Sex differences in impulsive action and impulsive choice

Here, we review the evidence for sex differences in behavioral measures of impulsivity for both humans and laboratory animals. We focus on two specific components of impulsivity: impulsive action (i.e., difficulty inhibiting a prepotent response) and impulsive choice (i.e., difficulty delaying gratification). Sex differences appear to exist on these measures, but the direction and magnitude of the differences vary. In laboratory animals, impulsive action is typically greater in males than females, whereas impulsive choice is typically greater in females. In humans, women discount more steeply than men, but sex differences on measures of impulsive action depend on tasks and subject samples. We discuss implications of these findings as they relate to drug addiction. We also point out the major gaps in this research to date, including the lack of studies designed specifically to examine sex differences in behavioral impulsivity, and the lack of consideration of menstrual or estrous phase or sex hormone levels in the studies.     

Valuations of Genetic Test Information for Treatable Conditions: The Case of Colorectal Cancer Screening

BackgroundThe value of the information that genetic testing services provide can be questioned for insurance-based health systems. The results of genetic tests oftentimes may not lead to well-defined clinical interventions; however, Lynch syndrome, a genetic mutation for which carriers are at an increased risk for colorectal cancer, can be identified through genetic testing, and meaningful health interventions are available via increased colonoscopic surveillance. Valuations of test information for such conditions ought to account for the full impact of interventions and contingent outcomes.ObjectivesTo conduct a discrete-choice experiment to elicit individuals’ preferences for genetic test information.MethodsA Web-enabled discrete-choice experiment survey was administered to a representative sample of US residents aged 50 years and older. In addition to specifying expenditures on colonoscopies, respondents were asked to make a series of nine selections between two hypothetical genetic tests or a no-test option under the premise that a relative had Lynch syndrome. The hypothetical genetic tests were defined by the probability of developing colorectal cancer, the probability of a false-negative test result, privacy of the result, and out-of-pocket cost. A model specification identifying necessary interactions was derived from assumptions of risk behavior and the decision context and was estimated using random-parameters logit.ResultsA total of 650 respondents were contacted, and 385 completed the survey. The monetary equivalent of test information was approximately $1800. Expenditures on colonoscopies to reduce mortality risks affected valuations. Respondents with lower income or who reported being employed significantly valued genetic tests more.ConclusionGenetic testing may confer benefits through the impact of subsequent interventions on private individuals.     

Quantifying population preferences around vaccination against severe but rare diseases: A conjoint analysis among French university students, 2016

BackgroundSeveral concepts are available to explain vaccine decision making by individual and inter-individual factors, including risk perception, social conformism and altruism. However, only a few studies have quantified the weight of these determinants in vaccine acceptance. Using a conjoint analysis tool, we aimed at eliciting preferences in a student population regarding vaccination against a rare, severe and rapidly evolving hypothetical disease, similar to meningococcal serogroup C meningitis or measles.MethodsDuring March-May 2016, we conducted an emailing survey among university students aged 18–24 years (N = 775) in Rennes, France. Participants were asked to decide for or against immediate vaccination in 24 hypothetical scenarios, containing various levels of four attributes: epidemic situation, adverse events, information on vaccination coverage, and potential for indirect protection. Data were analysed using random effect estimator logit models.ResultsParticipants accepted on average 52% of scenarios and all attributes significantly impacted vaccination acceptance. The highest positive effects were seen with an epidemic situation (OR 3.81, 95%-CI 3.46–4.19), 90% coverage in the community (3.64, 3.15–4.20) and potential for disease elimination from the community (2.87, 2.53–3.26). Information on “insufficient coverage” was dissuasive (vs. none of friends vaccinated: 0.65, 0.56–0.75). Controversy had a significantly greater negative effect than a confirmed risk of severe adverse events (OR 0.05 vs. 0.22). In models including participant characteristics, preference weights were unchanged, while trust in health authorities and vaccination perceptions strongly influenced acceptance themselves. The greatest significant variation of preference weights between subgroups was observed with controversy among students using alternative medicine daily (OR 0.28) and among students relying on scientific vaccine information (OR 0.02).ConclusionsAmong young adults, potential for indirect protection and factual information on coverage in the community and potential side effects positively impact theoretical vaccine acceptance. Conjoint analyses should be conducted to understand vaccine hesitancy in specific vaccination programs.     

