bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating dimensional organization in scripts using the pupillary response
Authors: Raisig Susanne , Welke Tinka , Hagendorf Herbert , Meer Elke Van Der
Published: September 2007

Scripts are mental representations of activities in memory and are thought to be organized dimensionally in a temporal dimension. We investigated the cognitive strategies during the processing of temporal order of an event sequence to gain insight into the organization of scripts. Subjects were presented with triplets of script events (A – B – C). Fifty percent of the items included sequence violations at different positions within the triplet (late: A – C – B, or early: C – A – B). Reaction times indicate that subjects use an economical strategy by comparing the relative temporal positions of event pairs (e.g., A vs. B and if necessary B vs. C) and only attend to information that is necessary. Pupil data and error rates indicate that the temporal information of the complete sequence affects the decision process even if the first event pair indicates that temporal order has been violated. Results are seen as evidence of a dimensional structure of scripts.
An investigation of concurrent ERP and self‐paced reading methodologies
Authors: Ditman Tali , Holcomb Phillip J. , Kuperberg Gina R.
Published: September 2007

Traditionally, event‐related brain potential (ERP) studies of language processing have presented words at a fixed rate using rapid serial visual presentation. Recent studies suggest, however, that the processes engaged during sentence comprehension are contingent on word presentation rate. These findings underscore the importance of allowing participants to read at a natural pace. The present study employed simultaneous self‐paced reading and ERP methodologies to examine behavioral and neural responses while participants read sentences containing pragmatic or morphosyntactic violations or no violations. ERP and self‐paced reading results replicated previous findings. This novel combination of behavioral and ERP methodologies combines the high temporal resolution and direct neural measures offered by ERPs with the more natural reading environment and information about processing load provided by self‐paced reading.
Dissociation of neural regions associated with anticipatory versus consummatory phases of incentive processing
Authors: Dillon Daniel G. , Holmes Avram J. , Jahn Allison L. , Bogdan Ryan , Wald Lawrence L. , Pizzagalli Diego A.
Published: September 2007

Incentive delay tasks implicate the striatum and medial frontal cortex in reward processing. However, prior studies delivered more rewards than penalties, possibly leading to unwanted differences in signal‐to‐noise ratio. Also, whether particular brain regions are specifically involved in anticipation or consumption is unclear. We used a task featuring balanced incentive delivery and an analytic strategy designed to identify activity specific to anticipation or consumption. Reaction time data in two independent samples (n=13 and n=8) confirmed motivated responding. Functional magnetic resonance imaging revealed regions activated by anticipation (anterior cingulate) versus consumption (orbital and medial frontal cortex). Ventral striatum was active during reward anticipation but not significantly more so than during consumption. Although the study features several methodological improvements and helps clarify the neural basis of incentive processing, replications in larger samples are needed.
Age effects to negative arousal differ for self‐report and electrodermal activity
Authors: Gavazzeni Joachim , Wiens Stefan , Fischer Håkan
Published: September 2007

Affective processing and emotional experience may change with age. Because findings of age differences in affective experiences are mixed even in studies using standardized stimuli, this study assessed age differences along gradual increases in negative arousal. Younger (20–30 years) and older (70–80 years) healthy adults (n=78) viewed 110 neutral to negative pictures (IAPS) while intensity ratings and electrodermal activity were recorded. Results showed that age had opposite effects on intensity ratings and electrodermal activity over gradual increases in normative arousal. Whereas older adults showed greater increases in intensity ratings than younger adults, they showed attenuated electrodermal activity, especially at high negative arousal. Because self‐reports of arousal capture various aspects of affective processes (e.g., physiological changes as well as experience), effects of age may vary for these different aspects.
The role of asymmetrical frontal cortical activity in aggression
Authors: Peterson Carly K. , Shackman Alexander J. , Harmon‐Jones Eddie
Published: September 2007

Aggression correlates with relatively greater left than right frontal electroencephalographic activity (inverse of EEG alpha power). The present experiment extends this research by manipulating frontal asymmetry and examining its effect on aggression. Participants were assigned to increase left frontal activation or increase right frontal activation by contracting their contralateral hand. They then received insulting feedback and played a game in which they could aggress toward the person who insulted them. Right‐hand contractions caused greater left than right central and frontal activation and aggression as compared to left‐hand contractions. Within the right‐hand contraction condition, greater relative left frontal activity was associated with greater aggression.
Influence of cognitive control and mismatch on the N2 component of the ERP: A review
Authors: Folstein Jonathan R. , Van Petten Cyma
Published: September 2007

Recent years have seen an explosion of research on the N2 component of the event‐related potential, a negative wave peaking between 200 and 350 ms after stimulus onset. This research has focused on the influence of “cognitive control,” a concept that covers strategic monitoring and control of motor responses. However, rich research traditions focus on attention and novelty or mismatch as determinants of N2 amplitude. We focus on paradigms that elicit N2 components with an anterior scalp distribution, namely, cognitive control, novelty, and sequential matching, and argue that the anterior N2 should be divided into separate control‐ and mismatch‐related subcomponents. We also argue that the oddball N2 belongs in the family of attention‐related N2 components that, in the visual modality, have a posterior scalp distribution. We focus on the visual modality for which components with frontocentral and more posterior scalp distributions can be readily distinguished.
Nurses in paediatric care – self‐reported professional self and perceived research utilization
Authors: Andersson Nina , Jylli Leena , Nilsson Kajermo Kerstin , Klang Birgitta
Published: September 2007

