Ethics, Cultural Competence, and the Changing Face of America

The population in the United States is increasingly multicultural. So, too, is the U.S. physician workforce. The combination of these diversity dynamics sets up the potential for various types of cultural conflict in the nation’s examining rooms, including the relationship between religion and medicine. To address the changing patient-physician landscape, we argue for a broad scale intervention: interdisciplinary bioethics training for physicians and other health professionals. This approach seeks to promote a common procedural expectation and language which can lead to an improved, patient-centered approach resulting in better patient-physician relationships that contribute to better health outcomes across the U.S. population. The authors illustrate their thesis and solution using a well-known case of cross-cultural dynamics taken from religion and medicine—Anne Fadiman’s The Spirit Catches You And You Fall Down.     

Adapting School-Based Substance Use Prevention Curriculum Through Cultural Grounding: A Review and Exemplar of Adaptation Processes for Rural Schools

A central challenge facing twenty-first century community-based researchers and prevention scientists is curriculum adaptation processes. While early prevention efforts sought to develop effective programs, taking programs to scale implies that they will be adapted, especially as programs are implemented with populations other than those with whom they were developed or tested. The principle of cultural grounding, which argues that health message adaptation should be informed by knowledge of the target population and by cultural insiders, provides a theoretical rational for cultural regrounding and presents an illustrative case of methods used to reground the keepin’ it REAL substance use prevention curriculum for a rural adolescent population. We argue that adaptation processes like those presented should be incorporated into the design and dissemination of prevention interventions.     

Guilt as a Source of Narcissistic Gratification

This article takes as its starting point a paper by Hugo Bleichmar presented at the 2003 Joseph Sandler Research Conference on Depression. The author argues in favour of viewing depression in a broad perspective. The Freudian prototype of “guilty depression” represents only one of many pathways leading to depressive states. Psychoanalytic understanding of depression should represent a multidimensional approach, characterised by interacting determinants, both internal and external. In clinical practice, this would imply an attitude of greater freedom and flexibility in the analyst. The paper compares the psychoanalytic account of depression with that given by the cognitive approach. It is argued that within a diverse research field, where depression is studied from different angles—as a disorder of the brain and in terms of cognitive deficits—the contribution of psychoanalysis is that depression is most usefully studied at the level of psychological causation. The psychoanalytic understanding of depressive states in terms of unconscious interpretation and meaning of experience represents a distinct contribution. Implications of viewing depression as an “illness” are discussed.     

The lived experiences of people diagnosed with multiple sclerosis in relation to exercise

The purpose of this study was to examine the lived experiences of people diagnosed with Multiple Sclerosis (MS). Seven active exercisers with MS participated in semi-structured interviews regarding their exercise experiences since diagnosis. Data were analysed using Interpretative Phenomenological Analysis (IPA; Smith?&?Osborn, 2003 Smith, JA and Osborn, M. 2003. “Interpretive phenomenological analysis”. In Qualitative psychology: A practical guide to research methods, Edited by: Smith, JA. 51–80. London: Sage.  [Google Scholar]). Interpretive Phenomenological Analysis. The results and interpretations of narratives revealed a number of functional limitations due to the severity of MS symptoms, which were found to have a major effect on the ability of the participants to exercise. Furthermore, psychological problems and the heightened behavioural adjustments to the progressive disability led to re-appraisal of ability to exercise. Previous, relevant exercise experience made participants more determined to continue to be able to exercise after diagnosis. The wider exercise experience narratives were related to concerns about safety, dependability on others to overcome the challenges, and potential environmental hazards. The loss of spontaneous opportunities to exercise because of these actual and perceived barriers was key to this population. This research highlighted the need to rethink the health and social service arrangements in relation to exercise provision for individuals with MS.     

Inhibition: Mental Control Process or Mental Resource?

The current study tested 2 models of inhibition in 45 children with language impairment and 45 children with normally developing language; children were aged 7 to 12 years. Of interest was whether a model of inhibition as a mental-control process (i.e., executive function) or as a mental resource would more accurately reflect the relations among mental-attentional (M) capacity, inhibition, updating, shifting, and language competence. Children completed measures of M-capacity (in the verbal and nonverbal domains), inhibition, updating, shifting, and language. Path analyses showed the data provided a poor fit to the model of inhibition as a mental-control process but a good fit to the model of inhibition as a mental resource. Results are consistent with the theory of constructive operators and suggest inhibition is a mental resource rather than a mental-control process.     

Efficacy of a Brief Relaxation Training Intervention for Pediatric Recurrent Abdominal Pain

This study is a preliminary investigation of the efficacy of a brief intervention for recurrent abdominal pain (RAP) via a multiple baseline across subjects design. The intervention consisted of a single 1-hour session including psychoeducation and coaching of breathing retraining; the length, duration, and content of the intervention were designed with a goal of maximum portability to primary-care settings. Five children with recurrent abdominal pain participated in this study, 1 of whom served as a pilot participant. Children received the intervention at 1-week intervals. Parent and child reports of each child's abdominal pain, general somatic complaints, functional disability, and anxiety were collected throughout the study. All children participated in a 3-month follow-up session. Results indicated that this brief intervention was successful in lessening abdominal pain, as demonstrated by decreased Abdominal Pain Index (API) scores in two children and decreased abdominal pain following breathing retraining practice in all children. The intervention was also successful in decreasing some children's general somatic symptoms. Functional disability and anxiety symptoms remained consistent for all children throughout the study, which may be due to low levels of these symptoms pretreatment. Limitations and directions for future research are discussed.     

Electroencephalographic registration of low concentrations of isoamyl acetate

Previous research has demonstrated electroencephalogram (EEG) changes in response to low-odor concentrations, resulting in near-chance detection. Such findings have been taken as evidence for olfaction without awareness. We replicated and extended previous work by examining EEG responses to water-water control, 0.0001, 0. 001, 0.01, and 1 ppm isoamyl acetate (IAA) in water paired with water only. Detection was above chance (>50%) for.001 and above, and alpha decreased only to those concentrations, suggesting that EEG changes corresponded to IAA awareness. However, when correct trial EEGs were compared to incorrect trial EEGs during.001 ppm, right posterior/central alpha decreased during incorrect trials and alpha decreased more globally (including frontal sites) during correct trials. These data may not reflect awareness or unawareness per se. Instead, results are discussed regarding activation of perceptual systems in the posterior region during incorrect trials and the activation of frontal action systems during a subset of correct trials.