The role of stressful life events on the cortisol reactivity patterns of breast cancer survivors

Objective: Atypical patterns of cortisol secretion following an acute stressor have been commonly reported in breast cancer survivors. Stressful life events have been associated with blunted acute cortisol levels in other populations. The purpose of this study was to explore the role of stressful life events on cortisol secretion patterns of breast cancer survivors following an acute stressor.

Design: The Trier Social Stress (TSST) was used to elicit a moderate stress response in breast cancer survivors (n = 19) and a control group (n = 17). Saliva samples were collected before, during and after the TSST to provide cortisol concentrations. During recovery, we recorded the frequency and subjective impact of stressful life events in the past year using the Life Experience Survey.

Results: Simple regressions analyses were performed; results suggest no group differences between the total number of stressful life events and their subjective impact. However, the total number of stressful life events as well as their subjective impact correlated negatively with the peak cortisol concentration in breast cancer survivors.

Conclusions: The cumulative effect of stressful life events, positive and negative, may impact the endocrine stress system of breast cancer survivors more so than that of women with no history of cancer.     

Perceptions of Stress,Coping, and Intervention Preferences among Caregivers of Disadvantaged Children with Asthma

Asthma remains the most prevalent chronic illness among children. Despite the substantial body of literature examining children with asthma, few studies have examined parents’ perspectives of the condition and experiences of caregiver stress. Parents of children with chronic illnesses experience elevated stress and may have limited opportunities to cope with complex emotions while caring for children with asthma. Drawing from focus groups and interviews with African American and Hispanic parents of children with asthma, this qualitative study was conducted as part of a patient-centered engagement process to inform the refinement of an intervention aimed at reducing stress among parents of children with asthma. All data were transcribed and underwent three waves of inductive analysis. The content analysis indicated that the unpredictable nature of asthma and the caregiving burden associated with managing children’s asthma contributed to parents’ stress, and external contexts compounded the impact of these stressors. Parents also reported having difficulty identifying how they coped with stress and employed approaches to coping with stress that they applied intermittently but encountered several barriers to enacting known or available coping strategies. Analyses also revealed that parents desired a multimodal stress reduction intervention that emphasized building relationships, allowed for flexibility, and encouraged staff-parent communication. Whereas African American and Hispanic parents’ experiences of stress and coping strategies were similar, their preferences differed in regards to incorporating technology into the intervention, the credentials of facilitators, and the salience of language preferences. Understanding the complexities of stressors facing caregivers is important for developing interventions to support parents and children coping with asthma, and in particular when working with families from diverse backgrounds.     

Opting out or denying discrimination? How the framework of free choice in American society influences perceptions of gender inequality

American women still confront workplace barriers (e.g., bias against mothers, inflexible policies) that hinder their advancement at the upper levels of organizations. However, most Americans fail to recognize that such gender barriers still exist. Focusing on mothers who have left the workforce, we propose that the prevalent American assumption that actions are a product of choice conceals workplace barriers by communicating that opportunities are equal and that behavior is free from contextual influence. Study 1 reveals that stay-at-home mothers who view their own workplace departure as an individual choice experience greater well-being but less often recognize workplace barriers and discrimination as a source of inequality than do mothers who do not view their workplace departure as an individual choice. Study 2 shows that merely exposing participants to a message that frames actions in terms of individual choice increases participants' belief that society provides equal opportunities and that gender discrimination no longer exists. By concealing the barriers that women still face in the workplace, this choice framework may hinder women's long-term advancement in society.     

Rats are sensitive to ambiguity

In the present study, we investigated response decisions made under conditions of incomplete information in rats. In Experiment 1, rats were trained on either a positive patterning (PP; A-, B-, AB+) or a negative patterning (NP; A+, B+, AB-) instrumental lever-press discrimination. Subjects that had learned an NP discrimination responded less to Cue A when Cue B was covered at test. The cover did not, however, affect test responses to Cue A in the PP condition. In Experiment 2, rats received concurrent training on both PP and NP discriminations. After concurrent training, responses to Cue A were different with B covered versus uncovered for both NP and PP discriminations. We discuss possible accounts for why exposure to a nonlinearly soluble discrimination (NP) may have affected sensitivity to cue ambiguity produced by the cover. These results have interesting implications for representational processes engaged in problem solving.     