The aim was to describe how nurses in different professional levels evaluated their professional self and perceived barriers to research utilization in paediatric care. The sample consisted of three groups of nurses: control, trainee and specialists (n = 113) employed at two Paediatric University hospitals in Sweden. The control and trainee groups were nurses with a general education and the specialists had a specialist education in paediatric care. The nurses answered the two questionnaires: the Professional Self Description Form (PSDF) and the Barriers Scale. The results showed that the highest scores in the PSDF were found in sensitivity in all the three groups and consideration (in control and specialist group) and creativity (trainee group). The control group scored significantly higher in the item persistence. In the Barriers Scale, the three groups scored the greatest barriers in; ‘there is insufficient time on the job to implement new ideas’ and ‘the nurses do not have time to read research’. The lowest barriers were found in; ‘the nurse is unwilling to change/try new ideas’ and ‘the nurse is unaware of research’. The specialist nurses had significantly higher barriers in; ‘the nurse is isolated from knowledgeable colleagues with whom to discuss the research’, ‘the nurse is unwilling to try new ideas’ and ‘administration will not allow implementation’. No correlations were found between the PSDF and the Barriers Scale. In conclusion, the self‐evaluation of professional self and perceived research utilization showed few differences between the nurses. These findings indicate that the professional self is independent of educational level and work experiences while barriers to research utililization increases with competence and experience.
Functioning in everyday life after stroke: a longitudinal study of elderly people receiving rehabilitation at home
Authors: Ekstam Lisa , Uppgard Brittmari , Von Koch Lena , Tham Kerstin
Published: September 2007

Objective:  There is a need to identify different rehabilitation needs over time among individuals with stroke in order to implement client‐centred rehabilitation interventions after stroke. The objective of this research was to describe changes in some aspects of functioning and to explore the patterns of change in functioning in everyday life during the first year after stroke for elderly patients participating in rehabilitation at home.

Design and subjects:  Patients who fulfilled the inclusion criteria for a regular rehabilitation‐at‐home programme after stroke were considered for participation in this study. Twenty‐seven elderly patients participated on four data collection occasions during the year immediately subsequent to a stroke. The mean age of the 27 participants was 78.8 years (SD = 5.9) and 67% of the participants were women.

Methods:  Data on certain aspects of functioning were collected and a person‐oriented approach was used to describe the patterns in the change in functioning for individuals.

Results:  Four different patterns were identified: (a) moderate change in functioning (n = 4), (b) minor change in functioning (n = 11), (c) minor change despite major life event (n = 7), (d) disrupted change in functioning (n = 5). The study group improved significantly in most aspects of functioning, but still, most participants (n = 20) showed dissatisfaction with life as a whole 12 months after their stroke.

Conclusion:  This study identified different patterns of change in functioning in everyday life. This knowledge should serve to help guide rehabilitation professionals in their assessment of clients’ needs during different phases after stroke.
Perceived health six months after delivery in women who have experienced low back pain and pelvic pain during pregnancy
Authors: Mogren Ingrid
Published: September 2007

Background and objectives:  A majority of women suffer from low back pain and pelvic pain (LBPP) during pregnancy. The aim of the study was to investigate perceived health, sexual life, social situation, sick leave and use of medical services 6 months after pregnancy in women with LBPP during pregnancy.

Research methods:  In a previous questionnaire study, 72% (n = 639) of the respondents had reported LBPP during pregnancy. These respondents were sent a second questionnaire approximately 6 months after delivery. The respondents were divided into three groups: ‘no pain’, ‘recurrent pain’ and ‘continuous pain’. Pearson's chi‐squared test was used to test the difference between groups.

Results:  Perceived health status 6 months after pregnancy was less favourable for women with persistent LBPP compared to women with remission of LBPP. Family situation, change of relationship and sexual life did not differ among women with remission of LBPP or persistent LBPP after pregnancy. Four of 10 women with persistent LBPP had sought medical care, and two of 10 had been on sick leave because of LBPP after pregnancy.

