Impact of Well-being Interventions for Siblings of Children and Young People with a Chronic Physical or Mental Health Condition: A Systematic Review and Meta-Analysis

Siblings of children and young people with a chronic illness are at increased risk of poor psychological functioning. A number of studies have attempted to implement and evaluate interventions targeting the psychological well-being of this at-risk group. This systematic review summarises the evidence regarding psychological functioning of siblings following an intervention targeting their well-being. The meta-analysis considered behaviour and knowledge, two of the most frequently studied outcomes. The following databases were used: PsycINFO, EMBASE, CINAHL, PubMed, Scopus and Web of Science. Seventeen studies were eligible to be included in the systematic review and eight in the meta-analysis. Results from the systematic review reflected the inconsistency of intervention evaluations in this area with a high level of heterogeneity and a total of 23 outcomes considered across the 17 included studies. The meta-analysis estimated effect sizes using a standardised mean difference (SMD) approach. Pre-post analysis suggested significant improvement in behavioural outcomes and knowledge of their sibling’s health conditions with a SMD of ? 0.44 [95% CI (? 0.6, ? 0.29); p = 0.000] and 0.69 [(95% CI = 0.42, 0.96); p = 0.000], respectively. The SMD was not significant for behavioural outcomes when considering treatment–control studies. In conclusion, the findings suggest interventions for well-being have a positive effect on the psychological functioning of siblings of children and young people with a chronic illness, but their specificity needs to be established. There is a need for further, more methodologically robust research in this area.     

Is Clinical Anxiety a Risk or a Protective Factor for Executive Functioning in Youth with ADHD? A Meta-regression Analysis

Comorbidity rates between ADHD and anxiety disorders (AD) are high, but little is known about the nature of this co-occurrence. A dominant idea is that AD may intensify some (i.e., attention and working memory) and attenuate other (i.e., inhibition) ADHD symptoms. Results are mixed, potentially because of between-study differences. To investigate this further we performed a meta-regression analysis on 11 studies (n ‘ADHD-only’ = 695; n ‘ADHD + AD’ = 608), containing 35 effect sizes on attention, inhibition and working memory. Main results were: (1) no evidence of a negative effect of AD on attention and working memory; (2) better response inhibition in children with ADHD with AD than those with only ADHD (medium ES g = ? .40); (3) medication moderated this association: the effect seemed limited to studies that included medication-naïve participants; (4) the difference between the two groups increased with age for attention and with proportion of boys for working memory ability. There was no effect of comorbid disruptive behavior disorder. In conclusion, AD seems to be a protective factor for inhibition problems as assessed with laboratory tasks in ADHD, especially in children who are medication naïve. Further, AD may have a protective function for attention in older children, and for working memory in boys with ADHD. It is therefore important to screen for AD when diagnosing ADHD, and to educate those with comorbid AD about the possible positive function of feeling anxious. Potential negative effects of ADHD medication on inhibition in children with comorbid AD should be considered.     

Presentism and the Notion of Existence

The aim of this paper is to make presentism a dynamic view of reality by basing it on a notion of dynamic existence, that is, on a notion of existence which has a dynamic character. The paper shows that both of the notions of existence which are used in metaphysical theories of time (in presentism and eternalism) have a static character and, while such a notion is useful for eternalists, it is useless for presentists if they want to make their view able to remain in agreement with our everyday experience and self-consistent. It is demonstrated that both empirical and theoretical arguments indicate that the presentist should replace the notion of this static existence with the notion of a dynamic existence and that this maneuver allows the presentist to treat his/her existential thesis as equivalent to the thesis that time flows. Not only does this strategy allow us to express presentism in a simple, homogenous way which remains in agreement with our experience, but also permits us to solve some of the difficult problems which presentism faces, such as, for example, the objection of triviality and the question about the rate of time passage. Moreover, such an approach to presentism allows us to solve fundamental metaphysical problems concerning time such as the problem of the openness of the future and the fixity of the past, direction of causation, and relations between presentism and persistence through time by endurance.     