Factors Influencing Nursing Career Choices and Choice of Study Program

In advance of a recruitment campaign, Israeli first-year nursing students of all ethnicities were surveyed to elucidate what factors had influenced them to make nursing their career and what sort of training track they preferred. The responses made it clear that different factors influence different groups differently. There were noticeable differences by gender, age, and ethnicity. Overall, training institutions were chosen for their closeness to the student's home but other factors also operated among particular groups, such as institutional prestige and flexible entry criteria. There was a blatant preference for academic, particularly university-sited, programs over diploma programs.     

Parents’ Willingness to Pay for Biologic Treatments in Juvenile Idiopathic Arthritis

BackgroundBiologic therapies are considered the standard of care for children with the most severe forms of juvenile idiopathic arthritis (JIA). Inconsistent and inadequate drug coverage, however, prevents many children from receiving timely and equitable access to the best treatment.ObjectiveThe objective of this study was to evaluate parents’ willingness to pay (WTP) for biologic and nonbiologic disease-modifying antirheumatic drugs (DMARDs) used to treat JIA.MethodsUtility weights from a discrete choice experiment were used to estimate the WTP for treatment characteristics including child-reported pain, participation in daily activities, side effects, days missed from school, drug treatment, and cost. Conditional logit regression was used to estimate utilities for each attribute level, and expected compensating variation was used to estimate the WTP. Bootstrapping was used to generate 95% confidence intervals for all WTP estimates.ResultsParents had the highest marginal WTP for improved participation in daily activities and pain relief followed by the elimination of side effects of treatment. Parents were willing to pay $2080 (95% confidence interval $698–$4065) more for biologic DMARDs than for nonbiologic DMARDs if the biologic DMARD was more effective.ConclusionsParents’ WTP indicates their preference for treatments that reduce pain and improve daily functioning without side effects by estimating the monetary equivalent of utility for drug treatments in JIA. In addition to evidence of safety and efficacy, assessments of parents’ preferences provide a broader perspective to decision makers by helping them understand the aspects of drug treatments in JIA that are most valued by families.     

Cognitive Overload? An Exploration of the Potential Impact of Cognitive Functioning in Discrete Choice Experiments with Older People in Health Care

ObjectivesThis exploratory study sought to investigate the effect of cognitive functioning on the consistency of individual responses to a discrete choice experiment (DCE) study conducted exclusively with older people.MethodsA DCE to investigate preferences for multidisciplinary rehabilitation was administered to a consenting sample of older patients (aged 65 years and older) after surgery to repair a fractured hip (N = 84). Conditional logit, mixed logit, heteroscedastic conditional logit, and generalized multinomial logit regression models were used to analyze the DCE data and to explore the relationship between the level of cognitive functioning (specifically the absence or presence of mild cognitive impairment as assessed by the Mini-Mental State Examination) and preference and scale heterogeneity.ResultsBoth the heteroscedastic conditional logit and generalized multinomial logit models indicated that the presence of mild cognitive impairment did not have a significant effect on the consistency of responses to the DCE.ConclusionsThis study provides important preliminary evidence relating to the effect of mild cognitive impairment on DCE responses for older people. It is important that further research be conducted in larger samples and more diverse populations to further substantiate the findings from this exploratory study and to assess the practicality and validity of the DCE approach with populations of older people.     

Creating a Health-Promoting Group for Elderly Couples on a Home Health Care Program

The hospital home care social worker has a unique opportunity to develop a home-keeping, health-promoting group for frail elderly couples within his or her caseload. Through home visits, working as a filial professional, the worker enters, then strengthens the couples' pre-illness formal and informal support networks, and then goes on to create an additional informal peer support group, that meets in each others' homes. The group is capable of decreasing the chance of nursing home placement for all its members. It is proposed that home health care agencies within hospitals incorporate such groups into their regular programs.     

The Impact of an Outpatient Program for Women with Substance Use-Related Disorders on Retention

Meeting the needs of women manifesting substance-use disorders is a goal in developing treatment programs for this population. As retention in treatment is positively related to treatment outcome, the length of stay in outpatient treatment of alcohol- and other drug-dependent women in Brazil was compared between two programs. Data were analyzed from 181 women entering a Mixed-Gender Program from 1986 to 1996 and from 80 women entering a Women-Only Program from 1997 to 1998. A greater 3-month retention rate was observed in the Women-Only as opposed to the Mixed-Gender Program. Moreover, the impact was more significant among the alcohol-dependent women. This finding suggests that the heterogeneity of women with substance-use disorders has to be taken into account when developing appropriate treatment strategies.