Conclusions:  Perceived health status was less favourable for women with persistent LBPP after pregnancy. Use of medical services among women with persistent LBPP was prevalent.
Adolescents’ experiences of well‐being when living with a long‐term illness or disability
Authors: Berntsson Leeni , Berg Marie , Brydolf Marianne , Hellström Anna‐Lena
Published: September 2007

Present‐day society has produced changes in family living patterns and conditions and this has resulted in new stressors and health problems. Most children and adolescents with chronic diseases and disabilities, who were previously cared for at hospitals and institutions for long periods, are now integrated in society and they are expected to live a normal life in the conditions that currently prevail. The number of young people with long‐term illnesses/disability has increased worldwide during the last decades. There is lack of studies relating to the way young people regard their daily lives and factors that are important for their well‐being. The aim of this study was to describe the meaning of feeling good in daily life in adolescents living with a long‐term illness or disability. Eight boys and seven girls, aged between 12 and 19 years, with different conditions of long‐term illness or disability, participated in the study. Tape‐recorded interviews were conducted between the years 2003–2004 and the data were analysed using content analysis. The results revealed that the adolescents with long‐term illness generally experienced well‐being like everybody else. Three themes were found to be important in order to feel good: ‘a feeling of acceptance of illness/disability as a natural part of life’, ‘a feeling of support’ and ‘a feeling of personal growth’. This study concludes that adolescents with long‐tem illness or disabilities experience well‐being when they are allowed to prepare for living a normal life integrated in society.
Self‐care as a health resource of elders: an integrative review of the concept
Authors: Høy Bente , Wagner Lis , Hall Elisabeth O.C.
Published: September 2007

Aim:  To review the literature related to self‐care and health promotion for elders and to develop an understanding of self‐care as a health resource.

Background:  Self‐care may improve health and prevent illness and disabilities in elders. Although studies of self‐care are numerous, the significance of the concept as a health resource for elders lacks clarity. Before 1989, research focused principally on medical self‐care at the expense of health care, and self‐care was seen more as supplementary to professional health care rather than as a health‐promoting approach in health care.

Method:  In this integrative review from 2006, we selected theoretical and empirical articles published between 1990 and 2006, where self‐care was related to elders’ health promotion. Data were extracted from primary sources and included definitions of self‐care, critical attributes, antecedents, goals and outcomes. We interactively compared data and display matrices to describe self‐care as a health resource.

Results:  Fifty‐seven articles addressed health self‐care and were integrated into a framework of self‐care as a health resource of elders. Self‐care was identified as a two‐dimensional construct including action capabilities and processes for health in self‐care practice. The capabilities consisted of fundamental capabilities, power capabilities and performance capabilities. The action processes included a process of life experience, a learning process and an ecological process.

Conclusion:  This review offers insight into self‐care as a significant health resource of elders with different health status. It suggests that an elder's self‐care ability is determined by the interaction of various sub‐resources and conditions and emphasizes the constantly evolving nature of self‐care. The framework may be of use in clinical practice, policy‐making and research into health care of frail or robust elders.
THE ROLE AND RESPONSIBILITIES OF WITNESSES IN THE INFORMED CONSENT PROCESS
Authors: ÁNGELES‐LLERENAS ANGÉLICA R. , WIRTZ VERONIKA , LARA‐ÁLVAREZ CÉSAR FRANCISCO
Published: September 2007

Various mechanisms to ensure the protection of subjects in human research have been suggested, including the presence of witnesses during the informed consent process. For our commentary on the use of witnesses and their potential role and responsibility during the consent process, we start by addressing current guidelines for human subjects research in four Latin American countries. By using examples from public health research, we highlight some of the practical difficulties of using witnessed consent, from becoming a meaningless ritual at one end of the spectrum to the research subject feeling intimidated or coerced to participate at the other. Apart from these practical difficulties, it is unclear what responsibility the witness could and should have. We argue that there are important ethical questions about the role of witnesses that have not been adequately addressed in national and international regulations. This work addresses these gaps and argues that more debate is required to define the role and responsibilities of witnesses in the consent process, their training requirements and whether a universal legal requirement for witnessed consent, regardless of the type of research, is desirable.
The ameliorative effect of cysteine prodrug l‐2‐oxothiazolidine‐4‐carboxylic acid on cisplatin‐induced nephrotoxicity in rats
Authors: Ali B.H. , Al Moundhri M.S. , Tag Eldin M. , Nemmar A. , Tanira M.O.
Published: September 2007

Pathogenesis of nephrotoxicity of the synthetic anticancer drug cisplatin (CP) involves generation of reactive oxygen species and free radicals in the kidney cortex, and cysteine prodrug l‐2‐oxothiazolidine‐4‐carboxylic acid (OTC) has been confirmed to have a strong antioxidant action. Therefore, in the present work, we aimed at testing the possible protective or palliative effect of OTC on CP nephrotoxicity in rats. OTC was given at an oral dose of 150 mg/kg/day for 7 days. On day 7, some of these rats were given a single intraperitoneal injection of CP (or vehicle) at a dose of 6 mg/kg. Rats were killed, blood and urine samples were collected, and the kidneys were removed 6 days after CP treatment. Nephrotoxicity was evaluated histopathologically by light microscopy, and biochemically by measuring the concentrations of creatinine and urea in serum, reduced glutathione (GSH) concentration and superoxide dismutase (SOD) activity in renal cortex, and by urinalyses. CP significantly increased the concentrations of urea and creatinine (P < 0.05) by about 128% and 170% respectively. CP treatment reduced cortical GSH concentration by about 34% (P < 0.05), and the activity of SOD by about 28% (P < 0.05). CP treatment significantly increased urine volume and N‐acetyl‐β‐d‐glucosaminidase (NAG) activity, and significantly decreased osmolality and protein concentrations. OTC significantly mitigated all these effects. Sections from saline‐ and OTC‐treated rats showed apparently normal proximal tubules. However, kidneys of CP‐treated rats had a moderate degree of necrosis. This appeared to be lessened when CP was given simultaneously with OTC. The concentration of CP in the cortical tissues was not significantly altered by OTC treatment. The results suggested that OTC had ameliorated the histopathological and biochemical indices of nephrotoxicity in rats. Pending further pharmacological and toxicological studies, OTC may potentially be useful as a nephroprotective agent.
Amine oxidases and monooxygenases in the in vivo metabolism of xenobiotic amines in humans: has the involvement of amine oxidases been neglected?
Authors: Strolin Benedetti Margherita , Tipton Keith F. , Whomsley Rhys
Published: September 2007