Does Low Dose Ionizing Radiation Cause Cancer? The Interplay of Epistemology and Ethics in Radiation Protection

In order to investigate the relationship between scientific evidence and social commitments this article addresses three questions: (1) does low dose ionizing radiation cause cancer? (2) Is the answer to this question different in a social setting than in a scientific context? (3) What are the consequences of the answers of 1 and 2 for the relationship between epistemology and ethics as played out in radiation protection? Conceptual analysis with basis in the philosophy of science, in particular traditional theories of causality. Whether low dose ionizing radiation causes cancer deeply depends on what we mean by causality. According to traditional scientific conceptions of causality it is not warranted to say that low dose ionizing radiation causes cancer. Standard approaches in radiation protection, however, imply that there is a causal connection, which is due to the strong social commitment in the field. There is a close relationship between social and scientific conceptions of causality, posing a series of challenges: one being that scientists covertly become moral experts, another one that the general public can be misinformed. There is a difference between causality in science and in policy making. Mixing these conceptions, as sometimes is done in radiation protection, can be misleading. Whether low dose ionizing radiation causes cancer is a social and not only a scientific issue. As such those who are warranted to have a say.     

Science and Political Imperatives: Orders of Precedence

An ideal view is sketched of the relationship between the facts established in science and the values of ethics and politics, and of the distinction between them. Some necessary qualifications are drawn, which do not essentially undermine the ideal. Then two cases of scientific work are considered in which considerations of value may in different ways be playing a more intimate role in the science than the ideal would suggest. These are Darwin’s theory of evolution and the current consensus on climate change. Are any general lessons to be drawn from these cases?     

Higher-Level Perspectives and Ethics of Technoscience

New accents in the philosophy of technology and philosophy of science amounting, e.g., to the so-called schools of the “New Experimentalism”, “New Instrumentalism” and, recently, “New Mechanism” emphasize the impact of instruments, experiments, and “mechanisms” of the respective technologies opened up by the progress of ever-improving measuring instruments, procedures etc. In addition, it would be necessary to accentuate the process- and action-orientation including practical responsibility problems and dynamic systems models from an epistemological perspective of the methodological scheme-interpretationist approach developed by the author since the seventies of last century. The necessity of multi-disciplinary mutual influences was already time and again stressed regarding philosophy of science. But relatively new is not only the methodological turn involved but also the necessity to go to higher levels of abstraction, metatheories, action- and value-orientation. Therefore, we have to go more interdisciplinary, systems-oriented, and higher-level. That implies notable consequences for an ethics, or rather, meta-ethics for philosophy of science. Practice-oriented philosophers of (techno-)science will have to go more methodological, multidisciplinary and even (meta-)responsible.     

Freedom as Non-domination and Democratic Inclusion

According to neo-republicans, democracy is morally justified because it is among the prerequisites for freedom as non-domination. The claim that democracy secures freedom as non-domination needs to explain why democratic procedures contribute to non-domination and for whom democracy secures non-domination. This requires an account of why domination is countered by democratic procedures and an account of to whom domination is countered by access to democratic procedures. Neo-republican theory of democracy is based on a detailed discussion of the former but a scant discussion of the latter. We address this lacuna by interpreting the two most influential principles of inclusion, the all-subjected principle and the all-affected principle, in light of neo-republican commitments. The preliminary conclusion is that both principles are able to capture relations of domination between the democratic state and the people controlled by it in the relevant sense. Yet, the state has virtually unlimited powers to control residents, but only limited powers to interfere in the lives of non-residents. Republican aspirations are therefore more in tune with the all-subjected principle according to which only residents in the territory of the state should be granted rights to political participation.     

Molecular Tumor Boards: Ethical Issues in the New Era of Data Medicine

The practice and development of modern medicine requires large amounts of data, particularly in the domain of cancer. The future of personalized medicine lies neither with “genomic medicine” nor with “precision medicine”, but with “data medicine” (DM) (big data, data mining). The establishment of this DM has required far-reaching changes, to establish four essential elements connecting patients and doctors: biobanks, databases, bioinformatic platforms and genomic platforms. The “transformation” of scientific research areas, such as genetics, bioinformatics and biostatistics, into clinical specialties has generated a new vision of care. Molecular tumor boards (MTB) are one response to these changes and are now providing better access to next-generation sequencing (NGS) and new cancer treatments to patients with inoperable or metastatic cancers, and those for whom the usual treatment has failed. However, MTB face a crucial ethical challenge: maintaining and improving the trust of patients, clinicians, researchers and industry in academic medical centers supported by private or public funding rather than providing genetic data directly to private companies. We believe that, in this era of DM, appropriate modern digital communication networks will be required to maintain this trust and to improve the organization and effectiveness of the system. There is, therefore, a need to reconsider the form and content of informed consent (IC) documents at all academic medical centers and to introduce dynamic and electronic informed consent (e-IC).