Medical students' and tutors' experiences of directed and self-directed learning programs in evidence-based medicine: a qualitative evaluation accompanying a randomized controlled trial

This qualitative study aims to interpret the results of a randomized controlled trial comparing two educational programs (directed learning and self-directed learning) in evidence-based medicine (EBM) for medical students at the University of Oslo from 2002 to 2003. There is currently very little comparative educational research in this field. In the trial, no statistically significant differences between the study groups were shown for any outcomes considered (EBM knowledge, skills, and attitudes). Further analysis suggests that main reason for the negative trial results was that the majority of students learned equally effectively, whichever program they received, although implementation of the educational programs was not complete because of varying attendance. This study illustrates a stepwise evaluation model that might be useful in evaluating other socially complex interventions.     

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.     

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.     

Moderating Effects of School Ethnic Composition of Acculturative Stress and Academic Outcomes in Latinx Youth

Acculturative stress has demonstrated significant negative relationships with Latinx students' academic outcomes. Framed through interpersonal contact theory, we examined the moderating roles of school ethnic representation (proportion of same-ethnic peers) and school ethnic diversity (proportion of different ethnic groups in student body) in the relationship between acculturative stress and both academic self-efficacy and school belonging. A sample of 190 Latinx youth (14–18 years old) completed measures of acculturative stress and school functioning, and they provided the name and location of their high school to facilitate calculation of school ethnic composition. Both ethnic representation and ethnic diversity moderated relationships between English Competency Pressure (ECP), a specific form of acculturative stress, and academic-self efficacy. School ethnic diversity also interacted with ECP to predict school belonging. Negative relationships between ECP and academic self-efficacy or school belonging only emerged for students in schools with very low ethnic diversity. In contrast, ECP was significantly negatively related to academic self-efficacy only for students in schools with the highest ethnic representation. These findings add complexity to the discussion of how school context matters for Latinx students' academic performance.     

Area-based urban regeneration comparing Denmark and Japan

In this paper, we study the characteristics and results of two different approaches to urban regeneration which we have termed ‘Metagovernance’ and ‘Pluricentric coordination’ following. We studied this through a comparative study of area-based, participatory urban regeneration projects in Denmark and Japan, representing each one approach. The paper aims to clarify results of the two approaches in terms of five aspects of urban regeneration, relevant to the process and results: (1) strategic spatial improvement, (2) influence of the legal system and transparency of the processes, (3) empowerment of citizens and diversity of participants, (4) innovative capacity (diversity and creativity of the projects) and (5) continuity and flexibility of the projects. The paper concludes that each approach has strengths and weaknesses and that each country can learn from the other to strengthen future participatory urban regeneration.     

Inequality aversion and antisocial punishment

Antisocial punishment—punishment of pro-social cooperators—has shown to be detrimental for the efficiency of informal punishment mechanisms in public goods games. The motives behind antisocial punishment acts are not yet well understood. This article shows that inequality aversion predicts antisocial punishment in public goods games with punishment. The model by Fehr and Schmidt (Q J Econ 114(3): 817–868, 1999) allows to derive conditions under which antisocial punishment occurs. With data from three studies on public goods games with punishment I evaluate the predictions. A majority of the observed antisocial punishment acts are not compatible with inequality aversion. These results suggest that the desire to equalize payoffs is not a major determinant of antisocial punishment.