Parent's risk preference and childhood vaccination: evidence from Indonesia

A vaccines advisory group to the World Health Organization (WHO) identified complacency, inconvenience in accessing vaccines, and lack of confidence as key reasons for hesitancy. In childhood vaccination, the decision to take a vaccine relies on parents' decisions. Our study explored the relationship between parents' risk aversion and complete childhood vaccination status to identify whether demand contributes to vaccine hesitancy in Indonesia. We examined risk aversion using data from the fifth-wave Indonesian Family Life Survey (IFLS), focusing on parents with extreme risk aversion or fear of uncertainty. The logistic regression shows a negligible relationship between parents' risk aversion and childhood vaccination; nevertheless, parents who fear uncertainty tend to avoid vaccination. The results of this study encourage public health professionals and policymakers to properly design vaccine campaigns with careful consideration of the risk preference dimension of the targeted beneficiaries.

Intention towards renewable energy investments in Malaysia: extending theory of planned behaviour

Renewable energy investments possess great potential for reducing the consumption of fossil fuels influenced by various determinants. This study investigates the individual investors' renewable energy investments' intention within the framework of the theory of planned behaviour (TPB) based on a survey conducted in 3 major states in Malaysia. The results indicate that one's intention to invest in renewable energy investments is influenced by attitude, subjective norm, perceived behavioural control and evaluation of regulatory framework. Risk aversion on the other hand was found to have no effect on investors' intention towards such investments. The findings also reveal that the evaluation of regulatory framework is the most important determinant. This outcome contradicts the outcomes arrived at by the previous studies that focus on investment behaviours or other types of pro-environmentally intention or behaviours. This research also investigates the indirect effects of TPB on explaining investor's intention towards renewable energy investments through the evaluation of regulatory framework. The results indicate that the investors' intention towards renewable energy investments is indirectly influenced by attitude and perceived behavioural control. Subjective norm does not have an indirect effect on investors' intention towards renewable energy investments. This study provides policymakers' important practical implications to improve renewable energy investments.

The Association Between Risk Aversion of Surgeons and Their Clinical Decision-Making

BACKGROUND

The extent to which a surgeon's risk aversion influences their clinical decisions remains unknown. We assessed whether a surgeon's attitude toward risk ("risk aversion") influences their surgical decisions and whether the relationship can be explained by differences in surgeons' perception of treatment risks and benefits.

MATERIALS AND METHODS

We presented a series of detailed clinical vignettes to a national sample of surgeons (n = 1,769; 13.4% adjusted response rate) and asked them to complete an instrument that measured how risk averse they are within their clinical practice (scale 6-36; higher number indicates greater risk aversion). For each vignette, participants rated their likelihood of recommending an operation and judged the likelihood of complications or full recovery. We examined whether differences in perceived likelihood of complications versus recovery could explain why risk-averse surgeons may be less likely to recommend an operation.

RESULTS

Surgeons varied in their self-reported risk aversion score (median = 25, interquartile range[22,28]). Scores did not differ by level of surgeon experience or gender. Risk-averse surgeons were significantly less likely to recommend an operation for patients with exactly the same condition (65.5% for surgeons in highest quartile of risk aversion versus 62.3% for lowest quartile; P = 0.02). However, after controlling for surgeons' perception of the likelihood of complications versus recovery, there was no longer a significant association between surgeons' risk aversion and the decision to recommend an operation (64.7% versus 64.8%; P = 0.96).

CONCLUSIONS

Surgeons vary widely in their self-reported risk aversion. Risk-averse surgeons were significantly less likely to recommend an operation, a finding that was explained by a higher perceived probability of post-operative complications than their colleagues.

