Is there a meaningful definition of the value of a statistical life?

A definition of the value of a statistical life is derived. This definition has a meaningful interpretation in terms of the monetary value of expected present value utility if consumption is age-independent. In all other cases, empirical estimates of the value of a statistical life are biased estimators of the monetary counterpart to expected present value utility.     

Outbreak of mumps in a vaccinated child population: a question of vaccine failure?

In Belgium, children are immunized against measles-mumps-rubella (MMR) in a two-dose schedule at the age of 15 months and 11 years. Despite these recommendations, epidemics of mumps still occur. During an outbreak of mumps in Bruges (Belgium), 105 cases were registered in seven schools (age group 3-12 years). Lower than optimal vaccination coverage, inadequate vaccination schedule and a combination of primary and/or secondary vaccine failure are considered as possible reasons for the outbreak as described in the article. The role of secondary vaccine failure is highlighted.     

Results of a meta-analysis of cost-benefit research: is this a question worth asking?

We attempted a meta-analysis of telemedicine research studies of the costs associated with telemedicine. First, we performed a search of six well known databases with a variety of relevant keywords. After discarding non-English publications, books and duplicate publications resulting from the same study, we were left with 551 articles for analysis. Our second step was to separate the articles into two groups: those with and those without quantitative cost data. Only 38 articles contained any type of real data. Because many of these 38 studies proved to be inadequately designed or conducted, we were unable to perform a traditional meta-analysis. Furthermore, there were a number of disturbing features common to these studies, including the omission of the number of consultations or patients, almost non-existent longitudinal data collection and lack of uniformity in cost analyses. We conclude that it is premature for any statements to be made, either positive or negative, regarding the cost-effectiveness of telemedicine in general.     

Is a history of trauma associated with a reduced likelihood of cervical cancer screening?

OBJECTIVE: We tested the hypothesis that a history of trauma (especially sexual trauma) was associated with a reduced likelihood of having had medically appropriate cervical cancer screening. STUDY DESIGN: A case-control study using mailed self-report questionnaires. POPULATION: The questionnaires were completed by an age-stratified random sample of adult women members of a large health maintenance organization. The sample included 364 women who had received medically appropriate cervical cancer screening and 372 who had not. OUTCOMES MEASURED: We defined cases as women who, according to their medical record, had not had cervical cancer screening within 2 years before the study. Controls were defined as women who had been screened. We evaluated exposures to trauma that we hypothesized to be associated with the case/control state. RESULTS: Women who had been sexually abused in childhood were less likely to have had a Pap smear within the past 2 years (36.0% vs. 50.4%, P =.050). Other traumatic events were associated with Pap testing in bivariate analyses but not when demographic characteristics and clinic location were controlled. Childhood sexual abuse remained associated with reduced odds of Pap screening in logistic regression analyses that controlled for clinic location, demographics, attitudes about Pap screening, and posttraumatic stress disorder symptoms (adjusted OR = 0.56, 95% CI 0.34 to 0.91). CONCLUSIONS: These findings suggest that childhood sexual abuse may lead to decreased probability of screening for cervical cancer, potentially contributing to the poorer health seen in other studies of women who have been sexually abused.     

The Cascading Effects of Multiple Dimensions of Implementation on Program Outcomes: a Test of a Theoretical Model

This study tests a theoretical cascade model in which multiple dimensions of facilitator delivery predict indicators of participant responsiveness, which in turn lead to improvements in targeted program outcomes. An effectiveness trial of the 10-session New Beginnings Program for divorcing families was implemented in partnership with four county-level family courts. This study included 366 families assigned to the intervention condition who attended at least one session. Independent observers provided ratings of program delivery (i.e., fidelity to the curriculum and process quality). Facilitators reported on parent attendance and parents’ competence in home practice of program skills. At pretest and posttest, children reported on parenting and parents reported child mental health. We hypothesized effects of quality on attendance, fidelity and attendance on home practice, and home practice on improvements in parenting and child mental health. Structural Equation Modeling with mediation and moderation analyses were used to test these associations. Results indicated quality was significantly associated with attendance, and attendance moderated the effect of fidelity on home practice. Home practice was a significant mediator of the links between fidelity and improvements in parent-child relationship quality and child externalizing and internalizing problems. Findings provide support for fidelity to the curriculum, process quality, attendance, and home practice as valid predictors of program outcomes for mothers and fathers. Future directions for assessing implementation in community settings are discussed.     

Is nursing a profession? Results of a Missouri study.

