Reducing the risk of bias in health behaviour change trials: Improving trial design,reporting or bias assessment criteria? A review and case study

Objective: It has been suggested that randomised controlled trials (RCTs) of health behaviour change (HBC) interventions are less rigorously designed than – for example– drug trials. This study presents an approach to clarifying whether this is due to poor trial design, incomplete trial reporting and/or the inappropriateness of commonly applied risk of bias assessment criteria.

Design: First, a framework of key sources of bias and common strategies for reducing bias risk is developed based on a literature review. Second, we describe the design of a multi-site RCT evaluating the cost-effectiveness of an HIV-treatment adherence intervention (case study). The choices made by the multidisciplinary team trying to minimise the risk of bias are compared against the risk of bias framework.

Main outcome measures: Implementation of common strategies for reducing the risk of bias in the case study; alternative or additional strategies applied; a justification for each deviation from the risk of bias framework.

Results: Most of the common strategies for reducing the risk of bias could be implemented. Alternative strategies were developed for minimising the risk of performance bias and contamination. Several additional, domain-specific risk of bias strategies were implemented.

Conclusions: The literature provides useful guidance for reducing the risk of bias in HBC trials. Yet, the case study suggests that HBC trial designers may face specific challenges that require alternative/additional measures for reducing the risk of bias. Using the risk of bias justification table (RATIONALE) could lead to better-designed HBC trials, more comprehensive trial reports and the data necessary for evaluating the appropriateness of commonly applied risk of bias assessment criteria to HBC trials.     

Effective coordination in medical emergency teams: The moderating role of task type

Coordination in health care action teams is an important factor in clinical performance and patient safety. Implementing a high-fidelity in situ simulation study, we investigated the performance-relevant effects of task distribution, provide information without request (PIWR) and closed-loop communication (CLC) in 68 medical emergency teams (METs) composed of fully qualified clinicians. We differentiated between two task types: algorithm-driven and knowledge-driven tasks. We assigned two different emergency tasks to each task type. We proposed not only a direct relationship between the three coordination behaviours and clinical performance, but also a moderating role for the type of task. Only CLC was related to performance and also moderated by task type. There was no relationship between the coordination behaviours task distribution and PIWR and performance. We discuss the differential effects of the three coordination behaviours on performance and emphasize the importance of the task in team research. In particular, we highlight theoretical and practical implications.     

Is a Finite Life Such a Bad Idea? Transhumanism and Theological Anthropology

Creaturely life is finite life. Transhumanism suggests that human life will be better and even fulfilled in a new way, if humans can overcome some of the finite conditions now given. I argue that there are theological, ethical, and biological points to be taken into consideration that may challenge the transhuman vision of a good life. The finite conditions of human life are what makes human life human, and these conditions are also part of why the deeper meaning of human life is realized in love for others, and not in the quest for making one's own life go on (almost) endlessly. In addition to looking at some material from popular culture and the philosopher Hans Jonas, the article also draws on recent discussions on transhumanism present in contemporary theology.     

The analytic setting today: using the couch or the chair?

This paper re‐visits Murray Jackson's 1961 paper in the Journal of Analytical Psychology, ‘Chair, couch and countertransference’, with the aim of exploring the role of the couch for Jungian analysts in clinical practice today. Within the Society of Analytical Psychology (SAP) and some other London‐based societies, there has been an evolution of practice from face‐to‐face sessions with the patient in the chair, as was Jung's preference, to a mode of practice where patients use the couch with the analyst sitting to the side rather than behind, as has been the tradition in psychoanalysis. Fordham was the founding member of the SAP and it was because of his liaison with psychoanalysis and psychoanalysts that this cultural shift came about. Using clinical examples, the author explores the couch/chair question in terms of her own practice and the internal setting as a structure in her mind. With reference to Bleger's (2013) paper ‘Psychoanalysis of the psychoanalytic setting’, the author discusses how the analytic setting, including use of the couch or the chair, can act as a silent container for the most primitive aspects of the patient's psyche which will only emerge in analysis when the setting changes or is breached.     

Person‐Group Value Congruence and Subjective Well‐Being in Students from Argentina,Bulgaria and Finland: The Role of Interpersonal Relationships

The present study examined the relations between personal values, value congruence, interpersonal relationships and subjective well‐being in psychology/education and business students from Argentina (N = 275), Bulgaria (N = 182) and Finland (N = 148). Regression analyses showed, first, that there were no direct relations between higher order value priorities and life satisfaction (LS), positive affect (PA) or negative affect (NA). Second, objective value‐congruence (VC)—the similarity between individual and group values—was positively related to LS and PA, and negatively related to NA. Most importantly, the effects of VC on LS, NA and PA were partially mediated by good interpersonal relationships. Our results show that interpersonal relationships are facilitated by sharing values similar to those of one's fellow students. More generally, personal values per se appear not to be associated with subjective well‐being, more important is how these values fit into the social context. Copyright © 2014 John Wiley & Sons, Ltd.     

The relative contributions of subjective and objective measures of body shape and size to body image and disordered eating in women

This research explored the relative contributions of subjective perceptions of body weight and body shape/proportion, as well as objective measures of body mass index (BMI) and waist-to-hip ratio (WHR) to disordered eating, exercise involvement, and body image. One hundred and fifty-eight female university students completed questionnaires and provided body measurements for this study. Although an interaction between BMI and WHR was found for some measures (i.e., Eating Disorder Examination Questionnaire total and subscale scores), results indicated that BMI was consistently the better objective predictor of disordered eating and body image. Subjective perceptions of body weight and, to a lesser extent, body shape, were found to account for the greatest proportion of variance in the dependent measures (disordered eating, body esteem, and body dissatisfaction). Overall, these results offer more support for sociocultural theories emphasizing the importance of thinness for women, than evolutionary theories emphasizing the role of WHR.