Arguing ‘for’ the Patient: Informed Consent and Strategic Maneuvering in Doctor–Patient Interaction

As a way to advance integration between traditional readings of the medical encounter and argumentation theory, this article conceptualizes the doctor–patient interaction as a form of info-suasive dialogue. Firstly, the article explores the relevance of argumentation in the medical encounter in connection with the process of informed consent. Secondly, it discloses the risks inherent to a lack of reconciliation of the dialectical and rhetorical components in the delivery of the doctor’s advice, as especially resulting from the less than ideal conditions of the internal states of the doctor and the patient, and the lack of symmetry in their status.     

Neuronal nitric oxide synthase gene inactivation reduces the expression of vasopressin in the hypothalamic paraventricular nucleus and of catecholamine biosynthetic enzymes in the adrenal gland of the mouse

The impact of a lifelong absence of the neuronal nitric oxide synthase (nNOS) in the neuroendocrine stress response was investigated in nNOS knockout (KO) and wild type (WT) mice under basal conditions and in response to forced swimming. In the hypothalamic paraventricular nucleus oxytocin and corticotropin-releasing-hormone mRNA levels did not differ between these genotypes under resting conditions, whereas vasopressin mRNA levels were significantly lower in nNOS KO than in WT animals. Also, in the adrenal glands basal levels of tyrosine hydroxylase protein, the rate-limiting enzyme for catecholamine biosynthesis, and of phenylethanolamine N-methyltransferase, which converts norepinephrine to epinephrine, were significantly reduced in nNOS KO mice. Plasma adrenocorticotropin, corticosterone, norepinephrine and epinephrine levels were similar in the KO and WT genotypes under resting conditions. In response to forced swimming, a similar increase in plasma adrenocorticotropin and corticosterone was observed in KO and WT animals. Stressor exposure triggered also an increased epinephrine release in WT animals, but did not significantly alter plasma epinephrine levels in KO mice. These data suggest that the chronic absence of nNOS reduces the capacity of epinephrine synthesising enzymes in the adrenal gland to respond to acute stressor exposure with an adequate epinephrine release.     

Differences in perceptions on sexual and reproductive health between service providers and people living with HIV: a qualitative elicitation study

The sexual and reproductive health (SRH)-related needs of people living with HIV/AIDS (PLHA) have not been sufficiently recognised in research and clinical care. Fifteen study sites in 13 European countries participated in this qualitative study to assess differences in perceptions between service providers (SP) and PLHA on SRH-related problems and needs of PLHA. Factors influencing SRH were determined to collect evidence on how to improve service provision. Qualitative data were obtained using an interpretative ethnographical approach. Data were analysed inductively on country level; a cross country data matrix was developed to facilitate the contextual analysis. Thirty-seven FGD discussions were organised with a total of 254 participants. A short survey was distributed to assess demographic characteristics. Results revealed insufficient information and lack of behavioural skills regarding SRH issues among PLHA. Intra- and interpersonal, provider-related, and social factors were found to influence the SRH behaviours of PLHA. Although from patients' perception SRH is a prioritized issue, it rarely comes up during routine HIV clinical care. SP need adequate counseling training to tackle SRH-related issues. A better integration between HIV care programs and SRH care settings is needed to improve effective service provision.     

Practical Adaptations of Cognitive Processing Therapy with Bosnian Refugees: Implications for Adapting Practice to a Multicultural Clientele

Recent findings suggest that established psychological treatments for PTSD are effective for diverse populations, including war refugees who have experienced multiple and severe losses, deprivations, hardships, and atrocities. Treating non-English-speaking traumatized refugees requires the clinician to overcome linguistic and various cultural dissimilarities with clients that complicate effective engagement. Examples of clinical adaptations for Bosnian clients are presented along with a discussion of the client’s and therapist’s relationship to the larger service delivery system.     

Out of the Clash of Hermeneutic Rules Comes Ethical Decision Making: But Does it?

