Informed Consent Revisited: Japan and the U.S.

Informed consent, decision-making styles and the role of patient–physician relationships are imperative aspects of clinical medicine worldwide. We present the case of a 74-year-old woman afflicted with advanced liver cancer whose attending physician, per request of the family, did not inform her of her true diagnosis. In our analysis, we explore the differences in informed-consent styles between patients who hold an “independent” and “interdependent” construal of the self and then highlight the possible implications maintained by this position in the context of international clinical ethics. Finally, we discuss the need to reassess informed-consent styles suitable to the needs of each patient regardless of whether he or she resides in the United States or in Japan.     

Treatment of posttraumatic stress disorder in U.S. combat veterans: a meta-analytic review

Among U.S. veterans who have been exposed to combat-related trauma, significantly elevated rates of posttraumatic stress disorder (PTSD) are reported. Veterans with PTSD are treated for the disorder at Veterans Affairs (VA) hospitals through a variety of psychotherapeutic interventions. Given the significant impairment associated with PTSD, it is imperative to assess the typical treatment response associated with these interventions. 24 studies with a total sample size of 1742 participants were quantitatively reviewed. Overall, analyses showed a medium between-groups effect size for active treatments compared to control conditions. Thus, the average VA-treated patient fared better than 66% of patients in control conditions. VA treatments incorporating exposure-based interventions showed the highest within-group effect size. Effect sizes were not moderated by treatment dose, sample size, or publication year. Findings are encouraging for treatment seekers for combat-related PTSD in VA settings.     

Gun culture and symbolism among U.K. and U.S. women

The authors explored attitudes of young women in the United Kingdom (n = 108) and the United States (n = 91) toward (a) the possession and use of guns through the Attitude to Guns Scale (N. R. Branscombe, J. A. Weir, & P. Crosby, 1992) and (b) guns' perceived functional and symbolic significance through the Symbolic Nature of Guns Scale (C. A. Cooke & J. E. Puddifoot, 1997). There were significant differences in beliefs concerning the right to own a gun and the protective effect of guns but not in the perceived contribution of guns to crime. Although neither group strongly equated guns symbolically with power or control, the U.S. women were more likely to perceive guns as expressions of freedom or independence, and the U.K. women were more likely to view guns as expressions of danger and violence. The findings were contextualized by comparison with samples of male control participants of similar ages.     

Tipping Motivations and Behavior in the U.S. and Israel

Tipping is a multibillion dollar phenomenon and a major source of income for millions of workers. The results of a study conducted in the U.S. and Israel suggest that people tip mainly to show gratitude, conform to the social norm, and because they know that waiters' income depends on tips. Tipping is motivated more by the positive consequences of tipping than by the negative results of not tipping. Patronage frequency and dining alone had no systematic effects on the level of tips or their sensitivity to service quality. Respondents reported tipping much more for excellent service than for poor service, suggesting that tipping can provide significant incentives for high‐quality service. A large majority prefers tipping to service charges.     

Gun Culture and Symbolism Among U.K. and U.S. Women

Abstract

The authors explored attitudes of young women in the United Kingdom (n = 108) and the United States (n = 91) toward (a) the possession and use of guns through the Attitude to Guns Scale (N. R. Branscombe, J. A. Weir, & P. Crosby, 1992) and (b) guns' perceived functional and symbolic significance through the Symbolic Nature of Guns Scale (C. A. Cooke & J. E. Puddifoot, 1997). There were significant differences in beliefs concerning the right to own a gun and the protective effect of guns but not in the perceived contribution of guns to crime. Although neither group strongly equated guns symbolically with power or control, the U.S. women were more likely to perceive guns as expressions of freedom or independence, and the U.K. women were more likely to view guns as expressions of danger and violence. The findings were contextualized by comparison with samples of male control participants of similar ages.     