In this review, the major enzyme systems involved in vivo in the oxidative metabolism of xenobiotic amines in humans are discussed, i.e. the monooxygenases [cytochrome P450 system (CYPs) and flavin‐containing monooxygenases (FMOs)] and the amine oxidases (AOs). Concerning the metabolism of xenobiotic amines (drugs in particular) by monoamine oxidases (MAOs), this aspect has been largely neglected in the past. An exception is the extensive investigation carried out on the inhibition of the metabolism of tyramine, when tyramine‐containing food is ingested by subjects taking inhibitors of MAO A or of both MAO A and B. Moreover, investigations in humans on the metabolism of drug amines on the market by AOs, such as semicarbazide‐sensitive amine oxidases (SSAOs) and polyamine oxidases (PAOs), are practically nonexistent, with the exception of amlodipine. In contrast to MAOs, monooxygenases (CYP isoenzymes more than FMOs) have been extensively investigated concerning their involvement in the metabolism of xenobiotics. It is possible that the contribution of AOs to the overall metabolism of xenobiotic amines in humans is underestimated or erroneously estimated, as most investigations of drug metabolism are performed using in vitro test systems optimized for CYP activity, such as liver microsomes, and most investigations of drug metabolism in vivo in humans carry out only the identification of the final, stable metabolites. However, for some drugs on the market, the involvement of MAOs in their in vivo metabolism in humans has been demonstrated recently, among these drugs citalopram, sertraline and the triptans are examples that can be mentioned.
Synergistic interaction between dexamethasone and tramadol in a murine model of acute visceral pain
Authors: Dürsteler Christian , Miranda Hugo F. , Poveda Raquel , Mases Anna , Planas Eulalia , Puig Margarita M.
Published: September 2007

Tramadol is effective in the management of mild to moderate postoperative pain, but its administration is associated with nausea and vomiting. Patients treated with tramadol, often receive dexamethasone as antiemetic. The aim of our investigation was to assess if the two drugs interact in a murine model of acute visceral pain. Using the acetic acid writhing test in mice, we assessed the antinociceptive effects of tramadol and dexamethasone (a glucocorticoid with antiemetic effect) administrated individually and in a 1 : 1 fixed ratio combination. Tramadol and dexamethasone induced a dose‐dependent inhibition of the writhing response when administered individually, with ED50values of 2.9 [2.09–4.31, 95% confidence limit (CL)] mg/kg, and 0.13 (0.05–0.29, 95% CL) mg/kg, respectively. The ED50of the combination was 0.13 (0.01–0.29, 95% CL) mg/kg; the isobolographic and interaction index analysis revealed a synergistic interaction. The results suggest that the combination of tramadol and dexamethasone could be beneficial in the management of postoperative pain in humans.
Protective effect of rutin, a polyphenolic flavonoid against haloperidol‐induced orofacial dyskinesia and associated behavioural, biochemical and neurochemical changes
Authors: Bishnoi Mahendra , Chopra Kanwaljit , Kulkarni Shrinivas K.
Published: September 2007

The occurrence and irreversibility of tardive dyskinesia (TD), a motor disorder of the orofacial region, resulting from chronic neuroleptic treatment has been considered a major clinical issue in the treatment of schizophrenia. The molecular mechanism underlying the pathophysiology of TD is not completely known. Several animal studies have demonstrated an enhancement of oxidative damage and increased glutamatergic transmission after chronic administration of neuroleptics. The present study investigated the effect of rutin, an antioxidant in haloperidol‐induced orofacial dyskinesia by using different behavioural (orofacial dyskinetic movements, stereotypic rearing, locomotor activity, percent retention), biochemical [lipid peroxidation, reduced glutathione levels, antioxidant enzyme levels (SOD and catalase)] and neurochemical (neurotransmitter levels) parameters. Chronic administration of haloperidol (1 mg/kg i.p. for 21 days) significantly increased vacuous chewing movements, tongue protrusions and facial jerking in rats, which were significantly inhibited by rutin. Chronic administration of haloperidol also resulted in dopamine receptor sensitivity as evident by a well‐shaped response (initial decrease followed by increase) in locomotor activity and stereotypic rearing and also decreased percent retention time on elevated plus maze paradigm. Pretreatment with rutin reversed these behavioural changes. Besides, haloperidol also induced oxidative damage in all regions of brain which was prevented by rutin, especially in the subcortical region containing striatum. Although turnover of dopamine and noradrenaline decreased in both cortical and subcortical regions after chronic administration of haloperidol, it was significantly reversed by high‐dose rutin treatment. The findings of the present study suggested the involvement of free radicals in the development of neuroleptic‐induced orofacial dyskinesia, a putative model of TD, and rutin as a possible therapeutic option to treat this hyperkinetic movement disorder.
Pharmacological evidence of calcium‐channel blockade by essential oil of Ocimum gratissimum and its main constituent, eugenol, in isolated aortic rings from DOCA‐salt hypertensive rats
Authors: Interaminense Leylliane Fátima Leal , Jucá Davi Matthews , Magalhães Pedro Jorge Caldas , Leal‐Cardoso José Henrique , Duarte Gloria Pinto , Lahlou Saad
Published: September 2007

