Health literacy, health inequality and a just healthcare system

Limited health literacy is a pervasive and independent risk factor for poor health outcomes. Despite decades of reports exhibiting that the healthcare system is overly complex, unneeded complexity remains commonplace and endangers the lives of patients, especially those with limited health literacy. In this article, we define health literacy and describe the empirical evidence associating health literacy and poor health outcomes. We recast the issue of poor health literacy from within the ethical perspective of the least well-off and argue that poor health outcomes deriving from limited health literacy ought to be understood as a fundamental injustice of the healthcare system. We offer three proposals that attempt to rectify this injustice, including: universal precautions that presume limited health literacy for all healthcare users; expanded use of technology supported communication; and clinical incentives that account for limited health literacy.     

Crime behaviours and distance travelled in homicides and rapes

We explored (1) distances between home and offence in homicides and rapes; (2) whether these distances differed from each other; and (3) whether offence features were associated with distances. The sample consisted of solved homicides (N = 40) and rapes (N = 37) from Finland with co‐ordinates for offence and offender home locations and information on crime features. Empirical models of incident density as a function of distance were estimated using CrimeStat III (Levine, 2004). Most of the distances were short displaying distance decay. Homicide median distance was 0.85km (Inter Quartile Range (IQR) = 0.13–7.69km) and rape median distance 2.44km (IQR = 0.83–6.96km) from perpetrators' home location. These distances differed significantly (Mann‐Whitney U = 543.0, p < 0.045). It was possible to identify crime features that were correlated with distances in both offence types. Spatial Behaviour Indices combining crime feature information correlated r_s = 0.77 with distance in homicides and r_s = 0.72 in rapes. Identifying theoretical constructs for understanding links between different crime features instead of looking at them in isolation is important. Copyright © 2007 John Wiley & Sons, Ltd.     

Moral Integrity and Academic Research

This paper focuses on some moral issues in academic journal publishing, from the standpoints of Publishers, editors, referees and authors.     

Measuring preschool cognitive growth while it's still happening: The Learning Express

Educators need accurate assessments of preschool cognitive growth to guide curriculum design, evaluation, and timely modification of their instructional programs. But available tests do not provide content breadth or growth sensitivity over brief intervals. This article details evidence for a multiform, multiscale test criterion-referenced to national standards for alphabet knowledge, vocabulary, listening comprehension and mathematics, developed in field trials with 3433 3–5¹/₂-year-old Head Start children. The test enables repeated assessments (20–30 min per time point) over a school year. Each subscale is calibrated to yield scaled scores based on item response theory and Bayesian estimation of ability. Multilevel modeling shows that nearly all score variation is associated with child performance rather than examiner performance and individual growth-curve modeling demonstrates the high sensitivity of scores to child growth, controlled for age, sex, prior schooling, and language and special needs status.     

The Findings of a Cochrane Meta-Analysis of Couple Therapy in Adult Depression: Implications for Research and Clinical Practice

The association between depressive symptoms and distressed intimate relationships supported the assumption that couple therapy, by focusing on the interpersonal context of depression, might be more effective as a treatment for depression than individual psychotherapy or drug therapy. This issue was addressed by a Cochrane meta-analysis assessing the evidence from clinical trials of couple therapy for depression in comparison with individual psychotherapy, drug therapy, and no/minimal intervention, including fourteen studies with 651 participants. No study was found free of bias and the quality of the evidence was low, with major problems of small sample sizes, missing outcome data, selective reporting, lack of information on random sequence generation and allocation concealment, recruitment of people not representative of clinical practice, and allegiance bias. The meta-analysis showed that both couple therapy and individual psychotherapy improved depressive symptoms at end of treatment and after 6 months or longer, with moderate effect sizes, without any difference between the two treatments. Couple therapy was more effective in reducing couple distress. This effect was larger in studies with distressed couples only and should be considered as relevant in its own right. Couple therapy is a viable option for the treatment of a depressed partner, especially in discordant couples. Future research should address several issues left open to provide a sound empirical foundation for clinical practice.     

Effect of naloxone pretreatment on habituation in the crab Chasmagnathus granulatus

On sudden presentation of a passing shadow, the crab Chasmagnathus granulatus reacts with an escape response that habituates after repeating the same stimulus. In a first series of experiments, a range of naloxone (NX) doses (0.8, 2.4, 3.2, and 6.2 micrograms/g) was injected into crabs 15 min before one 15-trial habituation session. An enhancing effect of 3.2 micrograms NX/g on responsiveness appeared over trials, that cannot be explained either by a ceiling effect or by a delay in peak drug action. Two doses below 3.2 microgram/g and one dose above had no significant effect. Results from a second series of experiments showed that the 3.2 microgram NX/g effect vanishes after 15 trials (1 h after injection). The hypothesis that crab's habituation involves the action of an endogenous opioid mechanism is put forward to account for the naloxone pretreatment effect.     

Perceptions of counsellor effectiveness: A study of two country groups

The perceptions of United States' (US) and Singaporean college students on directive and nondirective counselling approaches were examined. A total of 103 Singaporean students, studying in Canada and the US, and 108 US students participated in the study. Simulated counselling interviews of the two approaches were presented to students through videotapes. After watching the counselling sessions, students rated the counsellor with the Counsellor Effectiveness Rating Scale; they also were asked to write comments about the counselling session. A multivariate analysis yielded a two-way interaction effect by country of origin. Counsellor expertise was rated significantly higher by Singaporean students observing the nondirective style, while US students rated the directive style higher. Qualitative responses from students were also examined. Implications are discussed.     

The Role of Philosophy in Academic Ethics

This paper seeks to provide some of the roles of philosophy in the field of academic ethics.     

Forgetting Trauma: Socially Shared Retrieval‐induced Forgetting and Post‐traumatic Stress Disorder

Memory for related but unpracticed aspects of an event can be impaired by selectively retrieving parts of the same event. This occurs when selective retrieval [within‐individual retrieval‐induced forgetting (WI‐RIF)] is undertaken by individuals and has been extended to social contexts—RIF can be produced in listeners [socially shared retrieval‐induced forgetting (SS‐RIF)] by a speaker's selective recounting. The effects of post‐traumatic stress disorder (PTSD) on WI‐RIF and SS‐RIF were examined by two experiments. In Experiment 1, combat veterans (with or without PTSD) and non‐veteran dyads participated in a RIF paired‐associates paradigm adapted for combat‐related stimuli. WI‐RIF and SS‐RIF occurred for combat‐related and neutral pairs regardless of group. However, greater WI‐RIF and SS‐RIF for combat‐related words were shown by individuals with PTSD. These findings were replicated by Experiment 2, in which either a combat‐related or neutral story was learned by participants, and selective retrieval was embedded in a conversation. That the selective retrieval of trauma‐related stimuli leads to enhancement of induced forgetting for individuals with PTSD under certain conditions is suggested by these data. Copyright © 2011 John Wiley & Sons, Ltd.