'Irrational' stated preferences: a quantitative and qualitative investigation

Individuals' rationality has been a key issue long debated in Economics. While normative theories establish the way 'rational' consumers should behave, many empirical studies have documented numerous systematic violations of normative principles. This has led some to question the validity of classic economic models as an adequate approximation of individuals' real decision-making. This paper aims to shed more light on this debate. A stated preference choice experiment was set up to test rational choice properties. Attention was given to the extent to which satisfaction of such tests is related to both the complexity of the design, and subject characteristics. Quantitative and qualitative methods are applied. The majority of respondents passed the rationality tests. Satisfaction of the tests was sensitive to normatively irrelevant factors such as the complexity of the task and demographic characteristics. A significant proportion of those individuals who 'failed' seem to have reformulated the experiment in some way in their mental process. Implications for the design and analyses of future DCEs are discussed.     

Undergraduate students' attitudes to communication skills learning differ depending on year of study and gender

The authors wished to assess medical students' attitudes towards communication skills learning, and to validate the use of the Communication Skills Attitude Scale (CSAS) in a different population. This cross-sectional study of Years 1-3 MBChB students, University of Aberdeen, in 2002-03 (overall response rate=86.2%) identified significant differences in attitudes to communication skills teaching by year of study and gender. PAS (positive attitudes scores) for Year 1 were significantly higher than those for Years 2 and 3. NAS (negative attitudes scores) for Year 1 were significantly lower than the scores for Year 2 but not Year 3. The scores for Years 2 and 3 were not significantly different. Female students had a significantly higher mean PAS score and lower mean NAS score than males, and were more likely to disagree that their communication and clinical skills were competent. While cohort effects may be present, it seems that attitudes towards communication skills learning are positive initially, becoming less so until students experience interacting with patients. Differences between male and female students reflect those seen in previous studies. The findings presented support the use of the CSAS as an appropriate tool to measure attitudes in a wide population of medical students.     

A review of nursing skill-mix to optimise care in an acute trust

The main resource of the NHS is its workforce. However, achieving the correct mix of staff is crucial if it is to provide high-quality patient care in a cost-effective manner. When an acute trust was singled out in an independent analysis as having 'too rich' a skill-mix (compared with the rest of the strategic health authority), an internal review was undertaken to determine the ratio of qualified to unqualified nursing staff, and to compare these with acuity and dependency in each clinical area. The information was used to revise the nursing skill-mix within the trust.     

Are washable absorbents effective at containing urinary incontinence?

This article describes a pilot study to evaluate washable (or reusable) absorbent garments for adults with moderate to heavy urinary incontinence. The article will describe: The study process; How the individual products performed and how the washable and disposable products compared; How nurses can enable their patients to use washable products appropriately.     

Acute respiratory distress syndrome of the contralateral lung after reexpansion pulmonary edema of a collapsed lung

STUDY OBJECTIVE: To report that leukocyte-mediated acute injury may develop in a nonhypoxic lung after hypoxia-reoxygenation injury of the hypoxic lung and in other systemic organs in patients with reexpansion pulmonary edema. DESIGN: Case report analysis with examination of the literature. SETTING: Intensive care unit of a university hospital. PATIENTS: Three patients who developed leukocyte-mediated acute lung injury in the contralateral lung and systemic organ injury after ipsilateral reexpansion pulmonary edema of a collapsed lung. MEASUREMENTS: To rule out the possibility that the acute lung injury in the contralateral lung was an extension of the hypoxia-reoxygenation injury, we analyzed changes in leukocyte and platelet count in the peripheral blood in relation to the development of pulmonary edema in each lung. Changes in liver enzymes were also analyzed to detect hepatic dysfunction as evidence of systemic organ injury. MAIN RESULTS: Both leukocyte and platelet counts decreased when reexpansion pulmonary edema developed, and decreased further when acute lung injury developed in the contralateral lung (F = 8.42, p = 0.037 for leukocytes, and F = 17.66, p = 0.01 for platelets). Significant hepatic dysfunction developed, as evidenced by increases in both serum bilirubin (p = 0.001) and lactic dehydrogenase, indicating the presence of systemic organ injury. CONCLUSIONS: The hypoxia-reoxygenation injury of one lung can induce acute lung injury in the other lung and systemic organ injury.     

Cesarean section on request

Obstetricians are facing a tide of non-medically indicated requests for cesarean section. Risks and benefits of accepting cesarean section on request are discussed.     

Stress, trauma, and risky sexual behaviour among American Indians in young adulthood

This paper examines the relationship of risky sexual behaviour to stress and trauma-often the mediators of the content and structure of everyday life-among young American Indians. School, work, social life, and home life bring about demands and stresses for youth; choices young people make may depend on the quantity and content of those demands. Traumatic events or highly distressing situations may shatter fragile (or even resilient) systems of external and internal support from which youth may draw. American Indians live in some of the most impoverished areas of the country, where everyday life includes a heavy burden of stress and trauma. Using data from a representative sample of youth from a Northern Plains tribe, bivariate and adjusted ordered logit models are used to show that stress and trauma do play a role in the sexual decision-making of young people, especially young women. For example, young women who have experienced a trauma have a 20% probability of having had multiple casual partners in the prior year compared to 9% for those who have not experiences a trauma. Types and levels of stress and trauma also make a difference by gender.