Altered risky decision making in patients with early non-affective psychosis

Abnormal risky decision making may represent an important factor contributing to functional impairment in psychotic disorders. Previous research revealed impaired decision making under risk in patients with chronic schizophrenia. However, risky decision making is under-studied in the early course of illness. We examined risky decision making in 33 patients with early non-affective psychosis and 32 demographically matched controls, using two well-validated experimental paradigms, balloon analogue risk task (BART) and Risky-Gains task (RGT), which modeled and assessed actual risk-taking behaviors in deliberative and time-pressured decision-making situations, respectively. Our results showed that patients exhibited suboptimal decision making on the BART and were more risk averse than controls by having fewer average balloon pumps in non-burst trials, lower explosion rate and lower total points gained. On the RGT, patients also behaved more conservatively than controls, with lower overall rate in choosing the risky option. Intriguingly, patients performed comparably to controls in adjusting risk-taking pattern following punished trials, suggesting relatively preserved sensitivity to punishment in early psychosis. Risk-taking measures showed no significant correlations with any symptom dimensions, impulsivity traits, cognitive functions or antipsychotic treatment after correcting for multiple comparisons. This study is the first to investigate risk-taking propensity in early psychosis based on BART/RGT performance, and consistently indicate that patients with early psychosis displayed altered risky decision making with increased risk aversion relative to healthy participants. Further investigation is warranted to clarify the longitudinal course of aberrant risky decision making and its relationship with functional outcome in early psychosis.

Perspectives of region II OSHA authorized safety and health trainers about initial COVID-19 response programs

In this cross-sectional survey-based study conducted in early fall 2020, we attempted to measure and ascertain the extent of whether employers in New York and New Jersey were prepared to manage and follow occupational safety and health (S&H) regulations and industry risk processes in developing an exposure control response program to COVID-19, the disease caused by exposure to the coronavirus SARS-CoV-2. We focused on Region II of the U.S. Department of Labor (USDOL)-Occupational Safety and Health Administration (OSHA). In addition, we examined possible explanations for lack of compliance and uniformity across the region in various USDOL-OSHA regulatory aspects like training, respiratory protection program administration and proper task-specific application of occupational S&H hazard controls through risk management systems. We suggest opportunities for employer and governmental interventions to reduce potential worker exposures and better control future worksite biological hazards and infectious disease transmission. Overall, data suggested prevalent inconsistencies, noncompliance and a less than uniform approach to implementing COVID-19 response programs.

Irrational risk aversion in an ant

Animals must often decide between exploiting safe options or risky options with a chance for large gains. Both proximate theories based on perceptual mechanisms, and evolutionary ones based on fitness benefits, have been proposed to explain decisions under risk. Eusocial insects represent a special case of risk sensitivity, as they must often make collective decisions based on resource evaluations from many individuals. Previously, colonies of the ant Lasius niger were found to be risk-neutral, but the risk preference of individual foragers was unknown. Here, we tested individual L. niger in a risk sensitivity paradigm. Ants were trained to associate one scent with 0.55 M sucrose solution and another with an equal chance of either 0.1 or 1.0 M sucrose. Preference was tested in a Y-maze. Ants were extremely risk-averse, with 91% choosing the safe option. Based on the psychophysical Weber-Fechner law, we predicted that ants evaluate resources depending on their logarithmic difference. To test this hypothesis, we designed 4 more experiments by varying the relative differences between the alternatives, making the risky option less, equally or more valuable than the safe one. Our results support the logarithmic origin of risk aversion in ants, and demonstrate that the behaviour of individual foragers can be a very poor predictor of colony-level behaviour.

Relationship of attitudes toward uncertainty and preventive health behaviors with breast cancer screening participation

Backgroundcxs

Early detection of breast cancer is effective for prolonging survival, but the participation rate in breast cancer screening among target Japanese women remains low. This study examined the relationships between tendencies in decision-making under conditions of uncertainty, health behaviors, demographics, and breast cancer screening participation in Japanese women.

Methods

Secondary analysis was performed using data from the 2017 Keio Household Panel Survey (KHPS). The study population consisted of 2945 households. Data were obtained from the KHPS for women aged 40 years or older. Breast cancer screening participation in the past year, risk aversion, time preference, health behaviors (e.g., smoking, alcohol consumption, and medical treatment received in the past year), and demographic variables were analyzed.

Results

Data from 708 women were analyzed. Among the respondents, 28.8% had attended breast cancer screening in the past year. Factors found to significantly contribute to breast cancer screening participation included higher risk aversion (odds ratio [OR], 2.34; 95% confidence interval [CI] = 1.03–5.32; p = 0.043), medical treatment received in the past year (OR, 1.56; 95% CI = 1.06–2.30; p = 0.026), higher self-rated health (OR, 1.47; 95% CI = 1.18–1.83; p = 0.001), living above the poverty line (OR, 2.31; 95% CI = 1.13–4.72; p = 0.022), and having children (OR, 1.57; 95% CI = 1.02–2.42; p = 0.042). Factors significantly associated with non-participation in breast cancer screening were smoking (OR, 0.20; 95% CI = 0.10–0.42; p < 0.000), alcohol consumption (OR, 0.56; 95% CI = 0.37–0.86; p = 0.007), being self-employed (OR, 0.22; 95% CI = 0.10–0.46; p < 0.000), and being unemployed (OR, 0.48; 95% CI = 0.26–0.90; p = 0.022). No significant relationship was observed between time preference and screening participation.