Intravenous (i.v.) treatment of conscious DOCA‐salt hypertensive rats with the essential oil of Ocimum gratissimum L. (Labiatae) (EOOG) induced a hypotensive effect that seems related to an active vascular relaxation rather than withdrawal of sympathetic tone. To corroborate this hypothesis, the present study examined the vascular effects of EOOG and its main constituent, eugenol (EUG) and the putative mechanisms underlying these effects. Additionally, the role of the vascular β2‐adrenergic mechanism in the mediation of EOOG‐induced hypotension has also been investigated. In conscious DOCA‐salt hypertensive rats, the EOOG‐induced hypotension was reversible and remained unchanged by i.v. pretreatment with propranolol (2 mg/kg). In isolated aorta preparations with intact endothelium from DOCA‐salt hypertensive rats, EOOG (1–1000 μg/mL) and EUG (0.006–6 mm) relaxed the phenylephrine‐induced contraction similarly with IC50 [geometric mean (95% confidence interval)] values of 226.9 (147.8–348.3) μg/mL and 1.2 (0.6–2.1) mm, respectively. Vasorelaxant effects of EOOG were significantly altered by removal of the vascular endothelium [IC50 = 417.2 (349.5–497.8) μg/mL]. In a calcium‐free medium, the CaCl2‐induced contractions were significantly reduced and even abolished by EOOG at 300 and 1000 μg/mL, respectively, whereas EOOG (1000 μg/mL) did not have any significant effect on caffeine‐induced contractions. Similar results were obtained with EUG (1.8 and 6 mm) on both CaCl2‐ and caffeine‐induced contractions, respectively. The data suggest that hypotensive responses to EOOG in DOCA‐salt hypertensive rats are due to an active vascular relaxation, which is partly dependent upon the integrity of the vascular endothelium and seems predominantly mediated through an inhibition of plasmalemmal Ca2+ influx rather than Ca2+‐induced Ca2+ release from the sarcoplasmic reticulum.
The changing meaning of disaster
Authors: Furedi Frank
Published: September 2007

Adverse events such as disasters are interpreted through a system of meaning provided by culture. Historically, research into society's response to disasters provides numerous examples of community resilience in face of adversity. However, since the 1980s, numerous researchers have challenged the previous optimistic accounts and argue that such incidents result in long‐term damage to the community. It is claimed that community response to a disaster episode is far more likely to be defined by its vulnerability than its resilience. This new vulnerability paradigm of disaster response is underpinned by the belief that contemporary technologically driven disasters have a peculiarly destructive outcome. This paper explores the changing conceptualisation of adversity. It suggests that the shift from the expectation of resilience to that of vulnerability is best understood as an outcome of a changing cultural conceptualisation of adversity.
The impact of geographical indication on the revitalisation of a regional economy: a case study of ‘Boseong’ green tea
Authors: Suh Jeongwook , MacPherson Alan
Published: September 2007

Geographical indications are legal signs which identify a good as originating in a specific country or region, where the reputation of the product is attributable to its geographical roots. South Korea has operated with a geographical indication system since 1999. This research analyses the regional impacts of geographical indications using the case study of ‘Boseong’ green tea. The results show that geographical indication has enhanced the image of the product, leading to increased production and the stimulation of tea‐related industries. We argue that geographical indication can be used as an effective policy to cope with trade liberalisation.
Thinking critically and creatively about focus groups
Authors: Hopkins Peter E
Published: September 2007

Focus groups are now widely used by human geographers conducting qualitative research, and are clearly recognised as an established research method within the discipline. Despite this, there is a lack of discussion about the various methodological issues involved in using focus groups. This paper aims to open up discussion by suggesting that there is a need to think critically and creatively about using focus groups in human geography. I draw upon my experience of conducting focus groups with young Muslim men in order to suggest some of the ways in which human geographers might think critically about using focus groups. Some of the issues discussed include group size, location, context and timing, sensitivity of topic, the age of research participants and the positionalities of the researcher.
Getting it wrong first time: building an interdisciplinary research relationship
Authors: Jones Phil , Macdonald Neil
Published: September 2007

