The value of a statistical life: theoretical and empirical evidence

The value of a statistical life is an important concept in health and environmental economics. This paper provides definitions of the value of a statistical life, and considers single-period and life cycle models. It shows how the value of a statistical life can be measured simply in empirical studies, and addresses the important age profile issue. Available empirical evidence is briefly presented, and recent studies are included that use meta-analysis to determine which variables are appropriate to explain the variance of estimates of the value of statistical life.     

The role of life skills promotion in substance abuse prevention: a mediation analysis

Research has shown that life skills programs are the most effective single activity in school-based substance abuse prevention. However, little is known about the processes through which they are effective. This study examines whether an evidence-based prevention program targeting general competence is effective through the promotion of knowledge about life skills and enhanced related behaviors. Based on a sample of 442 fifth graders participating in a quasi-experimental prevention study, as expected, mediation analyses revealed that increased knowledge about life skills paralleled an increase in students' distant attitudes toward alcohol and nicotine use. Unexpectedly, behaviors manifesting enhanced life skills were found not only among program participants who remained experimental/non-smokers or stopped smoking but also among smokers. In general, findings suggest that favorable prevention outcomes may be influenced through building knowledge about general life skills. The notion of uniform mechanisms of effectiveness in prevention programs is discussed.     

Illness, everyday life and narrative montage: the visual aesthetics of cancer in Sara Bro's Diary

This article presents a study of Sara Bro's Diary (2004), a book montage of images and texts recording the experiences of a Danish breast cancer survivor, Sara Bro. It examines two montages of photography and text, drawing on Roland Barthes' concept of 'the third meaning' to explain and discuss the effect of the layered meanings in the montage alongside their multi-medium and self-referential expression. The discussion is centred on the aesthetic practices that are invited by Bro's book montage. The article considers how the juxtaposition of images and texts are experienced and co-created by the reader. It points to the effect of the aesthetics of disguise and carnival implicit in the visual-verbal montage and argues that these generate a third meaning. This meaning is associated with the breast cancer experience but is not directly discernible in the montage. The article concludes by discussing how Bro's montage acts as an ideological statement, subverting or 'poaching on' the health care system.     

Burnout as an identity rupture in the life course: a longitudinal narrative method

The methodological article explores the process by which identity rupture generated by work-related burnout is encountered and managed over time. The article presents an in-depth case study based on follow-up interviews with a woman in her sixties. The study attempts to discover what kinds of continuities and changes in meaning making patterns are included in the burnout process and how these meaning making patterns are used to perform and negotiate identity stabilities and changes in the life course. The study is part of a larger longitudinal qualitative investigation following a group of Finnish middle-aged employees in the context of burnout rehabilitation. As a result of analysis, four thematically and temporally overlapping meaning making patterns were identified: defining and legitimating illness, encountering and resisting the ‘vulnerable’ Other in self, developing and testing a new identity, and recapturing the past self. The burnout trajectory seems to consist of temporally stable meaning making patterns, such as legitimation of illness, preservation of the past self and resistance of the patient role. However, it also includes changes in meaning making that imply positively interpreted self-change. The study contributes to the methodological development of qualitative health and life course research.     

The evidence on breast cancer screening: the story continues

The publication of the new Cochrane review on screening for breast cancer with mamography has revived the debate on breats screening and raised some new topics. Whereas the Cochrane reviewers reasserted on their previous conclusion of the lack of efficacy of breast screening, the new review of the Swedish studies, the new systematic review of the Agency for Healthcare Research and Quality commissioned by the US Preventive Services Task Force, and the recent review of an IARC working group supported the efficacy of breast screening after carefully considering the methodological quality of trials. Nevertheless, the efficacy of breast screening for younger women remains controversial. The present controversy has raised other issues like the measure of the benefit in screening trials or the potential adverse effects of screening, particularly, overdiagnosis and its impact on therapy that are discussed in this papers. It also stresses of evaluating screening before introducing it and the need to inform the population about the benefits and the potential harms and about uncertainties about cancer screening.     

The role of vitamins in cancer: a review

Vitamins are essential nutrients for human metabolism, playing an important role as coenzymes or enzymes in many vital processes for the normal functioning of the body. In recent years, it has become apparent that vitamins are crucial in health and human disease, due to several studies that studied this relationship. Currently, it is known that vitamins can have an important role in the prevention and treatment of cancer, but until now no conclusive results were obtained. In this review, we will present the work and more relevant conclusions obtained in recent years of investigation about the relationship between vitamins and cancer, namely vitamin A, vitamin B complex, vitamin C, vitamin D, vitamin E, and vitamin K.     

Reconstructing Gloria: a narrative analysis of team meetings

This article focuses on the role of stories told about a patient in geropsychiatric team meetings in the construction of an image of the patient. Using the narrative techniques described by Gee, Labov, and Riessman, three team meeting discussions about a geropsychiatric patient are analyzed. The role of stories and the various images these engender are examined in relationship to (a) the team's evolving understanding of the patient, (b) the team's conception of the role of the patient, and (c) how the thematic components of these stories may influence patient care.     

The role of quality improvement in disease management: a statewide tuberculosis control success story.