Conclusions

The results indicate that women who recognize the actual risk of developing breast cancer or have high awareness of breast cancer prevention tend to participate in breast cancer screening. Barriers to screening participation are not working for an organization that encourages screening and low income.

What are parents willing to accept? A prospective study of risk tolerance in AIS surgery

INTRODUCTION

Surgical treatment of Adolescent Idiopathic Scoliosis (AIS) involves healthy individuals with spinal deformity. Parents are responsible for surgical consent on behalf of their children, a burden which causes trepidation and concern. Therefore, explanation of operative risk is a critical component of informed consent and parent decision-making. We set out to quantify parental risk aversion (RA).

METHODS

RA questionnaires were administered preoperatively to parents of 58 AIS patients undergoing spinal fusion (SF). RA is the likelihood of a parent to consent to their child's SF (1- least likely, 10- most) with increasing allotments of data about potential complications at each stage (S1-complication named, S2-explained, S3-incidence given, S4-all information). A statistically significant mean difference in answers for each stage was assessed using paired sample t test or Wilcoxon rank t test. Normality was assessed by performing Shapiro-Wilk test.

RESULTS

AIS patients (age 14.2 years, 85% female, major curve 61°) were included. Mean scores for each of the stages were 4.4 ± 3.1, 4.9 ± 3.1, 6.5 ± 3.0, 6.6 ± 3.0, respectively. Highest and lowest RA were reported for death and infection, respectively. The greatest increase in likelihood to proceed with surgery was seen after education on malposition of implants and on death, 2.6 and 2.5, respectively (p < 0.001). The lowest increase in likelihood to proceed with surgery was seen after education on infection, 1.5 (p < 0.001). For all complications, there was an increase in parent willingness to proceed after providing descriptions and occurrence rate with a mean increase from S1 to S4 of 2.1 (95% CI 1.4-2.4), p < 0.001.

CONCLUSION

As more detailed information was made available regarding potential complications with SF for AIS, parental RA toward surgery decreased and their willingness to proceed with surgery for their child improved.

How Much Are Borrowers Willing to Pay to Remove Uncertainty Surrounding Mortgage Defaults?

Using a large, non-student sample, we assess and differentiate between borrowers' Risk Aversion and Ambiguity Aversion levels and their willingness to pay to resolve a mortgage default settlement negotiation. Ambiguity Aversion is found to be negatively associated with willingness to pay for borrowers with high financial literacy in both the gain and loss domains, whereas personality traits matter more for borrowers with low financial literacy. This finding is important to policymakers in that they should adopt differential resolution strategies for defaulting borrowers based on these intervening variables.

The maturity of sovereign debt issuance in the euro area

We use information on new sovereign debt issues in the euro area to explore the drivers behind the debt maturity decisions of governments. We set up a theoretical model for the maturity structure that trades off the preference for liquidity services provided by short-term debt, roll-over risk and price risk. The average debt maturity is negatively related to both the level and the slope of the yield curve. A panel VAR analysis shows that positive shocks to risk aversion, the probability of non-repayment and the demand for the liquidity services of short-term debt all have a positive effect on the yield curve level and slope, and a negative effect on the average maturity of new debt issues. These results are partially in line with our theoretical framework. A forecast error variance decomposition suggests that changes in the probability of non-repayment as captured by the expected default frequency extracted from credit default spreads are the most important source of shocks.