This paper addresses recent debates on the need for greater collaboration across the physical and human geography divide. We discuss some of the problems of producing work that can be considered genuinely interdisciplinary. The paper reflects on a project examining the use of sustainable drainage systems in Glasgow and how we unwittingly produced a piece of social science research looking at a physical science topic. We suggest that more than simply the need for ‘trust’ between researchers, the actual practice of working together in the field – and, indeed, having the opportunity to make mistakes and learn from them – is essential. In working together, academics have a better opportunity to understand each other's intellectual and epistemological framework and develop projects where researchers can move beyond their disciplinary boundaries and weave their expertise into a coherent research output.
Moralising geographies: stigma, smoking islands and responsible subjects
Authors: Thompson Lee , Pearce Jamie , Barnett J Ross
Published: September 2007

As the long‐term negative health effects of continued smoking have become more obvious, smoking cessation has become a key focus of government attention across the developed world. Smoking cessation programmes have had mixed outcomes, with rates of smoking in certain socio‐economically disadvantaged and ethnic minority groups remaining high. The increasing stigmatisation of those who continue to smoke, coupled with the spatial segregation of poor and minority populations, may compound to produce ‘smoking islands’ that may serve to reinforce rather than discourage continued smoking. This paper examines practices of compliance and resistance by disadvantaged smokers and ex‐smokers to strategies of biopower.
Neoliberalism, climate governance and the scalar politics of EU emissions trading
Authors: Bailey Ian
Published: September 2007

The neoliberalisation of international climate policy through devices such as emissions trading has led to a significant restructuring of governance competencies between supranational, national and non‐state actors. This article explores the implications of this restructuring for the scalar politics of climate governance by examining the European Union emissions trading scheme, the world's largest multi‐state carbon‐trading scheme. Analysis shows that although the member states were prepared to accede to a common legal framework for emissions trading, its implementation has been characterised by intense sovereignty disputes over emissions allowances. The article concludes by reflecting on the scalar politics of international climate governance in an unevenly regulated and competitive world.
Impact of Multitiered Copayments on the Use and Cost of Prescription Drugs among Medicare Beneficiaries
Authors: Gilman Boyd H. , Kautter John
Published: September 2007

Objectives. To assess the impact of multitiered copayments on the cost and use of prescription drugs among Medicare beneficiaries.

Data Sources. Marketscan 2002 Medicare Supplemental and Coordination of Benefits database and Plan Benefit Design database.

Study Design. The study uses cross‐sectional variation in copayment structures among firms with a self‐insured retiree health plan to measure the impact of number of copayment tiers on total and enrollee drug payments, number of prescriptions filled, and generic substitution. The study also assesses the effect of enrollee cost sharing on the cost and use of prescription medications for the long‐term treatment of chronic conditions.

Data Collection Methods. We linked plan enrollment and benefit data with medical and drug claims for 352,760 Medicare beneficiaries with employer‐sponsored retiree drug coverage.

Primary Findings. Medicare beneficiaries in three‐tiered plans had 14.3 percent lower total drug expenditures, 14.6 percent fewer prescriptions filled, and 57.6 percent higher out‐of‐pocket costs than individuals in lower tiered plans. They also had fewer brand name and generic prescriptions filled, and a higher percentage of generics. The estimated price elasticity of demand for prescription drug expenditures was −0.23. Finally, for maintenance medications used for the long‐term treatment of chronic conditions, members in three‐tiered plans had 11.5 percent fewer prescriptions filled.

Conclusions. Higher tiered drug plans reduce overall expenditures and the number of prescriptions purchased by Medicare beneficiaries. Beneficiaries are less responsive to cost sharing incentives when using drugs to treat chronic conditions.
Identifying Persons with Treated Asthma Using Administrative Data via Latent Class Modelling
Authors: Prosser Robert J. , Carleton Bruce C. , Smith M. Anne
Published: September 2007

Objective. To develop a parsimonious model of the respiratory patient population in British Columbia (BC), Canada through latent class modelling (LCM), using administrative data records and to assess conventional case definitions for asthma in relation to model‐based case selection.

Data Sources. 1996–2001 data from linked provincial databases containing fee‐for‐service physician billing records, hospital inpatient separation abstracts, and prescription drug purchase records for 1.9 million BC respiratory patients.

Study Design. This is a retrospective methodological/descriptive study that assesses case definitions for asthma in terms of sensitivity and specificity using a model fitted to seven physician, hospital and medication utilization markers in place of a conventional gold standard.

Data Collection. We computed values of the treatment markers for each of the 5 years for each patient aged 5–55 years who had had at least one occurrence of a respiratory diagnosis code.

Principal Findings. The marker for prescription of short‐acting β agonists (SABAs) consistently had the highest sensitivity. Markers' specificities ranged from 0.97 to 1.0. The conventional case definitions' sensitivities were 0.41–0.87; specificities ranged from 0.98 to 0.997. Model‐based estimates of asthma prevalence increased from 827/10,000 in 1996 to 992/10,000 in 2001. Conventional case definitions' estimates were consistently lower.

