Search

Interactions in the healthcare system today involve an important new set of actors: evaluative health platforms (EHPs). These platforms are not neutral intermediaries, but active moderators of how patients express opinions, choose providers, and consume health-related information. This paper adds to our understanding of the varied and evolving commercial interests of EHPs and the implications these have for patient voice. We analyze 71 platforms in the USA, UK, and Germany and identify five ideal types: subscribers, analyzers, advertisers, regulators, and scammers. Each platform type enacts a unique competitive strategy through an evaluative infrastructure which constrains but also generates possibilities for patient voice. Based on our typology, we develop three contributions. First, we nuance universalizing claims about the consequences of platform capitalism by specifying the diverse strategies underpinning competition between EHPs in different countries, and showing how each strategy leads evaluative infrastructures to develop in ways that impact patient voice. Second, we show how patients can navigate the challenges of a complex EHP space by exercising their ability to choose between platforms. Finally, we outline the conditions platforms need to fulfil to become empowering. Overall, this study highlights the varied and complex relationship between platform business models and user voice, which exists not only in healthcare, but also in many other fields. • Typology of evaluative health platforms (EHPs) in the US, the UK, and Germany. • EHP business models and content moderation techniques vary considerably. • EHPs have a wide range of implications for patient voice. • More transparency and competition can help platforms increase patient empowerment. [ABSTRACT FROM AUTHOR]

Introduction: Quality of life is included in the economic evaluation of health services by measuring the preference for health states, i.e. health state utilities. However, most intervention studies include a disease-specific, not a utility, instrument. Consequently, there has been increasing use of statistical mapping algorithms which permit utilities to be estimated from a disease-specific instrument. The present paper provides such algorithms between the MacNew Heart Disease Quality of Life Questionnaire (MacNew) instrument and six multi-attribute utility (MAU) instruments, the Euroqol (EQ-5D), the Short Form 6D (SF-6D), the Health Utilities Index (HUI) 3, the Quality of Wellbeing (QWB), the 15D (15 Dimension) and the Assessment of Quality of Life (AQoL-8D). Methods: Heart disease patients and members of the healthy public were recruited from six countries. Non-parametric rank tests were used to compare subgroup utilities and MacNew scores. Mapping algorithms were estimated using three separate statistical techniques. Results: Mapping algorithms achieved a high degree of precision. Based on the mean absolute error and the intra class correlation the preferred mapping is MacNew into SF-6D or 15D. Using the R squared statistic the preferred mapping is MacNew into AQoL-8D. Implications for research: The algorithms reported in this paper enable MacNew data to be mapped into utilities predicted from any of six instruments. This permits studies which have included the MacNew to be used in cost utility analyses which, in turn, allows the comparison of services with interventions across the health system. [ABSTRACT FROM AUTHOR]

Socioeconomic inequalities in childhood Body Mass Index (BMI) are becoming increasingly more pronounced across the world. Although countries differ in the direction and strength of these inequalities, cross-national comparative research on this topic is rare. This paper draws on harmonized longitudinal cohort data from four wealthy countries—Germany, the Netherlands, the United Kingdom (UK), and the United States (US)—to 1) map cross-country differences in the magnitude of socioeconomic inequalities in childhood BMI, and 2) to examine cross-country differences in the role of three energy-balance-related behaviors—physical activity, screen time, and breakfast consumption—in explaining these inequalities. Children were aged 5–7 at our first timepoint and were followed up at age 8–11. We used data from the German National Educational Panel Study, the Dutch Generation R study, the UK Millennium Cohort Study and the US Early Childhood Longitudinal-Kindergarten Study. All countries revealed significant inequalities in childhood BMI. The US stood out in having the largest inequalities. Overall, inequalities between children with low versus medium educated parents were smaller than those between children with high versus medium educated parents. The role of energy-balance-related behaviors in explaining inequalities in BMI was surprisingly consistent. Across countries, physical activity did not, while screen time and breakfast consumption did play a role. The only exception was that breakfast consumption did not play a role in the US. Cross-country differences emerged in the relative contribution of each behavior in explaining inequalities in BMI: Breakfast consumption was most important in the UK, screen time explained most in Germany and the US, and breakfast consumption and screen time were equally important in the Netherlands. Our findings suggest that what constitutes the most effective policy intervention differs across countries and that these should target both children from medium as well as low educated families. • All countries showed substantial socioeconomic inequalities in childhood BMI. • In all countries, inequalities in BMI steepen over course of primary school. • Protective factors among the most advantaged seem to mainly drive inequalities. • Across most countries, underlying mechanisms for inequalities in BMI are similar. • The relative contribution of each mechanism to BMI inequalities differs per country. [ABSTRACT FROM AUTHOR]