Labor market frictions, capital, taxes and employment

This paper studies the role of the tax on mobile capital in labor markets with matching frictions and the effects of such frictions on inefficiency of capital taxation. Firms acquire capital and create vacancies, and workers apply for firms. Due to matching frictions, vacancies may not be filled, and workers may not be employed. Firms' investment in capital, wages and market tightness are determined in a way that a firm's profit and a worker's utility are jointly maximized. In addition, the return to capital net of the tax is equalized across jurisdictions, as capital moves between jurisdictions. An increase in the capital tax of a jurisdiction alters firms' capital investment, wages and market tightness of the jurisdiction. In particular, it decreases employment and wages of the jurisdiction, providing an explanation for why policymakers of a jurisdiction provide incentives such as tax cuts for mobile capital. More capital increases the wages only when workers are employed and hence have higher incomes, decreasing the benefit of more capital for risk-averse workers and reducing the incentives of a jurisdiction to lower the tax and attract capital. The equilibrium capital tax thus may be too low or too high relative to the efficient level, and capital is taxed even with the head tax.

Rare events and long-run risks

Rare events (RE) and long-run risks (LRR) are complementary approaches for characterizing macroeconomic variables and understanding asset pricing. We estimate a model with RE and LRR using long-term consumption data for 42 economies, identify these two types of risks simultaneously from the data, and reveal their distinctions. RE typically associates with major historical episodes, such as world wars and depressions and analogous country-specific events. LRR reflects gradual processes that influence long-run growth rates and volatility. A match between the model and observed average rates of return on equity and short-term bonds requires a coefficient of relative risk aversion, γ, around 6. Most of the explanation for the equity premium derives from RE, although LRR makes a moderate contribution. However, LRR helps in fitting the Sharpe ratio. Generating good matches to the equity premium and Sharpe ratio simultaneously is still challenging.

Risk aversion connectedness in developed and emerging equity markets before and after the COVID-19 pandemic

This study investigates the dynamic connectedness across the variance risk premium in international developed and emerging equity markets based on a Bayesian time-varying parameter vector autoregressive methodology. The empirical results indicate that the total spillover index is on average 65.6%, indicating a high, albeit declining, level of interconnectedness across the investor sentiment in the three markets under review until early 2020. Following the COVID-19 outbreak though, the total investors' risk aversion connectedness - as expected - strengthens, but more importantly, its dynamics alter, indicating that the risk aversion of emerging markets is an important contributor to the connectedness of international markets.

Blessed are the first: The long-term effect of birth order on trust

Acknowledging childhood as a crucial period for the formation of social preferences, we investigate whether the order of birth predicts trust in adult life. We find that laterborns trust on average 5% less than their older siblings, independently from personality traits, family ties, risk aversion and parental inputs. Family random- and fixed-effects estimates suggest that the variation in trust is mostly explained by within- rather than between-family characteristics. The effect of birth order is mediated by education outcomes only for women, while it is moderated by mother's education for the entire sample, thereby leading to relevant policy implications.

Psychological Constructs Related to Seat Belt Use: A Nationally Representative Survey Study

Seat belt use can significantly reduce fatalities in motor vehicle crashes (Kahane, 2000). Nevertheless, the current U.S. seat belt use rate of 89.6% (Enriquez & Pickrell, 2019) indicates that a relatively small but pervasive portion of the population does not wear seat belts on a full-time basis. Whereas much is known about the demographic predictors of seat belt use, far less is understood about psychological factors that predict individual proclivities toward using or not using a seat belt. In this study, we examined some of these potential psychological predictors. A probability-based web survey was conducted with 6,038 U.S. residents aged 16 or older who reported having driven or ridden in a car in the past year. We measured self-reported seat belt use and 18 psychological constructs and found that delay of gratification, life satisfaction, risk aversion, risk perception, and resistance to peer influence were positively associated with belt use. Impulsivity and social resistance orientation were negatively associated with belt use. Prior research has shown that psychological factors like delay of gratification, risk aversion/perception, and impulsivity predict other health behaviors (e.g., cigarette smoking, sunscreen use); our results extend this literature to seat belts and can aid the development of traffic safety programs targeted at non-users who-due to such factors-may be resistant to more traditional countermeasures such as legislation and enforcement.

Perception-based influence factors of intention to adopt COVID-19 epidemic prevention in China

BACKGROUND

The researches investigating the influence factors of epidemic prevention are not only scarce, but also provide a gap in the domain of perception-based influence factors of intention to adopt COVID-19 epidemic prevention.

OBJECTIVE

This work has attempted to examine the perception-based influence factors of individuals' intention to adopt COVID-19 epidemic prevention in a modified behavioral framework.

