Patient information leaflets: informing or frightening? A focus group study exploring patients' emotional reactions and subsequent behavior towards package leaflets of commonly prescribed medications in family practices.

BACKGROUND The purpose of patient information leaflets (PILs) is to inform patients about the administration, precautions and potential side effects of their prescribed medication. Despite European Commission guidelines aiming at increasing readability and comprehension of PILs little is known about the potential risk information has on patients. This article explores patients' reactions and subsequent behavior towards risk information conveyed in PILs of commonly prescribed drugs by general practitioners (GPs) for the treatment of Type 2 diabetes, hypertension or hypercholesterolemia; the most frequent cause for consultations in family practices in Germany. METHODS We conducted six focus groups comprising 35 patients which were recruited in GP practices. Transcripts were read and coded for themes; categories were created by abstracting data and further refined into a coding framework. RESULTS Three interrelated categories are presented: (i) The vast amount of side effects and drug interactions commonly described in PILs provoke various emotional reactions in patients which (ii) lead to specific patient behavior of which (iii) consulting the GP for assistance is among the most common. Findings show that current description of potential risk information caused feelings of fear and anxiety in the reader resulting in undesirable behavioral reactions. CONCLUSIONS Future PILs need to convey potential risk information in a language that is less frightening while retaining the information content required to make informed decisions about the prescribed medication. Thus, during the production process greater emphasis needs to be placed on testing the degree of emotional arousal provoked in patients when reading risk information to allow them to undertake a benefit-risk-assessment of their medication that is based on rational rather than emotional (fearful) reactions.

Scales of justice in water governance: hydropower controversies in Switzerland

One significant challenge for the operationalization of water justice arises from the many dynamic scales involved. In this paper we explore the scalar dimension of justice in water governance through the insights derived from empirical research on hydropower production in the Swiss Alps and the application of the geographical concept of politics of scale. More specifically, we investigate how different actors frame the justice problem, the scales that they invoke and which actors consequently get included or excluded in their justice assessments. This study shows that there is no ideal scale for justice evaluations; whichever scale is used, some actors and justice claims are included whereas others are excluded. This is particularly true when using Fraser’s trivalent concept of justice, taking into account issues of distribution, recognition and participation where each calls for its own set of scales. Moreover, focusing on the politics of scale framing, our study reveals that the justice claim itself can become a power element. Consequently, to achieve more just water governance, there is not only a need for debate and negotiations about the conceptions and meanings of justice in a specific context, there is also a need for debate about the relevance and implications of divergent scales involved in justice claims.

Neural correlates of evaluating hazards of high risk.

In personal and in society related context, people often evaluate the risk of environmental and technological hazards. Previous research addressing neuroscience of risk evaluation assessed particularly the direct personal risk of presented stimuli, which may have comprised for instance aspects of fear. Further, risk evaluation primarily was compared to tasks of other cognitive domains serving as control conditions, thus revealing general risk related brain activity, but not such specifically associated with estimating a higher level of risk. We here investigated the neural basis on which lay-persons individually evaluated the risk of different potential hazards for the society. Twenty healthy subjects underwent functional magnetic resonance imaging while evaluating the risk of fifty more or less risky conditions presented as written terms. Brain activations during the individual estimations of 'high' against 'low' risk, and of negative versus neutral and positive emotional valences were analyzed. Estimating hazards to be of high risk was associated with activation in medial thalamus, anterior insula, caudate nucleus, cingulate cortex and further prefrontal and temporo-occipital areas. These areas were not involved according to an analysis of the emotion ratings. In conclusion, we emphasize a contribution of the mentioned brain areas involved to signal high risk, here not primarily associated with the emotional valence of the risk items. These areas have earlier been reported to be associated with, beside emotional, viscerosensitive and implicit processing. This leads to assumptions of an intuitive contribution, or a "gut-feeling", not necessarily dependent of the subjective emotional valence, when estimating a high risk of environmental hazards.

Dental fear and satisfaction with dental services in Switzerland.