The Gender Difference in the Association Between Early Onset of Drinking and Problem Drinking Between the U.S. and Japan

Using comparable survey data from the GENACIS Project, collected from representative samples of people aged 20 to 70 years old in the U.S. (n = 2,598) and Japan (n = 1,734), this study examined, across these two diverse societies, the gender difference in the association between the early onset of drinking and the development of drinking problems. The results of this study suggest that there does not appear to be a cross-national causal relationship between the early onset of drinking and problem drinking because of significant country and gender variations in this association and because there is no association found among Japanese females. As hypothesized, the early onset of drinking predicted problem drinking among males more strongly than among females in both countries.     

Informed consent revisited: Japan and the U.S

Informed consent, decision-making styles and the role of patient-physician relationships are imperative aspects of clinical medicine worldwide. We present the case of a 74-year-old woman afflicted with advanced liver cancer whose attending physician, per request of the family, did not inform her of her true diagnosis. In our analysis, we explore the differences in informed-consent styles between patients who hold an "independent" and "interdependent" construal of the self and then highlight the possible implications maintained by this position in the context of international clinical ethics. Finally, we discuss the need to reassess informed-consent styles suitable to the needs of each patient regardless of whether he or she resides in the United States or in Japan.     

Clinical ethics and the suffering Christian.

Contrary to the ecumenical spirit of our time, the differences among the Christian religions bring into question what one can say or do in common with fellow Christians. This issue, echoing the program of this journal, accentuates those differences, specifically when we focus on the Christian who is ill and suffering. At the bedside, it is the specifics of a religion, including not only its doctrines, but its informing and sustaining narratives, that must particularly be brought into play for the sake of the patient. Given this, our focus in this article regards what such a view implies for the clinician who is caring for a Christian patient whose religion he may or may not share, in general or in its specifics. Our basic conclusion is that the tendency for the clinician to act as both the patient's spiritual counselor, as well as his clinician, is generally neither prudent nor appropriate. Both hats should not be worn concurrently. This view is advanced not only because of concerns regarding patient vulnerability and the possible abuse of power, but also because the two roles may collide with or undermine each other.     

Parents as Partners: A U.K. Trial of a U.S. Couples‐Based Parenting Intervention For At‐Risk Low‐Income Families

Despite the well‐established links between couple relationship quality and healthy family functioning, and burgeoning evidence from the international intervention field, there is little or no evidence of the efficacy of couples‐based interventions from the United Kingdom (U.K.). This study explored whether the Parents as Partners (PasP) program, a group‐based intervention developed in the United States, brought about the same benefits in the U.K. The evaluation is based on 97 couples with children from communities with high levels of need, recruited to PasP because they are at high risk for parent and child psychopathology. Both mothers and fathers completed self‐report questionnaires assessing parents’ psychological distress, parenting stress, couple relationship quality and conflict, fathers’ involvement in child care and, importantly, children's adjustment. Multilevel modeling analysis comparing parents’ responses pre‐ and postintervention not only showed substantial improvements for both parents on multiple measures of couple relationship quality, but also improvements in parent and child psychopathology. Analyses also indicated most substantial benefits for couples displaying poorest functioning at baseline. The findings provide initial evidence for the successful implementation of PasP, an American‐origin program, in the U.K., and add support for the concept of the couple relationship as a resource by which to strengthen families.     

Detecting Potential Underreporting of Suicide Ideation Among U.S. Military Personnel

Using a military sample comprised largely of National Guard personnel, zero‐inflation negative binomial regression was applied to estimate the effects of indirect, nonface valid indicators of suicide ideation [Thwarted Belongingness (TB), Perceived Burdensomeness (PB), and Hopelessness], in predicting suicide ideation. Data from a sample of 497 military personnel (82.1% male; m_age = 27.24; range = 18–59) were analyzed. TB and the interaction of TB with Hopelessness were significant predictors in the logistic regression, and in the negative binomial regression, the main effects of TB and hopelessness, and the interactions of TB with hopelessness and PB with hopelessness were significant. The findings further indicated that approximately 10% of those not reporting ideation would be predicted to be ideators. Clinically, these results indicate that, in samples reluctant to report ideation, the assessment of suicide risk may improve through the use of relevant measures that do not explicitly reference suicide thoughts.     