THEORETICAL FRAMEWORK

A behavioral framework composed of the theory of reasoned action and the theory of planned behavior is developed to incorporate some additional perception-based influence factors.

METHODS

A partial least square-based path analysis has been employed to estimate the path coefficients of those factors in terms of drivers, barriers, and neutral factors based on questionnaire data of 302 respondents from six universities and two hospitals in China.

RESULTS

Among the perception-based influence factors, governments' guidelines on epidemic prevention is found to be the most important and influential factor, which was followed by risk perception. Finally, attitude towards epidemic prevention exhibited the least degree of impact on individuals' intention to adopt epidemic prevention. Moral norms did not show any contribution to individuals' intention to adopt epidemic prevention.

CONCLUSION

Concerning importance ranking, the governments' guidelines on epidemic prevention, risk perception, and epidemic knowledge are revealed as the top three drivers of individuals' intention to adopt epidemic prevention, while the perceived feasibility to adopt epidemic prevention is found to be a barrier. Moreover, moral norms is identified to have an insignificant influence on individuals' intention to adopt epidemic prevention. Given the empirical results, dissemination of Governments' guidelines on epidemic prevention, proper risk perception, and knowledge about epidemic would help prevent the COVID-19 pandemic outbreak within China and worldwide.

Does style investing uniformly affect correlations in small and large markets?

Empirical and theoretical research concurs to show that style investing increases return correlations within assets that are classified into the same style. The theoretical model presented in this study addresses the question of how the correlation increases due to style investing depend on market size, and how they respond to economic downturns and to the incidence and awareness of style investing. The results show that correlation distortions caused by style investing are more robust for smaller markets. Further, the effect of style investing on correlations strengthens risk aversion, and hence during downturns. Market awareness, and incidence, of style investing also increase correlation distortions. The model yields closed-form analytical expressions for the correlation distortions caused by style investing, as well as for the effects of changes in risk aversion and in the incidence and awareness of style investing. Given the surge ETF-based style investing over the last two decades, the results have implications for portfolio risk diversification. This study predicts that the ability of risk mitigation through portfolio diversification diminishes particularly for small-market domestic investors as a result of the growing relevance of country-based ETF-based.

Threat of infectious disease during an outbreak: Influence on tourists' emotional responses to disadvantaged price inequality

The ongoing COVID-19 pandemic has negatively influenced the global tourism industry. Despite the documented negative impacts of diseases on tourism demand and people's perceived health risk, researchers have seldom examined the psychological responses of tourists travelling during an infectious disease outbreak. We therefore conducted three studies to examine this key aspect, and our findings indicate that tourists have a strong negative emotional reaction towards disadvantaged tourism-related prices in response to a high (vs low) infectious disease threat. Furthermore, risk aversion acts as an underlying mechanism driving this effect: tourists are more risk aversive under the threat of an infectious disease, which consequently magnifies their negative emotional reaction. At last, theoretical and practical implications of these findings for tourism are discussed.

Preferences of physicians for public and private sector work

BACKGROUND

The public-private mix of healthcare remains controversial. This paper examines physicians' preferences for public sector work in the context of dual practice, whilst accounting for other differences in the characteristics of jobs.

METHODS

A discrete choice experiment is conducted with data from 3422 non-GP specialists from the Medicine in Australia: Balancing Employment and Life (MABEL) panel survey of physicians.

RESULTS

Physicians prefer to work in the public sector, though the value of working in the public sector is very small at 0.14% of their annual earnings to work an additional hour per week. These preferences are heterogeneous. Contrary to other studies that show risk averse individuals prefer public sector work, for physicians, we find that those averse to taking career or clinical risks prefer to work in the private sector. Those with relatively low earnings prefer public sector work and those with high earnings prefer private sector work, though these effects are small.

CONCLUSIONS

Other job characteristics are more important than the sector of work, suggesting that these should be the focus of policy to influence specialist's allocation of time between sectors.