This article examines the question of whether or not nursing is or should be a profession. The conclusion is based primarily on an analysis of what constitutes a profession and an empirical study of some nursing practices and attitudes. The analysis of professions recognizes three prominent models in sociology: trait, functional, and power or control. It bypasses these in favor of a "cluster concept," which asserts that the public has a number of expectations of an occupation before it will bestow the status of profession upon it. We then give an analysis of some of the results of the survey of a sample of Missouri registered nurses. The gist of the data is said to reflect the facts that these nurses think nursing is or should be a profession, but that other factors tend to show that nursing lacks the requisite cluster to substantiate the claim to be a profession. We conclude that nursing should perhaps not be a profession since it has been a bastion of the "ethics of compassion" in a world that is increasingly beset by an "ethics of competence."     

Processing of a cowpea–groundnut blend into a miso-like product

A traditional salt-miso process was used to produce a miso-like product from a 50–50 mixture of cowpea and groundnuts in a 60-day fermentation process as part of a study to determine the suitability of local legumes as raw materials for the production of miso. The koji was freshly prepared from a locally obtained rice and Aspergillus oryzae spores obtained from Japan. An old miso sample also obtained from Japan was used as the source of lactic acid bacteria. The physico-chemical changes in the product associated with the fermentation and the functional and quality characteristics of the final product were determined. The study demonstrated the possibility of processing the legume blend into a miso-like product. The physico-chemical, functional and quality characteristics of the final product showed the suitability of the product for its intended use as a soup base. The product had a high protein and a moderately high lipid content (about 25% and 29%, respectively), which could contribute to the nutritional contents of diets.     

Feasibility of a randomized trial of a high‐vegetable diet to prevent breast cancer recurrence

Epidemiologic evidence supports the concept that diet influences risk for breast cancer and suggests that prognosis after the diagnosis of breast cancer may also be related to modifiable nutritional factors. The purpose of this study was to investigate the feasibility of a randomized trial of a high‐vegetable, reduced‐fat, and increased‐fiber diet intervention to reduce risk for recurrence among breast cancer survivors. This major change in dietary pattern was promoted through intensive telephone counseling. Participants were 93 women who had been diagnosed with breast cancer (stages I, II, and IIIA) within the previous four years and who had completed their initial treatment. We assessed adherence to the study diet using repeated 24‐hour dietary recalls at 6 and 12 months and measurement of circulating carotenoid concentrations. Six months after randomization, the intervention group had significantly increased their mean intake of vegetables (+4.6 servings/day), fruit (+0.7 servings/day), and fiber (+6.4 g/1,000 kcal) and significantly reduced their intake of dietary fat (‐9.9% of energy) compared with the control group. Circulating concentrations of carotenoids also increased in the intervention group. These changes persisted at the 12‐month visit. Results of this study demonstrate that telephone counseling can be a useful approach in diet intervention and that breast cancer survivors can adopt and maintain a high‐vegetable, reduced‐fat dietary pattern.     

Toward ‘seeing’ critically: a Bayesian analysis of the impacts of a critical pedagogy

Advances in Health Sciences Education - Critical reflection supports enactment of the social roles of care, like collaboration and advocacy. We require evidence that links critical teaching...     

Concurrent occurrence of a gastric cancer with a hepatocellular carcinoma: report of a case: incidental or causal association?

Little information regarding synchronous gastric cancer associated with hepatocellular carcinoma is available and has been sporadically reported. We report a new case of 60 years old patient operated for gastric carcinoma. The radiological investigations revealed a hepatic nodule which correspond to a hepatocellular carcinoma on histological examination. The aim of this study is to clarify the clinicopathologic and therapeutic features of this association.     

The perceptions of statutory service providers of a local Sure Start programme: a shared agenda?

Sure Start is the UK government's flagship scheme for providing services to children and their families in deprived areas. This study aimed to examine the perceptions of statutory service providers about their experience of working with Sure Start professionals in one Nottinghamshire (UK) Sure Start programme, and to explore the extent to which there was a shared agenda and successful collaboration. A purposive sample of 18 statutory providers working within existing mainstream health, education and social care services were interviewed, between January and March 2005. Data were analysed through thematic content analysis. We found that although interviewees welcomed the additional input provided by Sure Start for the most vulnerable families, a number of tensions arose over key divergences between the philosophical positions of statutory providers and Sure Start. The most important tension was over Sure Start's philosophy of targeting resources on an entire geographical area. This was seen as antithetical to statutory providers' case-by-case approach, and raised questions about access and equity for families living outside Sure Start's boundaries. Sure Start's concentration on young children, and the time-limited nature of their services and activities, frustrated statutory providers who had a broader family focus, and a longer term perspective. The perceived under-resourcing of statutory services in comparison to Sure Start, and statutory providers' responsibility for 'selling' Sure Start services, strained a sense of equality between agencies and professionals, and undermined a sense of a shared agenda. We conclude that successful collaboration and a shared agenda depends upon a mutual understanding of the basic philosophy of service provision. The government's commitment to developing interprofessional collaboration will be furthered significantly by placing Sure Start services under the umbrella of statutory provision, and ensuring that the differing service philosophies are reconciled.