Family-Friendly Environments and U.S. Army Soldier Performance and Work Outcomes

This study examined how perceptions of a family-friendly environment relate to physical fitness, efficacy beliefs, and intentions to remain in the military. Survey data and actual performance measures from 230 U.S. Army soldiers were examined. Findings indicated that a perceived family-friendly environment was positively related to intentions to remain in the military upon fulfillment of obligation. Additionally, perceptions of family-friendly environments were positively related to collective efficacy perceptions. These findings provide strong support for the need to create and maintain a strong family-friendly work environment, not only to improve the well-being of employees but also to benefit the organization's retention efforts, obtained from employees being more willing to remain with the organization.     

Euthanasia in psychiatry can never be justified. A reply to Wijsbek

In a recent article, Henri Wijsbek discusses the 1991 Chabot “psychiatric euthanasia” case in the Netherlands, and argues that Chabot was justified in helping his patient to die. Dutch legislation at the time permitted physician assisted suicide when the patient’s condition is severe, hopeless, and unbearable. The Dutch Supreme Court agreed with Chabot that the patient met these criteria because of her justified depression, even though she was somatically healthy. Wijsbek argues that in this case, the patient’s integrity had been undermined by recent events, and that this is the basis for taking her request seriously; it was unreasonable to expect that she could start again. In this paper, I do not challenge the Dutch euthanasia criteria in the case of somatic illness, but I argue that both Chabot and Wijsbek are wrong because we can never be sufficiently confident in cases of severe exogenous depression to assist the patient in her irreversible act. This is partly because of the essential difference between somatic and mental illness, and because of the possibility of therapy and other help. In addition, I argue that Wijsbek’s concept of integrity cannot do the work that he expects of it. Finally, I consider a 2011 position paper from the Royal Dutch Medical Association on euthanasia, and the implications it might have for Chabot-style cases in the future.     

Prosocial orientation and COVID-19 vaccine willingness in the U.S.

Despite evidence of the safety and effectiveness of COVID-19 vaccines and their wide availability, many in the U.S. are not vaccinated. Research demonstrates that prosocial orientations predict COVID-19 health behaviors (e.g., social distancing) and vaccination intentions, however, little work has examined COVID-19 vaccination willingness in the U.S. since vaccines were approved. Findings from two U.S. samples show that, in contrast to other COVID-19 health behaviors, vaccine willingness in unvaccinated people is unrelated to prosocial orientation. Study 2 demonstrates that the lack of association between vaccine willingness and prosocial orientation in unvaccinated participants was specific to those with stronger beliefs that COVID-19 vaccines are ineffective. Thus, in prosocial people, perceptions of vaccines' ineffectiveness may undermine COVID-19 vaccine willingness.     

Attitudes toward suicide: a comparison of Canadian and U.S. college students

The Suicide Opinion Questionnaire (SOQ) was administered to two samples (n = 100 each) of college students, one from Canada and one from the United States. A multivariate analysis of variance indicated substantial intergroup differences, but no sex differences. Univariate analyses indicated significant differences on 8 of the 15 SOQ factors, suggesting that Canadian college students perceive suicide as part of everyday life, not to be explained by recourse to religious, personality, or psychopathological constructs. The results are discussed in terms of six themes present in the suicide literature: motivation, acceptability, religion, impulsivity, recidivism, and misconceptions. Speculation is also provided regarding why such differences (despite considerable similarities) might exist.     

Social Support and Mental Health Outcomes Among U.S. Army Special Operations Personnel

Mental health disorders continue to plague service members and veterans; thus, new approaches are required to help address such outcomes. The identification of risk and resilience factors for these disorders in specific populations can better inform both treatment and prevention strategies. This study focuses on a unique population of U.S. Army Special Operations personnel to assess how specific avenues of social support and personal morale are related to mental health outcomes. The results indicate that, whereas personal morale and friend support reduce the relationship between combat experiences and posttraumatic stress disorder (PTSD), strong unit support exacerbates the negative effects of combat experiences in relation to PTSD. The study thus shows that although informal social support can lessen postdeployment mental health concerns, military populations with strong internal bonds may be at greater risk of PTSD because the support that they receive from fellow service members may heighten the traumatic impact of combat experiences.     