Public Health Ethics Education in a Competency-Based Curriculum: A Method of Programmatic Assessment

Public health ethics began to emerge in the 1990s as a development within bioethics. Public health ethics education has been implemented in schools of public health in recent years, and specific professionalism and ethics competencies were included in the Master of Public Health (MPH) competency set developed nationally and adapted by individual schools of public health around the country. The University of Texas School of Public Health approved the present set of MPH competencies in 2005. After 4 years of experience, we now report information measuring the extent to which “Professionalism and Ethics” competencies and subcompetencies are being met in the MPH degree program. To this end we have audited the MPH “Professionalism and Ethics” competency forms for FY2009 MPH graduates (n = 61). Eight courses, including required MPH core courses plus the practicum and culminating experience, were found to have substantial professionalism and ethics content. Further, 67.2% of graduates met eight or more of the 13 competencies and subcompetencies, but only 36.1% met all thirteen, indicating a need to identify topic areas to be added to, or enhanced in, the MPH curriculum. In addition, these findings will inform ongoing efforts to enhance ethics education in our health science center. Assessment of these competencies and subcompetencies is an essential step in strengthening ethics education at our institutions and in better preparing our graduates for a challenging future. We report our efforts here to demonstrate one way of carrying out programmatic assessment of ethics education in a school of public health.     

Bilingual Therapeutics: Integrating the Complementary Perspectives and Practices of Motivational Interviewing and Dialectical Behavior Therapy

Informed by the practice of code-switching or style-switching in linguistics, “bilingual therapeutics” is proposed as the complementary integration of two evidence-based practices in psychotherapy: motivational interviewing (MI) and dialectical behavior therapy (DBT). Unique features of MI and DBT are presented, current research of each practice is reviewed, and their similarities and distinctions are discussed. It is proposed that fluency in both “languages” of MI and DBT may usher in a new therapeutic perspective to enhance client case conceptualization, illuminate subtleties of the therapeutic process, and foster more intentional and deliberate practitioners. Specifically, MI and DBT code-switching may help recruit and retain clients in formal treatment (e.g.,”speaking” MI more prominently to prepare clients for 12-month standard DBT) and promote consultation among therapists. The complementary integration of MI and DBT also suggests the emergence of a linguistic “third space,” including “spirit as synthesis” and “improvisational dance.”     

Wittgenstein's Philosophical Grammar: A Neglected Discussion of Vagueness

In this paper I explore a neglected discussion of vagueness put forward by Wittgenstein in his Philosophical Grammar (1932–34). In this work, unlike Philosophical Investigations (1953), Wittgenstein not only discusses the venerable Sorites paradox but provides a novel conception of vagueness using an analogy with coin tossing and converging intervals. As he sees it, the problematic picture of vagueness arises because we conflate aspects of the functioning of vague concepts with those of non‐vague ones. Thus, while we accept that vague concepts have no sharp cut‐off points (are boundaryless), we nevertheless retain the idea that we can progress towards the penumbra the way we progress towards the cut‐off points of non‐vague concepts. As a potential remedy, Wittgenstein's analogy with coin tossing and converging intervals replaces this picture and provides an understanding of the functioning of vague concepts in which no notion of a progression arises.     

International stem cell tourism and the need for effective regulation. Part II: Developing sound oversight measures and effective patient support

Part I of this article, published in the March 2010 issue of the Kennedy Institute of Ethics Journal, traces and addresses the provision of unproven stem cell treatments in Russia and India, examines the concept of innovative treatment, and concludes that stronger regulations are needed to protect the health and informed choices of patients. The current paper, Part II, proposes that the regulatory frameworks for the development of safe and efficacious treatments in effect in the United States and the United Kingdom provide examples of strong oversight measures from which countries seeking to obtain international credibility for their biotechnological competence could draw when developing regulations for stem cell treatments. Major sources of information available to persons who consider receiving such unproven treatments are explored in order to understand and address their concerns. The paper concludes with proposed measures to inform those considering the pursuit of unproven stem cell treatments abroad more accurately about their efficacy and safety and provide them with improved medical and social support in their home countries.