Based on contemporary press articles and applying a comparative methodology, this study examines the responses of important British and American quality papers to the unfolding of Nazi anti-Semitism from September 1930 until April 1933. Besides reconstructing and comparing the press coverage, the study seeks to explain the patterns beneath the journalistic perceptions and interpretations of Nazi anti-Semitism in the liberal democracies. During the final years of the Weimar Republic the papers reported fully and critically on Nazi anti-Semitism, yet they underestimated its radical nature. The extent of the assault on the Jews following Hitler's seizure of power therefore surprised British and American observers. Between 30 January 1933 and the anti-Jewish boycott of 1 April 1933 the journalists struggled to grasp the nature of Nazi anti-Semitism and the role of Hitler therein. Ultimately, their reading of events in Germany was preconditioned by their own liberal democratic outlook. Even if they reached differing conclusions, they were united in their conviction that Hitler and the Nazis would not dare to continue their anti-Semitic campaign in the face of adverse ‘world opinion’. [ABSTRACT FROM PUBLISHER]

Using the InCites tool of Thomson Reuters, this study compares normalized citation impact values calculated for China, Japan, France, Germany, United States, and the UK throughout the time period from 1981 to 2010. InCites offers a unique opportunity to study the normalized citation impacts of countries using (i) a long publication window (1981 to 2010), (ii) a differentiation in (broad or more narrow) subject areas, and (iii) allowing for the use of statistical procedures in order to obtain an insightful investigation of national citation trends across the years. Using four broad categories, our results show significantly increasing trends in citation impact values for France, the UK, and especially Germany across the last thirty years in all areas. The citation impact of papers from China is still at a relatively low level (mostly below the world average), but the country follows an increasing trend line. The USA exhibits a stable pattern of high citation impact values across the years. With small impact differences between the publication years, the US trend is increasing in engineering and technology but decreasing in medical and health sciences as well as in agricultural sciences. Similar to the USA, Japan follows increasing as well as decreasing trends in different subject areas, but the variability across the years is small. In most of the years, papers from Japan perform below or approximately at the world average in each subject area. [ABSTRACT FROM AUTHOR]

After 1945, Western medicine was influenced mostly by investigations from Britain and the USA. This paper deals with the presentation of German medicine in the German weekly «Der Spiegel» between 1947 and 1955, when German society changed from a postwar community focussed on survival to a modern western society. The paper will particularly focus on medicine as a service, dealing not with diagnostic and therapeutic innovations, but with troublesome every-day problems of body and soul at the border of health and disease. The paper argues that »service medicine« was an important tool for German medicine to achieve social acceptance and to integrate itself into the new German democratic society with its private market economy. [ABSTRACT FROM AUTHOR]

The thesis of this paper is that governments of some otherwise enlightened states are increasingly fearful of acknowledging the restraints imposed on them by existing international law. They are also reluctant to enter into new commitments by way of international conventions that would expand the reach of international law. The paper asks whether these fears are based on a true understanding of international law or on some distorted view of it. It will draw comparisons and some contrasts between Australia and the United States in their reactions to a number of recent events as well as to some enduring situations of contemporary relevance. Had time (and the limits of my research) permitted, one might also have examined public attitudes toward international law in China, Japan, and Russia in this context, where similar fears appear to be entertained. France, Germany, Italy, and the United Kingdom, also enlightened states, appear by contrast to belong to a group more dedicated to international law. As Robert Kagan has recently remarked, the experience of two world wars at close quarters, and the formation of the European Union, have made the European countries more dedicated to process, where the United States is more interested in results. [ABSTRACT FROM AUTHOR]

