Cultural Missteps and Ethical Considerations with Indigenous Populations: Preliminary Reflections from Northeastern Ontario,Canada

Within this submission the authors share their experiences as a blended research team with Aboriginal community and mainstream academic researchers. The team has collaborated since 2004 on several externally funded research projects. Initially, the team engaged in research through mainstream methodologies. In the process, the community co-researchers and participants were silenced through mainstream cultural practices that were unfamiliar and meaningless in Wikwemikong culture. More recently, the team has employed a community conceived de-colonizing methodology, developed from within Wikwemikong Unceded Indian Reserve. Within this submission, the authors will highlight their initial cultural missteps, followed by more recently utilized culturally relevant approaches. It is proposed that what might be ethically sound research with mainstream participants and among mainstream researchers can silence and subvert practices among those from marginalized groups/cultures. Provisional suggestions are offered for researchers interested in co-researching in Aboriginal communities.     

Association between substance use disorders and self- and other-directed aggression: An integrated model approach

Our study's objective is to determine whether substance use disorders’ association with aggression differs according to the type of substance and/or the form of aggression, within the same population. We used data from the National Survey on Drug Use and Health across 2008–2014, with a pooled sample of 270,227 adult respondents. We used regression models to estimate the odds ratios for those having alcohol and/or drug use disorder(s) perpetrating (a) each form of aggression compared with no aggression and (b) other-directed compared with self-directed aggression. Alcohol use disorder alone and drug use disorder(s) alone were both associated with significantly increased odds of committing self-directed, other-directed, and combined aggression. Individuals with drug use disorder(s) alone were more likely to commit other-directed than self-directed aggression (adjusted odds ratio = 1.46, 95% CI = 1.04–2.05). Individuals with alcohol use disorder alone were not likely to commit one over the other (adjusted odds ratio = 1.20, 95% CI = 0.90–1.61). In conclusion, the integrated model of aggression based on the stress–diathesis model is a relevant framework to study risk factors for aggression. Further research is needed to identify longitudinal predictors of directionality of aggression.     

The Diabetes Family Behavior Checklist: A Psychometric Evaluation

The Diabetes Family Behavior Checklist (DFBC) assesses supportive and non-supportive parental behavior specific to diabetes management via parent and child reports. The DFBC was administered to 133 children with type 1 diabetes (T1D) and their caregivers. Subsequent analysis verified the two-factor structure of the DFBC corresponding to positive and negative support behaviors. Internal consistency was high for DFBC scores. Moderate to strong correlations with other measures of diabetes-specific familial behaviors, adherence, and metabolic control support the validity of the DFBC. Clinical application of the DFBC is discussed.     

Selective antagonism of GABAA receptor subtypes: an in vivo approach to exploring the therapeutic and side effects of benzodiazepine-type drugs

Benzodiazepines (BZs) are clinically used as anxiolytic, hypnotic, anticonvulsant, and antispasmodic drugs. Research using transgenic mouse models has suggested that the effects of BZs involve multiple subtypes of the gamma-aminobutyric acid type A (GABAA) receptor, identified by specific a subunits (alpha1, alpha2, alpha3, alpha5). This review discusses the experimental uses of b-carboline-3-carboxylate-t-butyl ester (betaCCT), a drug that binds preferentially to the GABAA alpha1 subtype but exerts no action (ie, is a pharmacologic antagonist at the GABAA alpha1 subtype receptor). betaCCT blocks the anxiolytic-like effects of BZs, although studies in primates suggests this antagonism may reflect multiple receptor populations. betaCCT antagonized the ataxic but not muscle relaxant effects of BZs, a finding that implicates the GABAA alpha1 subtype receptor in ataxia but not muscle relaxation. The potential clinical utility of betaCCT is discussed, both in terms of treatment (ie, hepatic encephalopathy) and as a diagnostic imaging agent. Altogether, these results indicate that subtype-selective antagonists represent a useful approach to studying receptor mechanisms underlying the behavioral effects of BZ-type drugs.     

