A terminal diagnosis: The carers’ perspective

This qualitative study explored the views of spouse carers in relation to the emotional impact of caring for a partner with a chronic or terminal illness. The study population consisted of nine full‐time spouse carers, recruited using a snowball sampling strategy. Semi‐structured interviews took place in the carers’ homes. These were recorded and transcribed verbatim. The data were then analysed using constant comparative analysis. Themes identified included the emotional and physical health of the carer, personality changes in the spouse, relationship issues, denial, anticipating death, accessing support and coping strategies. Findings indicate that these carers experienced a whole range of feelings and emotions, which impacted on their health and well‐being. They included fatigue, stress, distress, anxiety, depression, feelings of isolation and suicidal thoughts. These were particularly profound around the time of diagnosis, end of treatment, during a relapse and most particularly around the time of death. An increasing number of terminally ill people are now expressing a preference to be cared for at home. The potential risks to the health of caregivers therefore need to be taken into account. This study highlights the importance of assessing the needs of carers in order to identify those at risk of compromised health, which would then allow those requiring support to be offered prompt referral to specialist services.     

Meta‐CART: A tool to identify interactions between moderators in meta‐analysis

In the framework of meta‐analysis, moderator analysis is usually performed only univariately. When several study characteristics are available that may account for treatment effect, standard meta‐regression has difficulties in identifying interactions between them. To overcome this problem, meta‐CART has been proposed: an approach that applies classification and regression trees (CART) to identify interactions, and then subgroup meta‐analysis to test the significance of moderator effects. The previous version of meta‐CART has its shortcomings: when applying CART, the sample sizes of studies are not taken into account, and the effect sizes are dichotomized around the median value. Therefore, this article proposes new meta‐CART extensions, weighting study effect sizes by their accuracy, and using a regression tree to avoid dichotomization. In addition, new pruning rules are proposed. The performance of all versions of meta‐CART was evaluated via a Monte Carlo simulation study. The simulation results revealed that meta‐regression trees with random‐effects weights and a 0.5‐standard‐error pruning rule perform best. The required sample size for meta‐CART to achieve satisfactory performance depends on the number of study characteristics, the magnitude of the interactions, and the residual heterogeneity.     

Validation of Self-Report Impairment Measures for Section III Obsessive–Compulsive and Avoidant Personality Disorders

This study examined the validity of newly developed disorder-specific impairment scales (IS), modeled on the Level of Personality Functioning Scale, for obsessive–compulsive (OCPD) and avoidant (AvPD) personality disorders. The IS focused on content validity (items directly reflected the disorder-specific impairments listed in DSM-5 Section III) and severity of impairment. A community sample of 313 adults completed personality inventories indexing the DSM-5 Sections II and III diagnostic criteria for OCPD and AvPD, as well as measures of impairment in the domains of self- and interpersonal functioning. Results indicated that both impairment measures (for AvPD in particular) showed promise in their ability to measure disorder-specific impairment, demonstrating convergent validity with their respective Section II counterparts and discriminant validity with their noncorresponding Section II disorder and with each other. The pattern of relationships between scores on the IS and scores on external measures of personality functioning, however, did not indicate that it is useful to maintain a distinction between impairment in the self- and interpersonal domains, at least for AvPD and OCPD.     

Alcohol Intoxication and Metamemory: Little Evidence that Moderate Intoxication Impairs Metacognitive Monitoring Processes

There is minimal research on metacognition in alcohol‐intoxicated participants. Study 1 examined metacognition across sober, intoxicated, and placebo groups, with the intoxicated group's breath alcohol concentration reaching 0.074 g/210 L on average immediately prior to the metacognition task. Participants answered cued recall general knowledge questions and provided confidence ratings and feeling‐of‐knowing judgments. They then completed a recognition (i.e., multiple choice) version of the same task, indicating an answer and a confidence rating for each question. Findings suggest that metacognitive accuracy generally did not vary across intoxication levels, although the control group's retrospective confidence judgments better discriminated between accurate and inaccurate responses than the alcohol groups in the recognition task. Study 2 surveyed academic psychologists about their expectations regarding the relation between alcohol and metacognition. Study 1's results were counter to their expectations, as respondents generally predicted a relation would be present. We discuss the implications for alcohol and memory.Copyright © 2017 John Wiley & Sons, Ltd.     

Preliminary evidence of the impact of early childhood maltreatment and a preventive intervention on neural patterns of response inhibition in early adolescence

Maltreated youths in foster care often experience negative developmental and psychological outcomes, which have been linked with poor response inhibition. Recent evidence suggests that childhood maltreatment is also associated with alterations in the neural circuitry underlying response inhibition. However, a burgeoning line of research has begun to explore the mitigating effects of preventive interventions on neural functioning. The current study used event‐related functional magnetic resonance imaging to explore the impact of early childhood maltreatment and a preventive intervention on response inhibition in early adolescence. Thirty‐six demographically similar adolescents (ages 9–14 years) completed a Go/NoGo task. The sample included nonmaltreated adolescents (n = 14) and maltreated adolescents who were in foster care as preschoolers and randomly assigned to receive services as usual (n = 11) or a preventive intervention, Multidimensional Treatment Foster Care for Preschoolers (n = 11). The groups demonstrated similar behavioral performance but significantly different neural patterns. The maltreated adolescents who received services as usual demonstrated subcortical hypoactivity during successful response inhibition and subcortical hyperactivity during unsuccessful response inhibition. In contrast, the nonmaltreated adolescents and maltreated adolescents who received the intervention exhibited strikingly similar neural patterns during successful response inhibition, but the maltreated adolescents who received the intervention demonstrated prefrontal hypoactivity during unsuccessful response inhibition. These findings offer preliminary evidence that early childhood maltreatment alters the neural patterns underlying response inhibition in early adolescence and that participating in a preventive intervention could mitigate maltreatment‐related effects on these neural systems.     

