Psychosomatik der umweltbezogenen Gesundheitsstörungen

Environmental medicine focuses on acute and chronic effects of chemical and physical environmental influences on health as measured objectively and perceived subjectively. Since these influences are very complex, continuously changing and only partially accessible in scientific experiments, subjective causal attributions can be difficult to prove or disprove. Patients with symptoms attributed to environmental triggers perceive health threats from commonly used chemical agents or electromagnetic radiation, frequently without objective findings. Typical examples are “multiple chemical sensitivity (MCS)”, a generalized self-reported hypersensitivity towards ubiquitous chemicals, or “amalgam sensitivity”, where symptoms are attributed to amalgam from dental fillings. Here, the reported symptoms are almost invariably unspecific and show a high overlap with other medically unexplained syndromes. Based on modern psychosomatic conceptualizations, many environment associated illnesses can be regarded as somatoform disorders and treated as such. Apart from a high psychiatric comorbidity, special attention should be paid to dysfunctional cognitions, emotions and behaviour, and the patient’s often limited quality of life.     

Clinical trials: active control vs placebo — What is ethical?

The quest for effective medicines is very old. In modern times two important tools have been developed to evaluate efficacy of drugs: superiority and non-inferiority types of clinical trials. The former tests the null hypothesis of μ (the difference between a tested drug and comparator) ≤ 0 against μ > 0; the latter tests the null hypothesis of μ ≤ - Δ against, μ > - Δ, where Δ is the clinical difference from the comparator. In a superiority trial, a new drug is tested against a placebo; in a non-inferiority trial, a new drug is tested against active treatment. In this paper, arguments are presented to show that a superiority trial against a placebo is scientifically sound but ethically unacceptable, whereas a non-inferiority trial against active treatment is ethically sound but scientifically not reliable. Switching from a superiority type of trial with placebo to a non-inferiority trial with an active-control — following the latest revision of Declaration of Helsinki — is in practice switching from the violation of the uncertainty principle to uncertainty of results. Given human and financial resources, it appears an academic question as to which is more unethical: to violate patients’ rights or to produce results without scientific value. All presented considerations lead to the conclusion that the use of a superiority trial of design with an active control instead of placebo will satisfy scientific needs, expectation of patients, and the ancient quest for effective medicines. In the era of Good (Clinical, Laboratory, Manufacture) Practice, the attention of those performing clinical trials is focused on the procedure, not always on its essence. However even the excellent performance of a trial which is not worth doing is fruitless. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

Prediction of driving ability after stroke and the effect of behind-the-wheel training

The aim of this study was to examine the predictive value of a neuropsychological test battery relating to an on-the-road driving evaluation and to determine whether patients who failed the driving test could improve their driving through behind-the-wheel training. Thirty-four stroke patients were compared with 20 healthy, matched controls. Patients who failed the driving test were offered driving practice at a driving school and were then reassessed (neuropsychologically and practically). On most of the cognitive tests, patients performed significantly less well than control subjects. Almost 50% of the controls and the patients failed the driving evaluation. None of the neuropsychological tests was able to predict the driving outcome. Of the patients who failed the first driving evaluation, 85% passed the second evaluation after driving practice. There are few controlled studies focusing on the stroke population and the effect of behind-the-wheel training. It is suggested that more controlled studies are needed with more homogenous patient-groups and reliable and quantitative outcome measures.     

When sounds look right and images sound correct: Cross-modal coherence enhances claims of pattern presence

How do people decide whether a stimulus contains a pattern? One possibility is that they rely on a global, non-specific signal of coherence. Interestingly, this signal might reflect a combination of different stimulus sources. Consequently, the coherence of one stimulus might influence decisions about coherence of a second, unrelated stimulus. We explored this possibility in three experiments in which participants judged the presence of a pattern in targets from one sensory modality, while being exposed in the background to incidental coherent and incoherent stimuli in a different modality (visual → auditory, auditory → visual). Across all three experiments, using a variety of judgments, coherence of incidental background cross-modal patterns enhanced claims of pattern presence. These findings advance our understanding of how people judge order in the structured as well as in the unstructured world.     

Reporting Race and Ethnicity in Genetics Research: Do Journal Recommendations or Resources Matter?

Appeals to scrutinize the use of race and ethnicity as variables in genetics research notwithstanding, these variables continue to be inadequately explained and inconsistently used in research publications. In previous research, we found that published genetic research fails to follow suggestions offered for addressing this problem, such as explaining the basis on which these labels are assigned to populations. This study, an analysis of genetic research articles using race or ethnicity terms, explores possible features of journals that are associated with improved reporting of race and ethnicity in genetic research. A journal’s expressed commitment to improving how race and ethnicity are used in genetic research, demonstrated by an editorial or in its instructions to authors, was the strongest predictor of following recommendations about reporting race and ethnicity. Journal impact factor had only a limited positive effect on attention to these issues, suggesting that editorial resources associated with higher impact factor journals are not sufficient to improve practices. Our findings reiterate that race and ethnicity variables are used inconsistently in genetic research, but also shed light on how journals might improve practices by highlighting the need for scientists to carefully scrutinize the use of these variables in their work.     

Effects of Parent Emotion Socialization on the Neurobiology Underlying Adolescent Emotion Processing: A Multimethod fMRI Study

Research on Child and Adolescent Psychopathology - Parents’ emotion socialization (ES) practices impact socioemotional development throughout adolescence. Little is known, however, regarding...     

Salience and asymmetric judgments of physical distance

Previous research has shown that distance estimates made from memory are often asymmetric. Specifically, when A is a prominent location (a landmark) and B is not, people tend to recall a longer distance from A to B than from B to A. Results of two experiments showed that asymmetric judgments of distance are not restricted to judgments made from memory but occur also for judgments made when all relevant visual cues are still present. Furthermore, results indicated that situational salience is sufficient to produce asymmetric judgments and that distinctiveness (such as in the case of architectural landmarks) is not necessary.