OBJECTIVES Dental satisfaction is associated with continuity of dental care, compliance with dentist advice, and positive health outcomes. It is expected that people with higher dental fear might have less dental satisfaction because of more negative dental experiences. The objective of this study was to examine satisfaction and reasons for satisfaction with dental practitioners in Switzerland and variations by dental fear. METHODS A national sample of 1,129 Swiss residents aged 15-74 (mean = 43.2 years) completed a personal interview at their home with questions assessing dental fear, dental service use, general satisfaction with their dentist, and reasons for satisfaction or dissatisfaction. RESULTS Overall, 47.9 percent of participants responded that they were satisfied with their dentist and 47.6 percent that they were very satisfied. Satisfaction differed significantly by gender, language spoken, region of residence, and educational attainment. Greater dental fear was significantly associated with greater dissatisfaction with the dentist. The percentage of people who were very satisfied with the dentist ranged from 56.0 percent among people with no fear to 30.5 percent for participants with "quite a lot" of fear but was higher (44.4 percent) for people who stated that they were "very much" afraid of the dentist. The most common reasons attributed for satisfaction with dentists were interpersonal characteristics of the dentist and staff. People with "quite a lot" of fear were found to endorse these sentiments least. CONCLUSIONS Although higher dental fear was associated with more dissatisfaction with the dentist, the level of satisfaction among fearful individuals in Switzerland is still high.

Shakespeare, the Middle Ages and the Luck of the British: Medievalism and National Identity in The Hollow Crown (2012)

Images of the medieval past have long been fertile soil for the identity politics of subsequent periods. Rather than “authentically” reproducing the Middle Ages, medievalism therefore usually tells us more about the concerns and ideological climate of its own time and place of origin. To dramatise the nascent nation, Shakespeare resorts to medievalism in his history plays. Centuries later, the BBC-produced television mini-serial The Hollow Crown – adapting Shakespeare’s second histories tetralogy – revamps this negotiation of national identity for the “Cultural Olympiad” in the run-up to the 2012 London Olympics. In this context of celebratory introspection, The Hollow Crown weaves a genealogical narrative consisting of the increasingly “glorious” medieval history depicted and “national” Shakespearean heritage in order to valorise 21st-century “Britishness”. Encouraging a reading of the histories as medieval history, the films construct an ostensibly inclusive, liberal-minded national identity grounded in this history. Moreover, medieval kingship is represented in distinctly sentimentalising and humanising terms, fostering emotional identification especially with the no longer ambivalent Hal/Henry V and making him an apt model for present-day British grandeur. However, the fact that the films in return marginalise female, Scottish, Irish and Welsh characters gives rise to doubts as to whether this vision of Shakespeare’s Middle Ages really is, as the producers claimed, “for everybody”.

Cultural Legacies and Political Preferences: The Failure of Separatism in the Swiss Jura

The study of secession generally stresses the causal influence of cultural identities, political preferences, or ecological factors. Whereas these different views are often considered to be mutually exclusive, this paper proposes a two-stage model in which they are complementary. We posit that cultural identities matter for explaining secessionism, but not because of primordial attachments. Rather, religious and linguistic groups matter because their members are imbued with cultural legacies that lead to distinct political preferences – in this case preferences over welfare statism. Further, ecological constraints such as geography and topography affect social interaction with like-minded individuals. On the basis of both these political preferences and ecological constraints, individuals then make rational choices about the desirability of secession. Instrumental considerations are therefore crucial in explaining the decision to secede, but not in a conventional pocketbook manner. To examine this theory, we analyze the 2013 referendum on the secession of the Jura Bernois region from the Canton of Berne in Switzerland, using municipal level census and referendum data. The results lend support to the theory and suggest one way in which the politics of identity, based on factors like language and religion, can be fused with the politics of interest (preferences for more or less state intervention into the polity and economy) to better understand group behavior.

Veil: Mirror of Identity

The Islamic headscarf has become the subject of heated legal and political debate. France and Germany have legislated against it, and even the UK, long a champion of multiculturalism, has recently restricted the veil proper. Ever since home-grown Islamic terrorism struck Europe, these debates have become even more prominent, impassioned and wide-ranging, with vital global importance. In this concise and beautifully written introduction to the politics of the veil in modern societies, Christian Joppke examines why a piece of clothing could have led to such controversy. He dissects the multiple meanings of the Islamic headscarf, and explores its links with the global rise of Islam, Muslim integration, and the retreat from multiculturalism. He argues that the headscarf functions as a mirror of identity, but one in which national and liberal identities overlap, exposing the paradox that while it may be an affront to liberal values, its suppression is equally illiberal.