This study describes Mississippi's statewide latent tuberculosis infection (LTBI) control management efforts to improve treatment outcomes using scientific quality improvement tools. LTBI medication completion rates were observed by month and by nine administrative health districts for a 12-month period. Analysis of variance (ANOVA) was conducted to see if there was any significant change between preintervention and postintervention in medication completion rates. Regression analysis was performed to test the linearity of change across the monthly rates. A change from a rate of 79.7 percent to 90.5 percent completion of the LTBI medication regimen was observed after the quality improvement intervention was instituted. During the quality improvement intervention, the mean reached 96.5 percent completion, followed by a slight decline at the end of the intervention to 90.5 percent. The analysis revealed that the mean LTBI medication completion rate across the nine administrative health districts was significantly increased and variability was decreased across all administrative health districts, with minor exceptions. A quality improvement team approach was shown to be effective in disease management by increasing LTBI medication completion. New baseline expectations can be established when quality improvement initiatives are implemented. This success can be linked, in part, to the use of scientific methods, precise and valid data, persuasive and clear goal setting, appropriate feedback, and ongoing monitoring.     

Implementing information technology in the NHS: the role of narrative.

This paper analyses how groups use narratives in social processes of sensemaking and identity construction and in the pursuit and legitimation of their selfish interests. It does so through an examination of the narrativity of the experiences reported by the developers and users of an information technology (IT) system linking a haematology laboratory and a specialist haematology ward in a large acute hospital. The research contribution the paper makes is twofold. First, it illustrates the importance of group-level narratives in enacting organizational realities and especially in the social construction of IT systems. Second, it suggests that the narrative understanding of groups is a significant domain of organizational inquiry because it is through the spread and acceptance of their narratives that groups exercise their most profound influence.     

The role of trust in HPV vaccine uptake among racial and ethnic minorities in the United States: a narrative review

Despite the clinically proven benefits of the human papillomavirus (HPV) vaccine in preventing cervical and other HPV-associated cancers, vaccination coverage has been suboptimal among adolescents and young adults in the United States (US), particularly among racial and ethnic minority adolescents. Historical legacies, combined with current racial/ethnic disparities in healthcare, may contribute to suboptimal uptake and completion of the HPV vaccine in part through differing levels of trust in doctors and healthcare institutions. The purpose of this narrative review was to characterize trust and its role in decision making about HPV vaccine uptake among US racial and ethnic minorities. We conducted a literature search using the PubMed database, and our search terms yielded 1176 articles. We reviewed 41 full-text articles for eligibility and included 20 articles in this review. These studies used varied measures of trust or mistrust and assessed trust in not only doctors/healthcare providers, but also other sources including pharmaceutical companies, media, and clergy. Our review findings revealed generally high levels of trust in doctors and healthcare providers, but less so in pharmaceutical companies. Mistrust of either healthcare providers, government agencies or pharmaceutical companies was consistently associated with less favorable attitudes and lower vaccine uptake. The downstream effects of mistrust may occur through selected health beliefs regarding the perceived efficacy and safety of the vaccine. Minority groups were more likely to report trust in family members, religious organizations, and media sources compared to their white counterparts. Decision making about vaccine uptake is a multilayered process that involves comparing the perceived benefits of the vaccine against its perceived risks. Understanding how trusted sources can effectively harness the tools of social and traditional media to increase knowledge and awareness may help combat misinformation about the HPV vaccine and improve engagement with diverse communities.     

Quality of life in cancer patients: The role of optimism,hopelessness, and partner support

The interaction of optimism, hopelessness and social support as predictors of Health-Related Quality of Life (HRQL) among seriously ill people is not well understood. Also, the impact of partner characteristics on patient quality of life has often been overlooked. In this study the relationships between optimism, hopelessness, partner support and HRQL were investigated in 155 cancer patients and their partners. Special attention was given to the effects of optimism and hopelessness as mediators and moderators in the partner support–HRQL relationship. The impact of partner optimism and hopelessness on perceived partner support and patient HRQL was also studied. The results indicated substantial gender differences in the relationships between the study variables. High levels of partner support were associated with female patients’ optimistic appraisals, and together they predicted better HRQL at 8 months follow-up. Partial support was found for the effect of optimism as a mediator. For male patients, low hopelessness was the key variable predicting good HRQL. Clear evidence for the moderator effects of optimism/hopelessness was not found, and the expected impact of partner’s characteristics on partner support or patient HRQL could not be confirmed. Although partner support, patient optimism and hopelessness all appeared to be important determinants of HRQL in cancer patients, the relationships between these variables differed by gender. The proposed mediation and moderation models needs to be confirmed in future studies.     

Dualities of dementia illness narratives and their role in a narrative economy

The concept of ‘narrative economies’ has recently been proposed as a set of exchange relationships that, through biography and story‐telling, facilitate access to resources and act as a source of value. We utilise this concept to inform our analysis of 18 qualitative interviews with five people with dementia and four informal carers. Our participants are members of a pre‐existing group of dementia advocates, representing the voices of those living with the condition. There are a growing number of people in the early stages of dementia – like our participants – being called upon to account for their experience, as a means of developing a politicised ‘collective illness identity’. These interviews present an opportunity to study a group of people who are actively involved in speaking as, and for, people with dementia. Four themes emerged from the data: becoming a voice of or for people with dementia; biographical reinforcement; responsibilisation; and resistance. These themes illustrate the ways in which people with dementia participate in their own identity construction and, as representatives of those living with dementia, they also illustrate the ways in which illness narratives produce material and symbolic value.