Integrating ethical enquiry and health technology assessment: limits and opportunities for efficiency and equity

This paper aims at discussing some contributions, limitations and opportunities that efficiency and equity studies could make to form a better understanding of ethical issues involved in health technology assessment (HTA). Prenatal detection of Down syndrome is used as a case study for further discussions regarding efficiency and equity, as well as other ethical principles including beneficence, non-maleficence and autonomy. The development and use of adequate methods and the need for context appraisal are two imperative issues in this field of knowledge. The analysis of ethical implications in HTA should account for both. Economic evaluation methodologies have great potential in the assessment of some key ethical principles such as efficiency and equity but are of limited use concerning other fundamental principles. Social and individual values play a prominent role in this respect.     

Operational challenges in adaptive design implementation

Implementation of adaptive clinical trial designs raises challenges with regard to the processes by which accruing trial data is analyzed, reviewed, and acted upon. In line with current monitoring conventions, it should be viewed that inappropriate knowledge of interim results can raise concerns regarding maintaining trial integrity and interpretability of results. Here we discuss issues related to these processes in adaptive trials, and point out distinctions versus other more familiar monitoring situations. One topic involves the composition of the group of individuals who will have access to interim results in order to recommend adaptations. We discuss operational models for data review by this group; one question addressed is whether in adaptive trials a role in this process for a representative of the study sponsor could at times be warranted, and might be justified if adequate protections are in place. Another issue involves whether adaptations made based upon interim data can convey to observers an amount of information about the results, which could rise to a level of concern. We consider whether different types of adaptations might be more or less problematic with regard to this issue, and recommend steps that might be considered to mitigate this concern.     

Negotiating the Lines of Contention: Counterframing and Boundary Work in the School of the Americas Debate1

Counterframing scholars typically identify counterframes that interpretively distinguish arguments among opponents. This approach assumes that counterframing strategy centers on directly countering the claims of protesters. In my in‐depth examination of the ongoing debate between protesters and officials of the former School of the Americas, I identify a form of counterframing that agrees with and embraces the moral alternatives implicit in accusers’ claims. I bring boundary construction theory into conversation with counterframing analysis to expand understanding of how framing and counterframing strategies revolve around the competition for common, moral resources. I explain that in the movement to close the School of the Americas, protesters’ claims have served as moral boundaries against which the targeted institution has redefined its objectives and programs. I introduce the concept of “boundary negotiation” to argue that counterframing strategy and success lie in the negotiation of moral boundaries called into question by social movements. I outline defensive and offensive modes of boundary negotiation and identify boundary negotiation as a mechanism driving the link between counterframing and demobilization.     

External Information Model in a Compositional Perspective: Evaluation of Campania Adolescents’ Preferences in the Allocation of Leisure-Time

Social Indicators Research - The study of preferences of leisure-time activities provides important information on the characteristics and inclinations of specific demographics. Modeling these data...     

Effects of demography and urbanization on stress and body condition in urban white-tailed deer

Urban Ecosystems - White-tailed deer (Odocoileus virginianus) are becoming increasingly common in urban environments. How they respond to potential changes (i.e. increased human interactions,...     

Perceptions of Benzodiazepine Dependence Among Women Age 65 and Older

A phenomenological study explored whether older women who are chronic benzodiazepine users identified themselves as dependent, how dependence was perceived, and how meanings and understandings shaped experiences of benzodiazepine use. Self-reported benzodiazepine dependence was associated with being unable to reduce use or a desire to discontinue use and reliance on benzodiazepines to remain comfortable and able to handle daily life. Themes included: (a) benzodiazepine dependence is similar to dependence to diabetes or blood pressure medications; (b) dependence is distinctive from addiction/abuse; (c) addiction/abuse is perceived as worse than dependence; and (d) concerns of addiction/abuse result in low-dose benzodiazepine use.     

Older Workers: Who are the working poor in the U.S.?

With data from the 2000 Health and Retirement Study (HRS), the purpose of this study was to provide a profile of older workers who live poverty, and to compare the demographic, financial, employment, and health attributes of such individuals to similar persons not living in poverty. This study found that 3.5% of employed individuals between the ages of 51 and 61 belonged to the class of working poor. The results of the multivariate logistic regression analyses indicated that the older working poor were more likely to be non-White, less educated, non-married, and had lower levels of net worth than the working non-poor. They were more likely to be employed part time and were less likely to be covered by employee-sponsored health insurance.