Reducing Reimbursement Drug Price Risk to Enhance R&D Incentives without Raising Drug Prices/Expenditures: Implications of Simulations Based on Questionnaire Survey of Pharmaceutical Companies in Japan

Due to severe financial conditions and unmet medical needs, the Japanese government must prioritize both R&D incentives and drug prices/expenditures. However, increasing reimbursement drug prices to strengthen R&D incentives also increases the financial burden on patients and the National Health Insurance, wherein virtually all prescription drugs are reimbursed, with prices determined and controlled by the government. Hence, it is important to find ways to achieve higher R&D incentives without raising drug prices/expenditures. To seek such policies, we focus on the reimbursement drug price risk of pharmaceutical firms. An original questionnaire survey is used to collect data on the price-risk attitudes of R&D-oriented pharmaceutical firms in Japan. With this data, we conduct numerical simulations to quantify the effect of reducing the reimbursement drug price risk on firms' R&D incentives. Then, we check the robustness of our results. We find that many R&D-oriented pharmaceutical firms in Japan are risk averse. Thus, to enhance R&D incentives, reducing price risk is effective. The simulated impact of removing a ±10% price risk is equivalent to winning a 5% premium, which is substantial. These results are robust to changes in utility form, price/sales patterns and market size, while increased price risk enhances the simulated impact.

The paradox of pedestrian's risk aversion

Traffic accidents are becoming a significant cause for unnatural deaths around the world, with more than 1.25 million fatalities in road accidents each year, and over 20 million people severely injured. A large portion of accidents that result in fatalities involve interaction between vehicles and pedestrians. In the literature, researchers speculate on a wide range of reasons for these figures. This paper focuses on the relationship between pedestrians' urgency to cross a busy road and the resulting level of risk for an accident. The probability for an accident is determined by a prediction model for a collision between drivers and pedestrians at congested conflict spots. The model is based on a motion planner called the Probabilistic Navigation Function (PNF), initially designed for robot navigation in dynamic cluttered and uncertain environments. The model predicts pedestrians' trajectories when crossing a busy road in a sub-meter accuracy, based on the risk they are willing to take (a reflection of the level of urgency to cross the road). The paper describes an unexpected and surprising pedestrian behavior in simple road crossings scenarios. When the model is given a loose risk boundary (that reflects a high level of pedestrian urgency to cross), the resulting trajectory exposes the pedestrian to a lower risk compared with a trajectory constructed with a strict risk boundary (that reflects a more conservative pedestrian). This is equivalent to claiming that, paradoxically, pedestrians in some scenarios who are willing to take higher levels of risk, face a decreased probability for an accident while crossing a congested road. The paper introduces the PNF model for crossing pedestrians, analyses their performance in a set of simulations, and explains its rationale. Next, an analytic estimation for the risk level as a function of the crossing angle of the selected trajectory is provided. A series of experiments conclude the paper and support the claim that this phenomenon is frequent among crossing pedestrians. The experimental results suggest that in some common scenarios, more cautious pedestrians may lower the initial risk for an accident at the expense of a total higher risk for an accident during the entire road crossing process, compared with a pedestrian who takes an initial higher level of risk that results in, overall, a decreased probability for an accident. A statistical analysis implies that there are significant differences in this occurrence between adults and children.

Amygdala-prefrontal connectivity modulates loss aversion bias in anxious individuals

Anxious individuals tend to make pessimistic judgments in decision making under uncertainty. While this phenomenon is commonly attributed to risk aversion, loss aversion is a critical but often overlooked factor. In this study, we simultaneously examined risk aversion and loss aversion during decision making in high and low trait anxious individuals in a variable gain/loss gambling task during functional magnetic resonance imaging. Although high relative to low anxious individuals showed significant increased risk aversive behavior reflected by decreased overall gamble decisions, there was no group difference in subjective aversion to risk. Instead, loss aversion rather than risk aversion dominantly contributed to predict behavioral decisions, which was associated with attenuated functional connectivity between the amygdala-based emotional system and the prefrontal control regions. Our findings suggest a dominant role of loss aversion in maladaptive risk assessment of anxious individuals, underpinned by disorganization of emotion-related and cognitive-control-related brain networks.

Attitudes to reform: Could a cooperative health insurance scheme work in Russia?