Substantial cross-national differences in poverty alleviation are well documented. But the extent to which different parts of the social transfer system account for this variation is still relatively unexamined. This paper analyses the redistributive effects of specific social policy institutions in a comparative perspective. The main question is to what extent non-means-tested entitlements and means-tested benefits reduce relative economic poverty in different institutional settings. It is shown that the structure of non-means-tested benefits is more important than that of means-tested benefits in explaining differences in poverty alleviation across countries. The paper also presents a new method for estimating the anti-poverty effects of separate parts of the social transfer system. This method decomposes the anti-poverty effects of a set of social transfers into independent and combined effects, which produces more valid results than prevalent methods used to assess the impact of a particular transfer on poverty. The countries included in this study are Canada, Germany, Sweden, the United Kingdom and the United States. The empirical analyses are based on data from the Social Citizenship Indicators Programme (SCIP) and Luxembourg Income Study (LIS) describing the situation in the mid-1990s. [ABSTRACT FROM AUTHOR]

This paper compares recent developments in income inequality in Canada, Germany, Sweden, the United Kingdom, and the United States. In addition to describing cross-national variation in changes in income inequality, the paper examines different explanatory factors for these recent developments. The findings reported indicate that there is substantial cross-national variation, not only with regard to the level of inequality, but furthermore with regard to changes in inequality. The results indicate that the equalizing effect of welfare state redistribution did not decrease in all countries. By contrast, in all countries there was a universal tendency towards increased inequality in the pre-tax and transfer distribution, although the magnitude of the change differs from country to country. Even though a polarization of the earnings distribution is reported, the results still give no support to cross-national convergence with regard to income inequality during the 1980s. [ABSTRACT FROM AUTHOR]

Abstract: This paper analyzes the impact of WLAN technologies for incumbent MNOs based on an empirical cross-country study of the players in the public WLAN-hotspot market using the theory of disruptive innovation and theoretical extensions for the industry- and country-level. The main research question to be analyzed is whether and why PWLAN has shown a disruptive or sustaining impact trend for incumbent MNOs in the hotspot markets of Germany, the UK, and the USA in recent years. The results imply that incumbent MNOs and new entrants have taken advantage of the opportunity provided by PWLAN, but the market success of both types of players varies between the countries analyzed. Incumbent MNOs dominate in Germany but not in the UK and the USA. The reasons for these country-specific differences were further investigated, and the results suggest that the analysis of disruptive potential in telecommunications needs to include country- and firm-specific factors, which are, again, largely influenced by the local regulation. [Copyright &y& Elsevier]

Total water intake is seldom reported in dietary surveys and hydration status is rarely measured. Although adequate intake (AI) levels have been suggested by the European Food Safety Authority, the World Health Organization and the Institute of Medicine, uncertainties and confused messages abound regarding optimum intake. This paper reviews data on water intake internationally and examines associations with beverage consumption habits of adults in the UK, as determined from secondary analysis of individual diet records. On average, total water intake among British adults was equivalent to the European AI (2 l/day for women, 2.5 l/day for men) and 75% of this was derived from beverages. Factors that correlated with high total water intake included the consumption of a variety of beverages and drinking in the evening. Total water intake (and the contribution from soft drinks) is markedly higher in the USA than in Europe. Beverage consumption habits and trends were also reviewed. In the past 10 years, water beverages have become more popular and as such the overall energy contribution from beverages has declined slightly. Most people could be encouraged to drink a variety of beverages to maintain adequate hydration and to balance the energy content according to their needs. However, further work is needed to refine recommendations for water intake, as basing these on observational epidemiological data is essentially a circular argument. A standardized measurement tool, validated against biomarkers of hydration status, would be a step forward in assessing the adequacy of water intakes at a population level. Research may also be warranted to explore the context of drinking occasions (including time of day, weekdays weekends, lifestyle and meal patterns) as these may have an impact on water intake, hydration and also energy balance. [ABSTRACT FROM AUTHOR]

Objective This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Methods The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models. Results Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon. Conclusions The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems. [ABSTRACT FROM AUTHOR]