Conclusions. The linkage between utilization and case status is more complex than conventional case definitions allow for. LCM‐based case classification was consistent over time and tends to lead to larger prevalence estimates than conventional definitions. The estimated increases in asthma prevalence are reliable. LCM provides health services planners with a useful probability‐based approach for developing and assessing case definitions and estimating case prevalence.
Risks and Causes of Hospitalizations among Physicians in Taiwan
Authors: Lin Chi‐Miao , Yang Chiang‐Hsing , Sung Fung‐Chang , Li Chung‐Yi
Published: September 2007

Objectives. To assess the causes and cause‐specific risks of hospitalization among physicians in Taiwan.

Data Source. The data used in this study were retrieved from filed claims and registries of the National Health Insurance Research Database. A cohort of 33,380 physicians contracted with the national insurance program between 1997 and 2002 were linked to the information on the inpatient claim data for hospitalization.

Study Design. The physicians' incidence density of hospitalization was compared with that of the general population, other health personnel, and nurses to compute the calendar year‐, age‐, and gender‐standardized hospitalization ratios (SHRs). A multivariate log‐linear model was also used to assess the effects of gender, age, type of contract, and specialty on the risks of hospitalization.

Principal Findings. Compared with the general population, physicians experienced significantly reduced risks of all causes (SHR=54.5, 95 percent confidence interval [CI] 53.4–55.5) and all major cause‐specific hospitalizations, especially mental disorders (SHR=6.9, 95 percent CI 5.8–8.4). On the other hand, compared with other health personnel, physicians had a small but significantly higher risk of all causes of hospitalization (SHR=107.8, 95 percent CI 105.1–110.6). Higher risks of hospitalization were also noted for neoplasms (SHR=108.9, 95 percent CI 102.0–116.3) and diseases of the respiratory system (SHR=114.2, 95 percent CI 107.3–121.5). In addition to the above diagnoses, physicians also had significantly higher risks for genitourinary and musculoskeletal system and connective tissue problems than nurses. Compared with their physician colleagues, female physicians, young (<30 years) and older (≥60 years) physicians, and those working with the health institutions and programs were at elevated risks of hospitalization for all causes as well as for certain specific diseases.

Conclusions. Physicians in Taiwan are at higher risks of developing specific diseases compared with their allied health colleagues. As the health of physicians is vital to the quality of care, Taiwanese health policy analysts should recognize that increased patient volume and satisfaction with public health care should not be achieved at the expense of physicians' health.
The Effect of Premium Changes on SCHIP Enrollment Duration
Authors: Herndon Jill Boylston , Vogel W. Bruce , Bucciarelli Richard L. , Shenkman Elizabeth A.
Published: September 2007

Research Objective. To examine the impact of premium changes in Florida's State Children's Health Insurance Program (SCHIP) on enrollment duration.

Data Sources. Administrative records, containing enrollment and demographic data, were used to identify 173,330 enrollment spells for 153,768 children in Florida's SCHIP from July 2002 through June 2004. Health care claims data were used to classify the children's health status.

Study Design. Accelerated failure time models were used to examine the immediate and longer term effects on enrollment length of a temporary premium increase of $15 to $20 per family per month (PFPM) for children in families with income between 101–150 percent of the federal poverty level (FPL) and a permanent premium increase of $15 to $20 PFPM for children in families with 151–200 percent FPL. Health status and sociodemographic variables were included as covariates. Transfers to other public health insurance programs were taken into account.

Principal Findings. Enrollment lengths decreased significantly immediately following the premium increases, with a greater percentage decrease among lower income children (61 percent) than higher income children (55 percent). Enrollment lengths partially recovered in the longer term for both the temporary and permanent changes. Those with significant acute or chronic health conditions had longer enrollment lengths and were less sensitive to premium changes than healthy children.

Conclusions. An increase in the PFPM premium amount had differential effects across income categories and health status levels. Enrollment lengths remained shortened after the premium increase was rescinded for lower income families, suggesting that it may be difficult to reverse the impacts of even a short‐term premium increase.
Program Structure and Counselor–Client Contact in Outpatient Substance Abuse Treatment
Authors: Knight Danica K. , Broome Kirk M. , Simpson D. Dwayne , Flynn Patrick M.
Published: September 2007

Objectives. To examine organizational structural attributes associated with counselor–client contact.

Data Sources. Data were collected in 2004 and 2005 for a federally funded project, which simultaneously examines organizational structure, functioning, and resources among outpatient substance abuse treatment programs.

Study Design. The study uses a naturalistic design to investigate organizational structure measures—ownership, accreditation, and supplemental services—as predictors of time in counseling and case management, and caseload size, controlling for geographic differences.

Data Collection. Directors at 116 outpatient drug‐free treatment programs located in four regions across the U.S. (Great Lakes, Gulf Coast, Northwest, and Southeast) voluntarily completed a survey about program structure.