Taking the U.S. Patent Office Criteria Seriously: A Quantitative Three-Criterion Creativity Definition and Its Implications

Although creativity has recently attracted considerable theoretical and empirical research, researchers have yet to reach a consensus on how best to define the phenomenon. To help establish a consensus, a definition is proposed that is based on the three criteria used by the United States Patent Office to evaluate applications for patent protection. The modified version uses the criteria of novelty, utility, and surprise. Moreover, creativity assessments based on these three criteria are quantitative and multiplicative rather than qualitative or additive. This three-criterion definition then leads to four implications regarding (a) the limitations to domain-specific expertise, (b) the varieties of comparable creativities, (c) the contrast between subjective and objective evaluations, and (d) the place of blind variation and selective retention in the creative process. These implications prove that adding the third criterion has critical consequences for understanding the phenomenon. Creativity is not only treated with superior sophistication, but also paradoxes that appear using the most common two-criterion definition readily disappear when the third criterion is included in the analysis. Hence, the conceptual differences between two- and three-criterion definitions are not trivial.     

Education and Career Aspirations of Palestinian and U.S. Youth

Abstract

Belief in free will or determinism is related to attitudes toward punishment and to locus of control. The relationships remain ambiguous, however, perhaps because the belief has been viewed historically as a unidimensional construct. The responses of 507 American undergraduates to a free will-determinism questionnaire established the existence of two types of deterministic belief—psychosocial and religious-philosophical—and a separate, independent belief in libertarianism. Beliefs about punishment were multidimensional, consisting of attitudes toward punitiveness and rehabilitation. Respondents with higher scores on psychosocial or religious-philosophical determinism or libertarianism were more punitive than those with lower scores. High scores on either type of determinism were associated with more external locus of control scores. Respondents who rated the free will-determinism items for themselves and those who rated them for people in general differed on a number of dependent measures.     

Review Of The War Between Mentalism and Behaviorism: On the Accessibility of Mental Processes By William R. Utall.

Uttal's goals in writing this book are (a) to demonstrate that the war between mentalism and behaviorism is unwinnable because both sides are fundamentally flawed and (b) to describe a new version of behaviorism that resolves the conflict. The book is generally well written and contains many interesting and important points, but the goals are not attained because of weaknesses in some of the crucial analyses. For example, key terms such as mind and behavior are not defined; the scientific admissibility of inference is denied for philosophical reasons that are not relevant to inference as actually used; the accessibility of mind is both explicitly denied and implicitly assumed; two kinds of reductionism—between and within domains—are acknowledged but the distinction is not consistently maintained; and the proposed new behaviorism ignores rather than solves the old problems.     

Relationship between gender and knowledge of U.S. state names and locations

Two experiments were conducted to assess gender differences in knowledge of U.S. state names and locations. Subjects for both experiments were drawn from a population that was approximately 95% Caucasian, 2% Native American, 1% Black, 1% Asian, and 1% Hispanic. Experiment 1 demonstrated superior male performance with respect to ability to correctly label state outlines on a blank map. Providing subjects with a list of state names (as a recall aid) resulted in performance deficits that were of equivalent magnitude for both males and females. It is suggested that this may have changed subjects' labeling strategy. Experiment 2, which assessed ability to list state names, showed no gender differences and no effect for providing a blank map (as a recall aid). Therefore, the performance differences obtained in Experiment 1 appear mediated by a gender difference in geographical knowledge and not by a gender difference in knowledge of state names. Implications of geographical knowledge deficits are briefly discussed.     

临床肿瘤治疗决策的思考

肿瘤是一种全身性疾病,虽表现为局部的肿块,但其实质是全身免疫功能受损导致某些组织失去控制的异常生长,机体内部由于肿瘤的生长而发生了许多改变。肿瘤治疗的目的在于延长患者生存时间,即与疾病共生存。肿瘤并发症的治疗和术后肿瘤复发或再生的预防在改善生存方面发挥着重要作用。严格的技术准入和规范化治疗是提高治疗效果的保证。