Lay concepts of health and illness from a developmental perspective

Abstract

The concepts of children, adolescents and their mothers with regard to different aspects of health and illness in general and five specific diseases were explored in this study. An exploration with fully standardised questions and open answers was subjected to a content analysis. A reliable rating system was developed to score the sophistication of the answers. The study included 99 Ss of the age groups 5, 8, 12 and 16 years, as well as 48 mothers of the children. Many children and adolescents were able to define health positively (well-being) and not merely as the absence of illness. The definition of illness in general was frequently composed of somatic symptoms and disorders, feeling poorly and things one would like to accomplish but can't. The causality explanations of illness in general were dominated by contagion. The concepts of the older children and the mothers were richer, more elaborated, less concrete and less action-oriented than those of the younger children. However, abstract formulations and complex aspects of illness were very rarely expressed. In addition, concepts regarding the characteristics (definition, symptoms, causality, treatment and prevention) of five diseases (cold, measles, heart infarction, cancer and AIDS) were measured. The pattern of results was strongly influenced by age. By and large, the development of most disease concepts was linear with significant differences between age groups. Conversely, within a given age group, significant differences were found in the cognitive level of disease characteristics, either with respect to the same disease or between different diseases (“horizontal shifts”).     

White Racial Identity and White Racial Consciousness: Similarities,Differences, and Recommendations

To dispel apparent confusion, White racial identity and White racial consciousness are described and contrasted in terms of theoretical conceptualization and measures used. It is recommended that priority be given to the validation of existing or new measurement instruments to provide a sound basis for future findings. Para disipar la confusión aparente, la identidad racial Bianca, y el conocimiento racial Blanco, se describen y son contrastados en términos de sus conceptos teóricos y las medidas empleadas. Se recomienda dar prioridad a la validación de instrumentos existentes o nuevos para proporcionar una base sólida para los deseubrimientos futuros.     

The Coronary Health Improvement Project (CHIP) for lowering weight and improving psychosocial health

This study extends previous research evaluating the association between the CHIP intervention, change in body weight, and change in psychological health. A randomized controlled health intervention study lasting 4 wk. was used with 348 participants from metropolitan Rockford, Illinois; ages ranged from 24 to 81 yr. Participants were assessed at baseline, 6 wk., and 6 mo. The Beck Depression Inventory (BDI) and three selected psychosocial measures from the SF-36 Health Survey were used. Significantly greater decreases in Body Mass Index (BMI) occurred after 6 wk. and 6 mo. follow-up for the intervention group compared with the control group, with greater decreases for participants in the overweight and obese categories. Significantly greater improvements were observed in BDI scores, role-emotional and social functioning, and mental health throughout follow-up for the intervention group. The greater the decrease in BMI through 6 wk., the better the chance of improved BDI score, role-emotional score, social functioning score, and mental health score, with odds ratios of 1.3 to 1.9. Similar results occurred through 6 mo., except the mental health variable became nonsignificant. These results indicate that the CHIP intervention significantly improved psychological health for at least six months afterwards, in part through its influence on lowering BMI.     

The nature of intrusive memories after trauma: the warning signal hypothesis

Individuals who had experienced a range of different traumas were asked to describe the quality and content of their intrusive memories. Visual intrusions were the most common, and thoughts were uncommon. Intrusion quality varied little with type of trauma. Intrusive memories commonly consisted of stimuli that were present immediately before the traumatic event happened or shortly before the moments that had the largest emotional impact (i.e., when the meaning of the event became more traumatic). It is suggested that intrusive memories are about stimuli that through temporal association with the trauma acquired the status of warning signals, i.e., stimuli that if encountered again would indicate impending danger. This explains why intrusive memories are accompanied by a sense of serious current threat. The warning signal hypothesis may be useful in guiding therapists in identifying the moments with the largest emotional impact that will need reprocessing in treatment, and in educating patients about the nature of reexperiencing symptoms.     

Das Leugnen der Tat bei der Entscheidung über die Aussetzung der Reststrafe

The article is about the question whether or not a convicted person can be released on probation even though they are denying their offence. According to German Criminal Law, release on probation must be considered (by a special chamber of the court, “Chamber of Execution”; same question for any kind of Parole Board in other countries) in every case as soon as two thirds of the sentence are served, regardless the convicted person does or does not confess their offence. Using a case example, the article will show as to how the convict’s denial becomes a meaningful fact in the decision-making process. Besides referring to certain conclusions about criminal prognosis following from denying – which of course is a main issue with the decision about release, often valued by the help of expert testimony –, the focus will be set on the judicial framework around this question: Does the law give provisions on how to deal with denial, and how does the principle “nemo tenetur” (nobody has to charge themselves, harm their defence, nor give evidence against themselves) impact the considerations?     

Working models of attachment and reactions to different forms of caregiving from romantic partners

Inspired by attachment theory, the authors tested a series of theoretically derived predictions about connections between attachment working models (attachment to one's parents assessed by the Adult Attachment Interview; M. Main & R. Goldwyn, 1994) and the effectiveness of specific types of caregiving spontaneously displayed by dating partners during a stressful conflict-resolution discussion. Each partner first completed the Adult Attachment Interview. One week later, each couple was videotaped while they tried to resolve a current problem in their relationship. Trained observers then rated each interaction for the degree to which (a) emotional, instrumental, and physical caregiving behaviors were displayed; (b) care recipients appeared calmed by their partners' caregiving attempts; and (c) each partner appeared distressed during the discussion. Individuals who had more secure representations of their parents were rated as being more calmed if/when their partners provided greater emotional care, especially if they were rated as more distressed. Conversely, individuals who had more insecure (dismissive) representations of their parents reacted more favorably to instrumental caregiving behaviors from their partners, especially if they were more distressed. The broader theoretical implications of these findings are discussed.     

Contrasting roles for cingulate and orbitofrontal cortex in decisions and social behaviour

There is general acknowledgement that both the anterior cingulate and orbitofrontal cortex are implicated in reinforcement-guided decision making, and emotion and social behaviour. Despite the interest that these areas generate in both the cognitive neuroscience laboratory and the psychiatric clinic, ideas about the distinctive contributions made by each have only recently begun to emerge. This reflects an increasing understanding of the component processes that underlie reinforcement-guided decision making, such as the representation of reinforcement expectations, the exploration, updating and representation of action values, and the appreciation that choices are guided not just by the prospect of reward but also by the costs that action entails. Evidence is emerging to suggest that the anterior cingulate and orbitofrontal cortex make distinct contributions to each of these aspects of decision making.     

Developing operating principles for systems change

Based on an analysis of the articles in this special issue, the authors propose five operating principles for systems change work. These principles are: clarifying the purpose of the systems change; identifying whether the change is one to an existing system or the change is to create a new system; conceptualize the work as systems change from the beginning; use an eclectic approach; and be open to opportunities that emerge while also undertaking forma analysis to identify leverage points. The authors argue that the time is now ripe to develop such principles and encourage community change agents to engage in a dialogue to explore, revise, eliminate or expand on these principles.