Self-disgust mediates the relationship between dysfunctional cognitions and depressive symptomatology

Disgust has been linked to several psychopathologies, although a role in depression has been questioned. However, it has recently been proposed that rather than general disgust sensitivity, disgust directed toward the self (self-disgust) may influence the development of depression, providing a causal link between dysfunctional cognitions and depressive symptomatology. This possibility was examined by developing a scale to measure self-disgust (the Self-Disgust Scale; SDS) and then using mediator analysis to determine if self-disgust was able to explain the relationship between dysfunctional cognitions (measured with the use of the Dysfunctional Attitudes Scale) and depressive symptomatology (measured with the use of the Beck Depression Inventory and the Depression, Anxiety and Stress Scale). The developed SDS was found to exhibit a high level of internal consistency, test-retest reliability, and concurrent validity. Principal-components analysis revealed two factors to underlie responses to SDS items: the 'Disgusting self,' concerned with enduring, context independent aspects of the self, and 'Disgusting ways,' concerned with behavior. Self-disgust was found to mediate the relationship between dysfunctional cognitions and depressive symptomatology, demonstrating for the first time that self-disgust plays a role in depression.     

Prolonging life and delaying death: The role of physicians in the context of limited intensive care resources

In the past decade donor commitments to health have increased by 200 percent. Correspondingly, there has been a swell of new players in the global health landscape. The unprecedented, global response to a single disease, HIV/AIDS, has been responsible for a substantial portion of this boon. Numerous health success have followed this windfall of funding and attention, yet the food, fuel, and economic crises of 2008 have shown the vulnerabilities of health and development initiatives focused on short term wins and reliant on a constant flow of foreign funding. For too long, the international community has responded to global health and development challenges with emergency solutions that often reflect the donor's priorities, values, and political leanings, rather than funding durable health systems that can withstand crises. Progress towards achieving the Millennium Development Goals has stalled in many countries. Disease specific initiatives have weakened health systems and limited efforts to improve maternal and child health. As we enter this era of scarce resources, there is a need to return to the foundations of the Alma Ata Declaration signed thirty years ago with the goal of providing universal access to primary healthcare. The global health community must now objectively evaluate how we can most effectively respond to the crises of 2008 and take advantage of this moment of extraordinary attention for global health and translate it into long term, sustainable health improvements for all.     

Prolonging life and delaying death: The role of physicians in the context of limited intensive care resources

Critical care is in an emerging crisis of conflict between what individuals expect and the economic burden society and government are prepared to provide. The goal of critical care support is to prevent suffering and premature death by intensive therapy of reversible illnesses within a reasonable timeframe. Recently, it has become apparent that early support in an intensive care environment can improve patient outcomes. However, life support technology has advanced, allowing physicians to prolong life (and postpone death) in circumstances that were not possible in the recent past. This has been recognized by not only the medical community, but also by society at large. One corollary may be that expectations for recovery from critical illness have also become extremely high. In addition, greater numbers of patients are dying in intensive care units after having receiving prolonged durations of life-sustaining therapy. Herein lies the emerging crisis – critical care therapy must be available in a timely fashion for those who require it urgently, yet its provision is largely dependent on a finite availability of both capital and human resources. Physicians are often placed in a troubling conflict of interest by pressures to use health resources prudently while also promoting the equitable and timely access to critical care therapy. In this commentary, these issues are broadly discussed from the perspective of the individual clinician as well as that of society as a whole. The intent is to generate dialogue on the dynamic between individual clinicians navigating the complexities of how and when to use critical care support in the context of end-of-life issues, the increasing demands placed on finite critical care capacity, and the reasonable expectations of society.     

Book Reviews

Distorted interpretations and abusive uses of the Ham–Noah curse tale abound. This essay explores five common interpretations. Cohen's overly‐imaginative interpretation links wine, genitalia, and reproduction to accent Noah's potency and Ham's presumed designs on that potency. Nineteenth‐century slave owners used the text to undergird dangerous fantasies of white superiority. Fundamentalists, thinking Ham sodomised his father, inappropriately use the text to condemn modern homoeroticism. Some see Ham as uncontrolled libido. Intra‐biblical connections may suggest that Ham's act was maternal incest. The danger of getting stuck in ancient mythostories calls for a creative critique. Perryman puts Ham on trial in an effort to dismantle racist uses of the text, suggesting that a carnivalesque biblical hermeneutic that mocks the injustices perpetuated by this text may be the most effective way to counter textual abuse.     

Species differences in temporal control of behavior II: human performance

Human subjects responded on two panels. A differential-reinforcement-of-low-rate schedule with a limited-hold contingency operated on Panel A. In Condition 1, responses on Panel B produced a stimulus on the panel that signalled whether reinforcement was available on Panel A. In Condition 2, responses on Panel B briefly illuminated a digital clock. In both conditions, performance on Panel A was very efficient; with few exceptions, Panel A was pressed only when reinforcement was available. Thus, in effect, a fixed-interval schedule operated on Panel B. In Condition 1, a “break-and-run” response pattern occurred on Panel B; with increasing temporal parameters, the duration of the postreinforcement pause on Panel B increased linearly while overall response rate and running rate (calculated by excluding the postreinforcement pauses) remained approximately constant. In Condition 2, the response pattern on Panel B was scalloped; the postreinforcement pause was a negatively accelerated increasing function of schedule value, while overall response rate and running rate were negatively accelerated decreasing functions of schedule value. The performance of subjects in Condition 2, but not in Condition 1, was highly sensitive to the contingencies in operation, and resembled that of other species on the fixed-interval schedule.     

The need to reform our assessment of evidence from clinical trials: A commentary

The ideology of evidence-base medicine (EBM) has dramatically altered the way we think, conceptualize, philosophize and practice medicine. One of its major pillars is the appraisal and classification of evidence. Although important and beneficial, this process currently lacks detail and is in need of reform. In particular, it largely focuses on three key dimensions (design, [type I] alpha error and beta [type II] error) to grade the quality of evidence and often omits other crucial aspects of evidence such as biological plausibility, reproducibility, generalizability, temporality, consistency and coherence. It also over-values the randomized trial and meta-analytical techniques, discounts the biasing effect of single centre execution and gives insufficient weight to large and detailed observational studies. Unless these aspects are progressively included into systems for grading, evaluating and classifying evidence and duly empirically assessed (according to the EBM paradigm), the EBM process and movement will remain open to criticism of being more evidence-biased than evidence-based.