Situating Standards in Practices: Multi Drug-Resistant Tuberculosis Treatment in India

Public health care needs to cope with a basic dilemma between providing standardized care within public programmes across entire and at times resource-constrained countries and adapting this care locally when responding to individual needs. This tension between standardization and local adaptation becomes particularly obvious for the prolonged and complicated treatment of multidrug-resistant tuberculosis (MDR-TB). Situated standardization, as introduced by Zuiderent-Jerak [2007a, 2007b] offers a way out of this dilemma. It helps to focus on how standards need to be situated in practice rather than viewing standardization and local adaptation as mutually exclusive practices. How do actors relate standardization and individual care in their practices of treating MDR-TB? Results from qualitative fieldwork at the first MDR-TB treatment sites of the Indian TB programme show that actors situate standards in a particular way. They assess the role of guidelines in a particular situation and on that basis recognize the core recommendations of guidelines or go beyond the guidelines. This allows actors to negotiate how standards should be situated and reconciles the dilemma between local adaptation and standardization. Having guidelines internalized, as is common for Indian TB control, bears both promises and pitfalls for engaging in standardization processes in a situated manner. The results contribute to science and technology study scholarship on guideline development. They highlight how actors coordinate the situating of standards and how this depends upon cultures of control. This illustrates the potential of qualitative studies on local adaptation for guideline developers by revealing existing practices of relating and negotiating local adaptation and standardization.     

Subtypes of Adaptive and Maladaptive Perfectionism in Anorexia Nervosa: Associations with Eating Disorder and Affective Symptoms

Perfectionism is hypothesized to contribute to the etiology of anorexia nervosa (AN). However, there is little research regarding whether individuals with AN can be classified according to maladaptive (e.g., evaluative concerns) and adaptive (e.g., high personal standards) facets of perfectionism that predict distinct outcomes and might warrant different intervention approaches. In this study, a latent profile analysis was conducted using data from adults with AN (n?=?118). Frost Multidimensional Perfectionism Scale (Frost et al. Cognitive Therapy and Research, 14(5), 449–46, 1990) subscales were used to identify subgroups differing according to endorsed perfectionism features (e.g., adaptive and maladaptive perfectionism). Generalized linear models were used to compare subgroups on eating disorder and affective symptoms measured through questionnaire and ecological momentary assessment. Four subgroups were identified: (a) Low Perfectionism; (b) High Adaptive and Maladaptive Perfectionism; (c) Moderate Maladaptive Perfectionism; and (d) High Maladaptive Perfectionism. Subgroups differed on overall eating disorder symptoms (p?<?.001), purging (p?=?.005), restrictive eating (p?<?.001), and body checking (p?<?.001) frequency, depressive (p?<?.001) and anxiety (p?<?.001) symptoms, and negative (p?=?.001) and positive (p?<?.001) affect. The Low Perfectionism group displayed the most adaptive scores and the Moderate and High Maladaptive Perfectionism groups demonstrated the most elevated clinical symptoms. The High Adaptive and Maladaptive Perfectionism group demonstrated low affective disturbances, but elevated eating disorder symptoms. Results support the clinical significance of subtyping according to perfectionism dimensions in AN. Research is needed to determine if perfectionism subtyping can enhance individualized treatment targeting in AN.     

Early predictors of high school mathematics achievement

Identifying the types of mathematics content knowledge that are most predictive of students' long-term learning is essential for improving both theories of mathematical development and mathematics education. To identify these types of knowledge, we examined long-term predictors of high school students' knowledge of algebra and overall mathematics achievement. Analyses of large, nationally representative, longitudinal data sets from the United States and the United Kingdom revealed that elementary school students' knowledge of fractions and of division uniquely predicts those students' knowledge of algebra and overall mathematics achievement in high school, 5 or 6 years later, even after statistically controlling for other types of mathematical knowledge, general intellectual ability, working memory, and family income and education. Implications of these findings for understanding and improving mathematics learning are discussed.     

Effects of impoverished environmental conditions on working memory performance

This cross-cultural study investigates the impact of background experience on four verbal and visuo-spatial working memory (WM) tasks. A total of 84 children from low-income families were recruited from the following groups: (1) Portuguese immigrant children from Luxembourg impoverished in terms of language experience; (2) Brazilian children deprived in terms of scholastic background; (3) Portuguese children from Portugal with no disadvantage in either scholastic or language background. Children were matched on age, gender, fluid intelligence, and socioeconomic status and completed four simple and complex span tasks of WM and a vocabulary measure. Results indicate that, despite large differences in their backgrounds and language abilities, the groups exhibited comparable performance on the visuo-spatial tasks dot matrix and odd-one-out and on the verbal simple span task digit recall. Group differences emerged on the verbal complex span task counting recall with children from Luxembourg and Portugal outperforming children from disadvantaged schools in Brazil. The study suggests that whereas contributions of prior knowledge to digit span, dot matrix, and odd-one-out are likely to be minimal, background experience can affect performance on counting recall. Implications for testing WM capacity in children growing up in poverty are discussed.     

Intersecting cultural identities and help-seeking attitudes: the role of religious commitment,gender, and self-stigma of seeking help

ABSTRACT

The current study (N?=?404) used a moderated moderation model to examine how gender, religious commitment, and self-stigma toward seeking psychological help may interact in the prediction of help-seeking attitudes. Bivariate zero-order correlations indicated that help-seeking attitudes was negatively associated with self-stigma of seeking help (r?=??.55) and positively associated with religious commitment (r?=?.14), and self-stigma was not significantly associated with religious commitment. Men reported more negative attitudes than women (ΔM?=??.18). Furthermore, multiple regression results revealed a three-way interaction such that the relationship between gender and help-seeking attitudes was moderated by both self-stigma and religious commitment. Specifically, men with high religious commitment and high self-stigma endorsed the most negative help-seeking attitudes, suggesting that religious men’s help-seeking attitudes may be particularly susceptible to the influence of self-stigma. Implications for research and the development of targeted interventions are discussed.     

Ecological momentary assessment of bulimia nervosa: Does dietary restriction predict binge eating?

The purpose of this study was to examine the relationship between caloric restriction (CR) and binge eating (BE) using ecological momentary assessment (EMA). Participants included 133 women with bulimia nervosa (BN) who completed an EMA protocol for 2 weeks. Logistic regression analyses tested whether CR increased the probability of BE episodes. The results revealed that the odds of BE increased on the day that restriction occurred as well as on the following day. In addition, both restriction and BE on one day predicted the likelihood of BE the subsequent day, but restriction for two days prior to the episode failed to add additional information for predicting BE. These findings support the cognitive behavioral therapy (CBT) model of BN, suggesting that self-reported dietary restriction is predictive of subsequent BE episodes, and that reducing dietary restriction in treatment may lead to improvements in bulimic symptoms.