Gruppenpsychotherapie für Brustkrebspatientinnen

Zusammenfassung  Der Brustkrebs erzwingt geradezu unsere Aufmerksamkeit mit seiner hohen Prävalenz—30% aller Krebsneuerkrankungen bei nordamerikanischen Frauen sind Brustkrebs—, und er ist die zweithäufigste Todesursache bei Frauen in Nordamerika. Weiße nordamerikanische Frauen haben ein Risiko von 1:9, im Laufe ihres Lebens an Brustkrebs zu erkranken. Es gibt zahlreiche Anknüpfungspunkte, darunter genetische und familiäre Prädisposition, primäre Krebserkrankung/Langzeitüberleben und rezidivierende oder metastasierende Krankheit. Brustkrebs ist eine Krankheit, bei der jede Form der Krebsbehandlung eingesetzt wird—Chirurgie, Chemotherapie, Bestrahlung, Hormontherapie und die viel versprechenden, kürzlich entwickelten immunologischen Interventionen. Zugleich ist die Brust als Körperteil kulturell hochgradig besetzt und als Symbol der Weiblichkeit, der Attraktivität, der Sexualität und der Fortpflanzung aufmerksam und emotional viel beachtet. In der vorliegenden Arbeit wird die Anwendung von Gruppenpsychotherapien auf dieses Spektrum klinischer Belange diskutiert.

Biomedical research and mining of the poor: The need for their exclusion

Almost all ethical guidelines and legislative policies concerning biomedical research involving human subjects contain provisions about relevance of research for the participating populations, informed consent, adequate care for research induced injuries and several other safeguards but the poor continue to suffer. Globalization has further aggravated poor people’s vulnerability by exposing them to international markets. Since the developing countries are abode of higher population of the poor they have become the unholy mines of this human ore for researchers. In this paper I examine various dimensions of poverty and analyze the international ethical responses in the area of biomedical research involving human subjects in order to determine their adequacy to protect the poor against exploitation and misuse and conclude that in view of the poor’s inherent and extreme vulnerability and the failure of ethical pronouncements to protect them from misuse and exploitation, they should be excluded from being enrolled as research subjects This paper was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005.     

Family narrative interaction and children's sense of self

Family narratives about the shared past may be a particularly significant site for preadolescents' emerging sense of self both as an individual and as a member of a unified family. We examined the relations between family narrative interaction style when reminiscing and preadolescents' sense of self. Results indicated three narrative interaction styles that describe the extent to which families discuss or fail to discuss their past in integrated and validating ways. Specifically, conversations with a coordinated perspective incorporated information from all members and were related to higher self-esteem, especially in girls. Conversations with an individual perspective, in which family members took turns telling their thoughts and feelings about the event without integration among the perspectives, were associated with a more external locus of control, especially in boys. Conversations with an imposed perspective, in which one family member was in charge of the conversation or in which unpleasant exchanges between members occurred, were not associated with either self-esteem or locus of control. Implications of these narrative interaction styles for children's developing sense of self are discussed.     

Sociology and psychology within the scope of scientific dishonesty

A survey is undertaken based on qualitative analyses of the cases of scientific misconduct from the Danish Committee on Scientific Dishonesty’s first five years of collecting data, with additional information from selected international sources, in which underlying psychological motivations can be judged. An carlier version of this paper was presented at a symposium, Scientific Misconduct. An International Perspective, organised by The Medical University of Warsay, 16 November, 1998.     

On self-disclosure: The vulnerable therapist

The therapist may stimulate the family's growth by sharing his personal experiences directly with them. This helps by providing the family with a model of a real (versus symbolic) person and encouraging them to respond in new and competent ways. As a result, the emotional commitment of the therapeutic system may deepen, while unconscious conflicts that have been causing impasses may surface and be resolved. The therapist hopes that his self-disclosure will benefit the therapy, but understands that there are risks involved. Specific guidelines can help in deciding when not to share, what kinds of problems can be revealed, and what attitudes best strengthen this endeavor. Self-disclosure is discussed here in an experiential frame-work. The author illustrates the above points with examples from his own personal clinical and supervisory experiences.The author would like to thank his wife, Linda Barth Garfield, MSS, without whose sustaining support this paper could not have been written, and his partner, Ellen Berman, MD, for her valuable comments and encouragement. The masculine pronoun is used in this paper for convenience, and because the author is often referring to himself.