MEDIATING ROLE OF MATERNAL SENSITIVITY: ENHANCING LANGUAGE DEVELOPMENT IN AT‐RISK FAMILIES

Home‐visiting programs have gained increasing importance in family‐centered prevention and intervention. However, few studies have examined the mechanisms underlying early intervention treatment effects. The goal of this study is to analyze the mediating role of maternal sensitivity in enhancing language development with the home‐visiting program Parents as Teachers (PAT). Data were collected and analyzed within the ongoing, long‐term ZEPPELIN study, a randomized controlled trial with 251 participating at‐risk families. Via longitudinal mediation analysis, we examined whether effects of the PAT on receptive and expressive language outcomes at 24 and 36 months were mediated by maternal sensitivity at 12 months. Within a moderated mediation framework, we investigated whether the level of family psychosocial stress affects this mediation. Results showed that intervention effects on language outcomes are mediated by maternal sensitivity—weakly and through specific pathways. Moderation and moderated mediation analyses indicated that effects of the PAT and also specific mediation effects increase with the level of psychosocial stress. Implications of the results for practice are discussed.     

Trusting families: Responding to Mary Ann Meeker, "Responsive care management: family decision makers in advanced cancer"

Mary Ann Meeker's article admirably reminds readers that family members are involved in--or "responsively manage"--the care of relatives with severe illness in ways that run considerably beyond the stereotypes at play in many bioethical discussions of advance directives. Her observations thus make thinking about the role of families in healthcare provision more adequate to the facts, and this is an important contribution. There's reason to be worried, however, that one explicit aim of the article--to ease the standing anxieties that many clinicians and ethicists have about the reliability of family members as proxy decision makers--will be frustrated by its very success. Those already inclined to suspicion may tend to think that the more intricate and pervasive the ways in which families influence the healthcare decision making of their sick, the more chances they have for altering the connection between patients' interests and the actions of professional providers. To determine whether and when such alterations are something to be concerned about, we'll need to supplement a better grasp of the pertinent facts with a deeper sense of how human agency works and why we value it. We may also need some reminders about the defensibility of diverse moral understandings. Although both professionals and family members may profess an ethic that sets patients' interests above those of non-patients--as Meeker's own results suggest--any strict allegiance to such a framework may be more notional than normative--as her findings also hint. The actual working norms (among professionals, as well as within families) will likely be more complex, but not necessarily any the less defensible for that.     

Complex Environmental Reactions,as a New Concept to Describe Spontaneous “Paranormal” Experiences

A systemic phenomenological model that assumes the movability of the Cartesian cut is proposed and elucidated by means of a single exploratory case study. The model assumes that a continuum from purely psychosomatic disorders to RSPK cases exists. The degree of externalization (locus of control) of the affected person serves as an ordering parameter for the location of the Cartesian cut. It turns out that the dynamics of the disorder develops in four phases, like in the RSPK-model of the MPI. However, in contrast to the decline phase of the RSPK cases (because of the NT-axiom), CER cases lead to petrification of the complaints.     

Different interference effects in musicians and a control group

In the present study musicians and normal control subjects performed an S1-S2 pitch comparison task, which included the presentation of intervening tones during the retention interval. The time for encoding and storing the pitch of S1 was varied between 200 and 1,500 ms by changing the pause between the S1 offset and the onset of the intervening tones. Although musicians outperformed the control group with longer pauses after the S1 offset, this advantage was relatively small with shorter pauses. These results suggest that the advantage of musicians in storing auditory information is not solely due to their superior encoding of information but also to improved working memory operations.     

An age-related deficit in prefrontal cortical function associated with refreshing information

Older adults are slower than young adults to think of an item they just saw, that is, to engage or execute (or both) the simple reflective operation of refreshing just-activated information. In addition, they derive less long-term memory benefit from refreshing information. Using functional magnetic resonance imaging (fMRI), we found that relative to young adults, older adults showed reduced refresh-related activity in an area of dorsolateral prefrontal cortex (left middle frontal gyrus, Brodmann's Area 9), but not in other refresh-related areas. This provides strong evidence that a frontal component of the circuit that subserves this basic cognitive process is especially vulnerable to aging. Such a refresh deficit could contribute to poorer performance of older than young adults on a wide range of cognitive tasks.     

An analysis of social anxiety in anorexic,bulimic, social phobic,and control women

Responses to the Social Phobia and Anxiety Inventory (SPAI) were examined in 23 women with anorexia nervosa, 54 women with bulimia nervosa, 50 female college undergraduates, and 43 social phobic women. Results indicated that women with anorexia nervosa and bulimia nervosa scored comparably high to social phobic women on measures of social anxiety and that these fears were not limited to fears of eating or drinking in public. This study suggests that fears of negative evaluation in women with eating disorders may generalize beyond the fears of scrutiny of body shape and size to more traditional social situations.     

Families, communities, and making medical decisions

In his carefully crafted article, which, it is hoped, will stimulate further dialogue about this issue, David J. Doukas reviews some of the literature on this subject. He does not seem to differentiate between the family's role in decision making for competent or incompetent patients. His interest is prior to that: it is in working out a general agreement prior to the time that such an agreement may be needed. He favors a family covenant, one in which trust accumulates over time, and he offers a model of such a covenant. At first blush, the notion of covenant rather than the notion of contract seems far more suited to the medical milieu. I have no problem with the idea of covenant and trust, but I have serious reservations about its implementation....