A longitudinal study of the psychosocial impact of stroke on primary support persons

We investigated longitudinally the effects of a stroke on the social support systems and well-being of the patient's primary support person, both acutely and as the condition stabilized. Individuals who had suffered a first stroke and a primary support person participated in two waves of data collection, carried out in 6-month intervals beginning 7 weeks after the stroke. Our data show that the prevalence of depressive symptoms is from 2 1/2 to 3 1/2 times higher than rates found among representative samples of middle-aged and elderly populations. Mean level of depression did not change over time, although level of optimism declined significantly. Multiple regression analyses showed that levels of depression and perceived burden in support persons are highly related to aspects of the stroke such as its severity, and that demographic variables such as age and income play a relatively minor role in attenuating these relations in the acute adjustment phase. However, from 7 to 9 months after the stroke, well-established demographic variables such as health, income, and age were significant predictors of depression. Individuals who were older and who had good health and higher incomes were least depressed.     

Cognitive monitoring and strategy choice in younger and older adults

Younger (24- to 39-year-old) and older (60- to 88-year-old) adults learned a list of vocabulary words; one half of the words were studied using a generally more powerful strategy (mnemonic keyword method), and one half mediated with a less powerful approach (generating semantic contexts). Before using these strategies as part of the experiment, neither younger nor older adults judged that the keyword method was more effective and neither group preferred one strategy over the other. After using the strategies and taking a test of strategically studied unfamiliar vocabulary words, the younger subjects reported accurately the relative effectiveness of the two strategies and selected the one that had worked better for them to apply to a subsequent list of vocabulary items. The older participants were not as aware of the differential potency of the strategies and did not rely as much as did the younger subjects on knowledge of strategy utility in making strategy choices. In short, metacognitive awareness of strategy effects produced by monitoring and use of metacognitive awareness in regulating strategy choice were more pronounced in the younger compared with the older sample in this study.     

Remarriage as a coping response for widowhood

Consideration and use of remarriage as a response to cope with the death of a husband was examined in 39 women who had been widowed and had subsequently remarried, 192 widows who had considered remarriage but had not yet remarried, and 420 widows who had not considered remarriage. Controlling for age, we found that women who had remarried reported fewer current concerns than did the other two groups. Furthermore, we found that women who retrospectively recalled the most concerns immediately after the death of the spouse were the ones who eventually remarried. The remarried group believed that they were experiencing significantly fewer concerns now than they had after the spouse's death; the women who had not considered remarriage believed that they were experiencing the same number of concerns now as before; and those women who had considered remarriage believed that they were experiencing significantly more concerns. Implications for remarriage as a coping mechanism for widowhood and the relation of age to remarriage decisions are discussed.     

Professional liability (malpractice) coverage of humanist scholars functioning as clinical medical ethicists

In contrast to theoretical discussions about potential professional liability of clinical ethicists, this report gives the results of empirical data gathered in a national survey of clinical medical ethicists. The report assesses the types of activities of clinical ethicists, the extent and types of their professional liability coverage, and the influence that concerns about legal liability has on how they function as clinical ethicists. In addition demographic data on age, sex, educational background, etc. are reported. The results show that while nearly one third (28.9%) of the ethicists regularly make recommendations about patient care, only 10.8% of them regularly make entries in the medical record; only approximately half (53.0%) of them are covered by professional liability (malpractice) insurance; and the vast majority (84.3%) of them say that concerns about legal liability do not influence the way they function as clinical ethicists.     

Beyond medical ethics: New directions for philosophy and medicine

A unique relationship exists between physicians and philosophers — one that expands on the constructive potential of the liaison between physicians and, for example, theologians, on the one hand, or, social workers on the other. This liaison should focus in the scientific aspects of medicine, not just the ethical aspects. Philosophers can provide physicians with a perspective on both the philosophy and the history of medicine through the ages — a sense of how medicine has adapted to the social cultural and ethical needs of each period. This perspective, while emphasizing medicine asscience, should not be limited to matters of methodology, or to criteria for distinguishing science from other intellectual pursuits, but should be concerned also with the history, sociology and politics of science. Both physicians and philosophers stand to gain from a strengthening of their active liaison now as never before; but most of all, the public will be the beneficiary.     

Oh death,where is thy sting? Reflections on dealing with dying patients

This paper examines the reactions of physicians and other health-professionals when they become involved in decisions about the death of their patients. The way people understand the condition of death has a profound influence on attitudes towards death and dying issues. Four traditional views of death are explored. The problem that physicians have in helping patients die (be it by hastening death through pain control, assisting patients in suicide or by more active means) is analyzed. Physicians, in dealing with such patients, must be mindful of their own, and their patients beliefs as well as mindful of the community in which such dying takes place. They must try to reconcile these often divergent views but can neither paternalistically deny patients their rational will, hide themselves behind an appeal to the law or go against their own deeply held moral views. When such views cannot be reconciled, compassionate transfer to a more compatible physician may be necessary.     

A rapid and sensitive method for measuring the conditional emotional response II: On-the-baseline excitatory conditioning and extinction

The present study outlines a rapid and sensitive on-the-baseline conditional emotional response (CER) procedure. Using rats as the experimental subject, the method detects delay conditioning, incubation, extinction and spontaneous recovery. In addition, the method detects conditional responding using electric shock ranging from 0.23 to 0.50 mA as the unconditional stimulus. Because of its speed and sensitivity, the method shelters the subject from unnecessary long-term deprivation and pain.     

Using direct and indirect measures to study perception without awareness

Many studies directed at demonstrating perception without awareness have relied on the dissociation paradigm. Although the logic underlying this paradigm is relatively straightforward, definitive results have been elusive in the absence of any general consensus as to what constitutes an adequate measure of awareness. We propose an alternative approach that involves comparisons of the relative sensitivity of comparable direct and indirect indexes of perception. The only assumption required by the proposed approach is that the sensitivity of direct discriminations to relevant conscious information is greater than or equal to the sensitivity of comparable indirect discriminations. The proposed approach is illustrated through an evaluation of Avant and Thieman’s (1985) recent claim that an indirect measure of perception based on judgments of apparent visual duration provides a more sensitive indicator of perception than does a direct measure based on forced-choice recognition. Contrary to this claim, when direct and indirect indexes are measured under comparable conditions, an indirect measure based on judgments of perceived duration provides a less sensitive index of perceptual processing than do comparable direct measures. The proposed approach provides a general conceptual/methodological framework for using the dissociation paradigm in studies directed at establishing unconscious processes.