Conventional wisdom on party systems in advanced industrial democracies holds that modern electorates are dealigned and that social cleavages no longer structure party politics. Recent work on class cleavages has challenged this stylized fact. The analysis performed here extends this criticism to the religious-secular cleavage. Using path analysis and comparing the current electorates of the United States, Germany, and Great Britain with the early 1960s, this paper demonstrates that the religious-secular cleavage remains or has become a significant predictor of conservative vote choice. While the effects of the religious-secular cleavage on vote choice have become largely indirect, the total of the direct and indirect effects is substantial and equivalent to the effects of class and status. [Copyright &y& Elsevier]

There is accumulating evidence that individual differences in stress reactivity contribute to the risk for stress-related disease. However, the assessment of stress reactivity remains challenging, and there is a relative lack of questionnaires reliably assessing this construct. We here present the Perceived Stress Reactivity Scale (PSRS), a 23-item questionnaire with 5 subscales and 1 overall scale, based on an existing German-language instrument. Perceived stress reactivity and related constructs were assessed in N = 2,040 participants from the United Kingdom, the United States, and Germany. The 5-factor structure of the PSRS was found to be similar in the 3 countries. In the U.S. sample the questionnaire was applied using 2 modes of administration (paper-pencil and computerized), and measures were repeated after 4 weeks. Measurement invariance analyses demonstrated full invariance across mode of administration and partial invariance across gender and countries. Scale scores differed between countries and genders, with women scoring higher on most scales. Overall, reliability analysis suggested good stability of PSRS scores over a 4-week period, and validation analysis showed expected associations with related constructs such as self-efficacy, neuroticism, chronic stress, and perceived stress. Perceived stress reactivity was also associated with depressive symptoms and sleep. These associations were particularly strong when individuals scoring high on perceived stress reactivity were exposed to chronic stress. In sum, our findings suggest that the PSRS is a useful and easy-to-administer instrument to assess perceived stress reactivity. [ABSTRACT FROM AUTHOR]

This paper empirically analyzes the labor supply effects of two “making work pay” reforms in Germany. We provide evidence in favor of policies that distinguish between low effort and low productivity by targeting individuals with low wages rather than those with low earnings. We discuss our results more generally and with comparisons to the family-based tax credits in force in the US and the UK. For the evaluation of the policies, we apply a static structural labor supply framework and explicitly account for demand-side constraints by using a double-hurdle model. [ABSTRACT FROM AUTHOR]

In an effort to quell ongoing debate about the ethics of human embryonic stem cell (hESC) research, there have been concerted efforts to develop ethical standards for both embryo and hESC research and to entrench these standards in law. Surprisingly these efforts have not included efforts at standardizing the meaning of the pivotal term 'embryo'. This paper reviews the legal framework for embryo research in the United Kingdom, the United States and Germany and highlights the absence of any agreed upon standard for what counts as a human embryo. This is an important lacuna, especially in light of the most recent advances in stem cell research involving the reprogramming of human somatic cell nuclei to generate human induced pluripotent stem (iPS) cells. [ABSTRACT FROM AUTHOR]

By comparing the US environmental justice movement with recent European developments, this paper suggests an environmental justice framework which is based on the idea of environmental justice as a heterogeneous process rather than an analytical or normative category. Using major debates on environmental justice particularly in the UK and Germany as a touchstone, eight dimensions of environmental justice are carved out and integrated into a processual model. It is discussed how environmental justice as a process may become robust enough to integrate and react to changing natural and social conditions. [ABSTRACT FROM AUTHOR]

The "big trade-off," described by Arthur Okun some thirty years ago, is back again: equality or efficiency, or to put it differently, modern highly developed economies and societies have to choose between the Scylla of income inequality and the Charybdis of unemployment. Furthermore, it looks like the continental European economies—foremost Germany and France—sided with more egalitarian ends accepting higher unemployment while the liberal economies such as the United States and the United Kingdom chose higher inequality for lower unemployment. In this paper it is argued that the trade-off is not a supply-side necessity to maintain work effort in a situation of incomplete contracts, but is a politico-economic issue of particular interest groups seeking rents. However, unlike in Mancur Olson's seminal approach, it is not the trade unions that are forming distributional coalitions on the labor market, but rather the meritocracy which is happy to use Keynesian-type demand management to advance their material interests by pursuing a "meritocratically optimal rate of unemployment" (MORU). [ABSTRACT FROM AUTHOR]