As for all health systems, in Russia, the demand for medical care is greater than its health system is able to guarantee the supply of. In this context, removing services from the state guaranteed package is an option that is receiving serious consideration. In this paper, we examine the attitudes of the Russian population to such a reform. Exploiting a widely-used methodology, we explore the population's willingness to pay for cooperative health insurance. Distinguishing between socioeconomic and demographic factors, health-related indicators and risk aversion we find, consistent with other literature, positive income and risk aversion effects. We interpret the former as evidence that the Russian population is not opposed to the idea of progressive redistribution, to pool the costs of health-related risks; and the latter as evidence that risk-averse individuals demand more insurance coverage. In exploring these results further, we show that cognitive bias is important: overestimating the benefits leads to the purchase of additional insurance, while underestimating lowers demand for insurance. Our overall conclusion is that the introduction of a supplementary cooperative health insurance scheme in Russia could increase the accessibility of healthcare, lower the tendency for informal payments, incentivize the personal maintenance of good health and create a new source of funding for public healthcare.

Risk Aversion and Alzheimer Disease in Old Age

OBJECTIVE

To test the hypothesis that late-life risk aversion is partly a prodromal sign of dementia.

METHODS

The authors' design was a longitudinal clinical-pathologic cohort study. The setting included participants' residences in the Chicago area, and a total of 874 older persons without dementia were enrolled. At baseline, risk aversion was assessed with questions involving choices between certain smaller rewards and uncertain larger rewards. At annual intervals thereafter, participants underwent evaluations that included cognitive testing and diagnosis of mild cognitive impairment (MCI) and dementia. At death, a neuropathologic examination was done to quantify common pathologies linked to dementia.

RESULTS

Risk aversion at study onset ranged from 0.05-0.91 (mean: 0.32, standard deviation: 0.31). During a mean of 4.6 years of follow-up, 123 (of 874) developed dementia. Higher risk aversion was associated with higher dementia incidence (hazard ratio [HR]: 2.08; 95% confidence interval: 1.18, 3.65) and more rapid decline in episodic (estimate: -0.062; standard error [SE]: 0.019; t [3677]: -3.33; p < 0.001) and semantic (estimate: -0.039; SE: 0.015; t [3655]: -2.61; p = 0.009) memory but not in other cognitive systems. Of 702 people without cognitive impairment at baseline, 223 developed incident MCI. Higher risk aversion was associated with higher incidence of MCI (HR: 2.10; 95% confidence interval: 1.34, 3.29) and more rapid episodic memory decline. In 181 neuropathologically examined individuals, higher risk aversion was associated with higher levels of plaques, tangles, and cerebral amyloid angiopathy.

CONCLUSION

The results support the hypothesis that high risk aversion in old age is partly an early sign of the pathology of Alzheimer disease.

Non-technical attributes and surgical experience: A cross-sectional study comparing communication styles and attitudes in surgical staff, trainees and applicants

BACKGROUND

This monocentric study aimed to explore whether key non-technical attributes can be reliably measured in a mixed population of candidates applying for surgical training, surgical trainees and staff and to identify any differences between these groups.

MATERIALS & METHODS

Candidates applying for surgical training, surgical trainees and staff from four surgical specialties (general surgery, orthopedics, plastic surgery or urology) at a tertiary academic teaching hospital were all sent an online self-report questionnaire. The Communication Styles Inventory (CSI, 96 items) was used to assess a six-dimensional behavioral model of participant communication styles (expressiveness, preciseness, verbal aggressiveness, questioningness, emotionality and impression manipulativeness). Attitudes toward uncertainty and risks were assessed with the Physicians' Reaction toward Uncertainty (PRU, 15 items) and Physician Risk Attitudes (PRA, 6 items) scales respectively. Data was encoded and analyzed using parametric testing.

RESULTS

The questionnaire was completed by 177 participants (110 candidates; 42 trainees; 25 staff). All scales had very good internal consistency (Cronbach's alpha >0.80). After controlling for gender-based differences, surgical candidates scored significantly higher on 'expressiveness' (P = 0.012) and were significantly less risk-averse (P = 0.006) than trainees and staff. Surgical trainees scored lowest on the CSI 'questioningness' subscale (P = 0.019) and had significantly more difficulties dealing with uncertainty, characterized by their highest scores on the 'concern about bad outcome' (P = 0.021) and reluctance to disclose uncertainty to patients' (P = 0.05) subscales. Multiple subscales revealed gender-based differences in candidate and trainee groups, which were not noted for surgical staff.

CONCLUSIONS

Meaningful differences in non-technical attributes of surgical staff, trainees and candidates have been identified, which may be explained by differences in clinical experience and learning and may suggest that these develop over time. Further research on assessment of non-technical attributes during surgical selections and the role of both technical and non-technical attributes in surgery at large is needed.