Primary Findings. Clients received more counseling hours in programs that were “intensive,” publicly owned, accredited, and had a lower proportion of recently hired counselors. More case management hours were offered in “intensive,” private‐for‐profit or publicly owned (versus private‐nonprofit) programs, serving a lower proportion of dual‐diagnosis clients, and providing more on‐site supplemental services. Smaller caseloads were found in programs that were accredited and had a smaller average client census and a lower proportion of criminal justice referred clients.

Conclusions. Organizational attributes are related to counselor–client contact and may have implications for staff turnover and service quality.
Drug Use Patterns in Severely Mentally Ill Medicare Beneficiaries: Impact of Discontinuities in Drug Coverage
Authors: Simoni‐Wastila Linda , Zuckerman Ilene H. , Shaffer Thomas , Blanchette Christopher M. , Stuart Bruce
Published: September 2007

Objective. To describe the extent of drug coverage among severely mentally ill Medicare beneficiaries and to determine whether and to what extent discontinuities in prescription drug coverage influence the use of medications used to treat serious mental health conditions.

Data Source. 1997–2001 Medicare Current Beneficiary Surveys.

Study Design. We use a zero‐inflated negative binomial model to estimate: (1) the probability of not receiving any mental health drug and (2) the number of medications received, adjusting for age, race, income, census region, health status, and comorbidity. Severe mental illness is defined using inpatient and outpatient claims with ICD‐9 codes of schizophrenia, other psychotic disorders, bipolar disorders, and major depression. Mental health medications include antidepressants, antipsychotics, mood stabilizers, anxiolytic/sedative‐hypnotics, and stimulants. Prescription drug coverage is assessed as full coverage (0 percent discontinuities), no coverage (100 percent discontinuities), or as discontinuous coverage, measured as 1–25, 26–50, and 51–99 percent of time without coverage.

Data Collection/Extraction Methods. We constructed three 3‐year longitudinal cohorts of severely mentally ill Medicare beneficiaries residing in the community (n=901).

Principal Findings. Severely mentally ill Medicare beneficiaries with drug coverage discontinuities are more likely than their continuously insured peers not to receive medications used to treat mental health disorders, with the most significant impact seen in the probability of receiving any psychiatric medications. Analysis of two therapeutic classes—antidepressants and antipsychotics—revealed varying impacts of drug gaps on both probability of any drug use, as well as number of medications received among users.

Conclusions. Severely mentally ill Medicare beneficiaries may be particularly vulnerable to the Medicare Part D drug benefit design and, as such, warrant close evaluation and monitoring to insure adequate access to and utilization of medications used to manage mental illness.
Development of a Measure of Physician Engagement in Addressing Racial and Ethnic Health Care Disparities
Authors: Alexander G. Caleb , Lin Shang , Sayla Maliha A. , Wynia Matthew K.
Published: September 2007

Objective. To develop a measure of physician engagement in addressing health care disparities.

Data Sources/Study Design. Cross‐sectional survey of a national sample of physicians assessing each hypothesized component of engagement (Awareness, Reflection/Empowerment, and Action [AREA]).

Data Collection/Extraction Methods. Results examined using factorial analysis; predictive validity of final scale examined among highly engaged physicians.

Principal Findings. A nine‐item scale derived from the AREA model has face validity, content validity, and applicability to a diverse group of physicians in measuring engagement. Partial correlations confirmed the mediating role of Reflection and/or Empowerment between Awareness and Action. Use of the scale among expert physicians suggests it reliably detects highly engaged physicians.

Conclusions. A nine‐item survey can measure physician engagement in addressing health care disparities.
Strategic Orientation and Nursing Home Response to Public Reporting of Quality Measures: An Application of the Miles and Snow Typology
Authors: Zinn Jacqueline S. , Spector William D. , Weimer David L. , Mukamel Dana B.
Published: September 2007

Objective. To assess whether differences in strategic orientation of nursing homes as identified by the Miles and Snow typology are associated with differences in their response to the publication of quality measures on the Nursing Home Compare website.

Data Sources. Administrator survey of a national 10 percent random sample (1,502 nursing homes) of all facilities included in the first publication of the Nursing Home Compare report conducted in May–June 2004; 724 responded, yielding a response rate of 48.2 percent.

Study Design. The dependent variables are dichotomous, indicating whether or not action was taken and the type of action taken. Four indicator variables were created for each of the four strategic types: Defender, Analyzer, Prospector, and Reactor. Other variables were included in the seven logistic regression models to control for factors other than strategic type that could influence nursing home response to public disclosure of their quality of care.

Data Collection/Extraction Methods. Survey data were merged with data on quality measures and organizational characteristics from the first report (November 2002).

Principal Findings. About 43 percent of surveyed administrators self‐typed as Defenders, followed by Analyzers (33 percent), and Prospectors (19 percent). The least self‐selected strategic type was the Reactor (6.6 percent). In general, results of the regression models indicate differences in response to quality measure publication by strategic type, with Prospectors and Analyzers more likely, and Reactors less likely, to respond than Defenders.

Conclusions. While almost a third of administrators took no action at all, our results indicate that whether, when, and how nursing homes reacted to publication of federally reported quality measures is associated with strategic orientation.