Patients' understanding of risk associated with medication use: impact of European Commission guidelines and other risk scales

Patients want and need comprehensive and accurate information about their medicines so that they can participate in decisions about their healthcare: In particular, they require information about the likely risks and benefits that are associated with the different treatment options. However, to provide this information in a form that people can readily understand and use is a considerable challenge to healthcare professionals. One recent attempt to standardise the Language of risk has been to produce sets of verbal descriptors that correspond to specific probability ranges, such as those outlined in the European Commission (EC) Pharmaceutical Committee guidelines in 1998 for describing the incidence of adverse effects. This paper provides an overview of a number of studies involving members of the general public, patients, and hospital doctors, that evaluated the utility of the EC guideline descriptors (very common, common, uncommon, rare, very rare). In all studies it was found that people significantly over-estimated the likelihood of adverse effects occurring, given specific verbal descriptors. This in turn resulted in significantly higher ratings of their perceived risks to health and significantly lower ratings of their likelihood of taking the medicine. Such problems of interpretation are not restricted to the EC guideline descriptors. Similar levels of misinterpretation have also been demonstrated with two other recently advocated risk scales (Caiman's verbal descriptor scale and Barclay, Costigan and Davies' lottery scale). In conclusion, the challenge for risk communicators and for future research will be to produce a language of risk that is sufficiently flexible to take into account different perspectives, as well as changing circumstances and contexts of illness and its treatments. In the meantime, we urge the EC and other legislative bodies to stop recommending the use of specific verbal labels or phrases until there is a stronger evidence base to support their use.

Taking time to understand: articulating relationships between technologies and organizations

Dynamic relationships between technologies and organizations are investigated through research on digital visualization technologies and their use in the construction sector. Theoretical work highlights mutual adaptation between technologies and organizations but does not explain instances of sustained, sudden, or increasing maladaptation. By focusing on the technological field, I draw attention to hierarchical structuring around inter-dependent levels of technology; technological priorities of diverse groups; power asymmetries and disjunctures between contexts of development and use. For complex technologies, such as digital technologies, I argue these field-level features explain why organizations peripheral to the field may experience difficulty using emerging technology.

The risk-taking and self-harm inventory for adolescents: Development and psychometric evaluation

In this study, we report on the development and psychometric evaluation of the Risk-Taking (RT) and Self-Harm (SH) Inventory for Adolescents (RTSHIA), a self-report measure designed to assess adolescent RT and SH in community and clinical settings. 651 young people from secondary schools in England ranging in age from 11.6 years to 18.7 years and 71 young people referred to mental health services for SH behavior in London between the ages of 11.9 years and 17.5 years completed the RTSHIA along with standardized measures of adolescent psychopathology. Two factors emerged from the principal axis factoring, and RT and SH were further validated by a confirmatory factor analysis as related, but different, constructs, rather than elements of a single continuum. Inter-item and test–retest reliabilities were high for both components (Cronbach's α = .85, rtt = .90; Cronbach's α .93, rtt = .87), and considerable evidence emerged in support of the measure's convergent, concurrent, and divergent validity. The findings are discussed with regard to potential usefulness of the RTSHIA for research and clinical purposes with adolescents.

Local versus organic: a turn in consumer preferences and willingness-to-pay

Demand for local food in the United States has significantly increased over the last decade. In an attempt to understand the drivers of this demand and how they have changed over time, we investigate the literature on organic and local foods over the last few decades. We focus our review on studies that allow comparison of characteristics now associated with both local and organic food. We summarize the major findings of these studies and their implications for understanding drivers of local food demand. Prior to the late 1990s, most studies failed to consider factors now associated with local food, and the few that included these factors found very little support for them. In many cases, the lines between local and organic were blurred. Coincident with the development of federal organic food standards, studies began to find comparatively more support for local food as distinct and separate from organic food. Our review uncovers a distinct turn in the demand for local and organic food. Before the federal organic standards, organic food was linked to small farms, animal welfare, deep sustainability, community support, and many other factors that are not associated with most organic foods today. Based on our review, we argue that demand for local food arose largely in response to corporate cooptation of the organic food market and the arrival of “organic lite.” This important shift in consumer preferences away from organic and toward local food has broad implications for the environment and society. If these patterns of consumer preferences prove to be sustainable, producers, activists, and others should be aware of the implications that these trends have for the food system at large.

Taking the LEED? Analyzing spatial variations in market penetration rates of eco-labeled properties

This paper investigates the impact of policies to promote the adoption of LEED-certified buildings across CBSA in the United States. Drawing upon a unique database that combines data from a large number of sources and using a number of regression procedures, the determinants of the proportion LEED-certified space for more than 170 CBSA in the US is modeled. LEED-certified space still accounts for a relatively small proportion of commercial stock in all markets. The average proportion is less than 1%. There is no conclusive evidence of a positive impact of policy intervention on the levels of LEED-certified space. However, after accounting for bias introduced by non-random assignment of policies, we find preliminary evidence of a positive impact of city-level green building incentives. There is a significant positive association between market size and indicators of economic vitality on proportions of LEED-certified space.