton). Results: The overall response rate was 22.3, 95% confidence interval (CI) 18.0, 27.4% (67/300); the effective response rate was 19.9, 95% CI 15.7, 24.9% (58/291), after excluding 6 FPs that reported TN evaluation was outside their scope of practice and three FPs with an invalid mailing address. There were no missing responses to questions. The demographic characteristics were as follows: 58.6% (34/58) from Markham, 55.2% (32/58) were female, 58.6% (34/58) were in practice > 10 years, and 32.8% (19/58) affiliated with a University. All FPs reported easy access to thyroid ultrasound (TUS). About half of FPs were concerned about overdiagnosis of TC and most did not believe that there was any TC survival advantage with routine screening TUS. Although appropriate indications for TUS were endorsed by most respondents (e.g. palpable TN, incidental TN on other imaging), inappropriate recommendations were observed in a third of FPs (19/57) who recommended TUS for abnormal thyroid blood tests about half of FPs (30/56) who endorsed biopsy of sub-centimeter nodules. About half of FPs (31/58) reported that their patients sometimes request medically unnecessary TUS. Conclusion: There are likely multiple complex factors leading to potential overdiagnosis of TC in primary care, including some physicians' knowledge gaps about appropriate indications for TN investigations as well as patients' requests and expectations. [ABSTRACT FROM AUTHOR]