In this paper I identify whether budgets in Denmark, Germany, the United Kingdom, and the United States are punctuated and investigate the variation in budget punctuations over time. Building on stochastic process methods, I find that budgets in all four cases exhibit mostly incremental changes punctuated by extreme shifts. In order to explain variation in budget punctuations over time, I rely on two models: partisan control of government and partisan distance of the assembly. The two models are tested using national budgetary data across all government functions for the four countries from the mid-1960s to 1989. I find that greater distance in strength and ideology among parties leads to increases in the degree of punctuations in the German and the British cases, whereas there is some evidence for the partisan control model in the American cases. In the Danish cases, partisan distance reduces the degree of budget punctuations. [ABSTRACT FROM AUTHOR]

This paper compares the regulation of biotechnology in Britain, Germany and the United States and shows that systematic differences have developed around four issues: abortion, assisted reproduction, stem cells, and genetically modified crops and foods. Policy choices with respect to these issues reflect the capacity of each nation's regulatory institutions to deal with the scientific, social and ethical uncertainties around biotechnology. National regulatory frameworks constitute an apparatus of collective sense-making through which governments and publics interpret biotechnology's risks and promises. Specifically, regulatory choices position the novel ontologies created by biotechnology either on the side of the familiar and manageable or on the side of the unknown and insupportably risky. The comparison shows that public responses to biotechnology are embedded within robust and coherent political cultures and are not ad hoc expressions of concern that vary unpredictably from issue to issue. [ABSTRACT FROM AUTHOR]

Clinical trials for the treatment of schizophrenia now often include cognitive assessments in addition to clinical ratings of symptoms. Recently, these trials have included cross-national assessments. It is not clear if translated psychological tests produce consistent results across different languages. This paper presents the results of a study of the comparability of the results of cognitive assessments in different English-speaking countries and a number of countries where tests were translated into other languages. Performance on tests of executive functioning, verbal and visuo-spatial learning and memory, language skills, psychomotor speed, and vigilance was compared across the first episode patients with schizophrenia (n=301) assessed in six different languages (English, French, Finnish, German, Hebrew, and Afrikaans), including two different countries where patients were assessed in English and other languages: Canada (French) and South Africa (Afrikaans). The variance in performance across the sites tested in English was as large as the variance between English and non-English speakers when all tests were considered. Performance differences across English and other languages were found only for executive functions, vigilance, and psychomotor speed, with executive functioning differences nonsignificant when education was considered. No differences were found between English and non-English speakers in Canada. These results suggest that the translation of tests of memory and verbal skills can lead to consistent results across translated versions of the tests. Differences between countries were greater than differences between languages, suggesting the need to consider representativeness of patient samples in terms of local educational attainment. In general, these data support the validity of cross-national neuropsychological assessments. [Copyright &y& Elsevier]

Background: Patient safety in primary care is an emerging field of research with a growing evidence base in western countries but little has been explored in the Gulf Cooperation Council Countries (GCC) including the Sultanate of Oman. This study aimed to review the literature on the safety culture and patient safety measures used globally to inform the development of safety culture among health care workers in primary care with a particular focus on the Middle East. Methods: A systematic review of the literature. Searches were undertaken using Medline, EMBASE, CINAHL and Scopus from the year 2000 to 2014. Terms defining safety culture were combined with terms identifying patient safety and primary care. Results: The database searches identified 3072 papers that were screened for inclusion in the review. After the screening and verification, data were extracted from 28 papers that described safety culture in primary care. The global distribution of the articles is as follows: the Netherlands (7), the United States (5), Germany (4), the United Kingdom (1), Australia, Canada and Brazil (two for each country), and with one each from Turkey, Iran, Saudi Arabia and Kuwait. The characteristics of the included studies were grouped under the following themes: safety culture in primary care, incident reporting, safety climate and adverse events. The most common theme from 2011 onwards was the assessment of safety culture in primary care (13 studies, 46%). The most commonly used safety culture assessment tool is the Hospital survey on patient safety culture (HSOPSC) which has been used in developing countries in the Middle East. Conclusions: This systematic review reveals that the most important first step is the assessment of safety culture in primary care which will provide a basic understanding to safety-related perceptions of health care providers. The HSOPSC has been commonly used in Kuwait, Turkey, and Iran. [ABSTRACT FROM AUTHOR]