Every Child Still Matters: interdisciplinary approaches to the spirituality of the child

Abstract

Ten years ago, I was a researcher with the Evaluation of Children’s Trusts which examined a key aspect of U.K. government policy, Every Child Matters. Every Child Matters was partly a response to Lord Laming’s 2003 report into the murder of 8-year old Victoria Climbié, which concluded that children’s services needed to be better integrated to avoid such tragedies in the future. Children’s Trusts were regional hubs, set-up across England to facilitate integrated professional practice; but Every Child Matters was bigger than this because it set out a policy vision for rethinking the child as a whole person. At the time, I was struck by the absence of any reference to spirituality in this new holistic view of the child, and this led me to write an article which was published in 2006 entitled, ‘Every Child Matters and children’s spiritual rights: does the new holistic approach to children’s care address children’s spiritual well-being?’.

This article was originally a keynote talk at the 2016 International Conference on Children’s Spirituality with the theme Spirituality and the whole child: interdisciplinary approaches, and this provided the opportunity both to see where we are now with integrated working for children and young people more generally, and to focus our attention on interdisciplinary approaches to children’s spirituality and the whole child in particular. The article begins by summarising some of the current thinking spirituality, the whole child and interdisciplinary working. The article then goes on to consider a long-standing concern of mine, and one which was highlighted in my 2006 article, which is what we intend to mean – collectively, as academics and professional practitioners concerned with children’s (and adults’) spirituality – when we use the term ‘spirituality’ in the professional context. In my view, it is time to stop stating that spirituality is hard to define, and come to an agreement about what we mean when we use it. Interdisciplinary approaches to children’s (and adults’) spirituality, and holistic approaches to the child (and adult), will not be successful unless there is a clear, shared agreement about what we mean, and the article ends with suggestions for ways forward.     

DNA Testing for Family Reunification in Canada: Points to Consider

Countries have adopted different laws, policies, and practices that allow immigration officers to request in certain cases DNA tests to confirm biological relationships in the context of family reunification. In Canada, Citizenship and Immigration Canada has adopted a policy of suggesting DNA testing only as a last resort in cases where no documentary evidence has been submitted or where the evidence provided is deemed unsatisfactory. However, in practice, there have been concerns on the increasing use of DNA tests in family reunification processes of nationals from certain regions including Africa, Asia, and Latin America. Moreover, the Immigration and Refugee Protection Regulations (IRPR) presents a biological definition of family as a determinant of parenthood in the context of family reunification that is inconsistent with the psychosocial definition used in provincial family laws. Although there are cases that can justify the request for DNA tests, there are also significant social, legal, and ethical issues, including discrimination and unfair practices, raised by this increasing use of genetic information in immigration. This policy brief identifies points to consider for policymakers regarding the use of DNA testing in Canadian family reunification procedures. These include (1) the need to refine the policy of “using DNA testing as a last resort” and its implementation, (2) the need to modify the definition of “dependent child” under the IRPR to reflect the intrinsic reality of psychosocial family ties, and (3) the importance of conducting more research on the use of DNA testing in other immigration contexts.     

The regression trunk approach to discover treatment covariate interaction

The regression trunk approach (RTA) is an integration of regression trees and multiple linear regression analysis. In this paper RTA is used to discover treatment covariate interactions, in the regression of one continuous variable on a treatment variable withmultiple covariates. The performance of RTA is compared to the classical method of forward stepwise regression. The results of two simulation studies, in which the true interactions are modeled as threshold interactions, show that RTA detects the interactions in a higher number of cases (82.3% in the first simulation study, and 52.3% in the second) than stepwise regression (56.5% and 20.5%). In a real data example the final RTA model has a higher cross-validated variance-accounted-for (29.8%) than the stepwise regression model (12.5%). All of these results indicate that RTA is a promising alternative method for demonstrating differential effectiveness of treatments. Supported by The Netherlands Organization for Scientific Research (NWO), grant 030-56403 to Jacqueline Meulman for the Pioneer project “Subject-Oriented Multivariate Analysis,” and grant 451-02-058 to Elise Dusseldorp for the Veni project “Modeling interaction effects as small trees in regression and classification.” We thank Bram Bakker for making the data of his doctoral dissertation available, and David Hand, Jerome Friedman, Bart Jan van Os, Philip Spinhoven, and the anonymous reviewers for their helpful suggestions. Special thanks are due to Lawrence Hubert.