On value-judgements and ethics in health technology assessment

The widespread application of technology in health care has imposed a broad range of challenges. The field of health technology assessment (HTA) is developed in order to face some of these challenges. However, this strategy has not been as successful as one could hope. One of the reasons for this is that social and ethical considerations have not been integrated in the HTA process. Nowadays however, such considerations have been included in many HTAs. Still, the conclusions and recommendations of the HTAs are not followed. The reason for this may be that the methods for integrating ethics for HTA are not sufficiently developed, or that they are not adequate. This article presents a supplementary approach to the ethical inquiry in HTA. It is argued that a value analysis is crucial in order to address the ethical issues of health care technology in a fruitful way and to make viable decisions about such technology.

The Divergent Meanings of Life Satisfaction: Item Response Modeling of the Satisfaction with Life Scale in Greenland and Norway

Cultural differences in response to the Satisfaction With Life Scale (SWLS) items is investigated. Data were fit to a mixed Rasch model in order to identify latent classes of participants in a combined sample of Norwegians (N = 461) and Greenlanders (N = 180). Initial analyses showed no mean difference in life satisfaction between the two subsamples. After transforming the ordinal raw scores into interval scales while simultaneously controlling for response bias, different results appeared. First, approximately 80% of the participants in the Greenlandic subsample fit a latent class with a large degree of random responding to the SWLS. Second, relative to the Norwegians, more Greenlanders were using extreme categories in responding to the SWLS. After statistically controlling for this tendency, Norwegians were in general more satisfied with their lives than Greenlanders. Third, Greenlanders who belonged to one specific latent class were more satisfied than their Norwegian counterparts. A salient feature of this class was the relative unwillingness of respondents to change the circumstances of their lives if they were given such an opportunity. The above results are a reminder of the care that must be used in analyzing survey data across cultures. The analytical strategy applied in the article offers an improved approach to handling such data.     

Conflicting strategic objectives in hospital design

This paper presents a multigoal linear programming model designed to analyse the impact of different strategic objectives in the planning of hospitals. The paper argues that it is necessary to adopt an overall point-of-view in planning; that it is necessary to consider the interactions between the hospital, other social and health institutions and the community at large in order to attain an efficient plan. A simplified cost-benefit analysis is suggested, and it is demonstrated that the opportunity costs of lost working days may be more important than both capital and operating costs from a social point of view.     

Iterative bias reduction: a comparative study

Multivariate nonparametric smoothers, such as kernel based smoothers and thin plate splines smoothers, are adversely impacted by the sparseness of data in high dimension, also known as the curse of dimensionality. Adaptive smoothers, that can exploit the underlying smoothness of the regression function, may partially mitigate this effect. This paper presents a comparative simulation study of a novel adaptive smoother (IBR) with competing multivariate smoothers available as package or function within the R language and environment for statistical computing. Comparison between the methods are made on simulated datasets of moderate size, from 50 to 200 observations, with two, five or 10 potential explanatory variables, and on a real dataset. The results show that the good asymptotic properties of IBR are complemented by a very good behavior on moderate sized datasets, results which are similar to those obtained with Duchon low rank splines.     

Constructions of ‘the ageless’ asylum seekers: An analysis of how age is understood among professionals working within the norwegian immigration authorities

This article explores how professionals within the Norwegian immigration authorities conceptualise age when doing non-medical age assessments. By using social constructivism, which challenges an ethnocentric quantifying understanding of age, we delve into how socially constructed perceptions of childhood and adulthood manifest in assessment practices and the implications of these. By examining how applicants’ physical appearance, body language and life experience are used as an assessment basis, we argue that the ways age is conceptualised relate to Western ideas and ideals while overlooking other social and cultural backgrounds in which age is embedded.     

Quality of Life as Medicine: Interventions that Induce Salutogenesis. A Review of the Literature

This paper reviews the medical (salutogenic) effect of interventions that aim to improve quality of life. Review of studies where the global quality of life in chronically ill patients was improved independently of subjective and objective factors (like physical and mental health, yearly income, education, social network, self-esteem, sexual ability and problems or work). The methods used were subtypes of integrative medicine (non-drug CAM) like mind body medicine, body psychotherapy, clinical holistic medicine, consciousness-based medicine and sexology. In about 20 papers on QOL as medicine, in cancer, coronary heart disease, chronic pain, mental illness, sexual dysfunction, low self-esteem, low working ability and poor QOL, the most successful intervention strategy seems to be to create a maternal, infantile bonding induced by a combination of conversation therapy and bodywork. The papers examined the treatments of over 2,000 chronically ill or dysfunctional patients and more than 20 different types of health problems. Global QOL measured by SEQOL, QOL5, QOL1, self-rated physical health, self-rated mental health, self-rated sexual functioning, anorgasmia, genital pain, self-rated working ability, self-rated relation to self, well-being, life-satisfaction, happiness, fulfillment of needs, experience of temporal and spatial domains, expression of life’s potentials, and objective functioning. We found “QOL as medicine” able in the treatment of physical disorders and illnesses including chronic pain (Number Needed to Treat (NNT) = 1–3, Number Needed to Harm (NNH) > 500), in mental illness (NNT = 1–3, NNH > 500), in sexual dysfunctions (NNT = 1–2, NNH > 1,000), self-rated low working ability (NNT = 2, NNH > 500), and self-rated low QOL (NNT = 2, NNH > 2,000). We found that QOL improving interventions helped or cured 30–90% of the patients, typically within one year, independent of the type of health problem. “QOL as medicine” seems to be able in improving chronic mental, somatic and sexual health issues without side effects.     

The role of local stakeholders in transforming economic upgrading into social upgrading in Ethiopian textile and garment firms

The authors examine the links between economic and social upgrading in a developing country with stringent industry policy and employment legislation, focusing on the strategies of local firms participating in global apparel production networks. Based on the 2015 case studies of five textile and garment firms in Ethiopia, they find that employment security and physical well-being were driven mainly by government labour regulations negotiated by local employers, workers and trade unions rather than by global buyers and conclude that upgrading and downgrading can occur simultaneously within a firm.