IRBs and REBs use specialized language. A process of definition and re-definition of the situation occurs. That process of interpretation can usefully be considered from the perspective of interpretive social science models involving Symbolic Interaction, Semiotics and Hermeneutics. Seven examples are provided to flesh out the nuances of contextual decision making and the “casuistic” aspects of a balanced approach to complex problems. While many decisions are relatively unproblematic and can follow a template, it is not possible simply to apply a fixed and mechanical approach. Hence, a socialization process occurs in which committee members must learn the actual application of the rules as opposed to the formal requirements. A “tightrope” between overly rigid and overly lax interpretations must be crossed and the more we understand the process of semiosis and the semiotic context the more likely it will be that truly ethical decisions will be “accomplished.” The lack of adequate survey data makes it all the more important to have good theoretical understanding of process.     

Sex differences in the association of math achievement with visual-spatial and verbal working memory: Does the type of math test matter?

Previous research on sex differences in mathematical achievement shows mixed findings, which have been argued to depend on types of math tests used and the type of solution strategies (i.e., verbal versus visual-spatial) these tests evoke. The current study evaluated sex differences in (a) performance (development) on two types of math tests in primary schools and (b) the predictive value of verbal and visual-spatial working memory on math achievement. Children (N = 3175) from grades 2 through five participated. Visual-spatial and verbal working memory were assessed using online computerized tasks. Math performance was assessed five times during two school years using a speeded arithmetic test (math fluency) and a word problem test (math problem solving). Results from Multilevel Multigroup Latent Growth Modeling, showed that sex differences in level and growth of math performance were mixed and very small. Sex differences in the predictive value of verbal and visual-spatial working memory for math performance suggested that boys seemed to rely more on verbal strategies than girls. Explanations focus on cognitive and emotional factors and how these may interact to possibly amplify sex differences as children grow older.     

Effects of nutritive and non-nutritive sucking on infant heart rate variability during the first 6 months of life

The effects of eating on heart rate variability (HRV) differ between adults and newborns. This may reflect the impact of suckling on the overall psychophysiological and autonomic nervous system maturation. The purpose of the present study was to explore whether the reactions of HRV during feeding change towards the adult pattern during the first 6 months of life. In addition, the effects of non-nutritive and nutritive sucking on heart rate (HR) and HRV were compared. The participants were 23 infants on whom recordings were performed as newborns and at 6, 12 and 24 weeks old. Nutritive sucking caused an increase in HR and a decline in HRV. The results were consistent with previous reports of a decrease in high frequency components of HRV during feeding in newborns, reflecting a decrease in parasympathetic activity. This response was apparent in all four ages studied, and remained similar throughout the 6-month period. However, age as an independent factor seemed to influence both HR and HRV. Pacifier sucking had no significant effects on HRV at any age. The results demonstrate the physical strain that sucking imposes on the baby, with a specific autonomic nervous system response involved. We consider this response an essential part of the overall psychophysiological maturation of infants.     

Serious fun: preschoolers engage in more exploratory play when evidence is confounded

Researchers, educators, and parents have long believed that children learn cause and effect relationships through exploratory play. However, previous research suggests that children are poor at designing informative experiments; children fail to control relevant variables and tend to alter multiple variables simultaneously. Thus, little is known about how children's spontaneous exploration might support accurate causal inferences. Here the authors suggest that children's exploratory play is affected by the quality of the evidence they observe. Using a novel free-play paradigm, the authors show that preschoolers (mean age: 57 months) distinguish confounded and unconfounded evidence, preferentially explore causally confounded (but not matched unconfounded) toys rather than novel toys, and spontaneously disambiguate confounded variables in the course of free play.     

Retrospective ratings of ADHD symptoms made at young adulthood by clinic-referred boys with ADHD-related problems, their brothers without ADHD, and control participants

Retrospective childhood attention-deficit/hyperactivity disorder (ADHD) symptoms are required to diagnosis adult ADHD, but the validity of self-rated symptoms across time is questionable. Here, boys with ADHD-related problems, their brothers without ADHD, and former schoolmates rated themselves during young adulthood for ages 9, 14, and 19. Brothers rated probands retrospectively at the same ages. The young adults referred as children for ADHD (a) acknowledged childhood symptoms; (b) described improvement over time; (c) did not differ from brothers or controls on most self-ratings of young adult symptoms; (d) rated themselves as more symptomatic at age 9, but less symptomatic at age 19, than their brothers rated them; and (e) agreed only to some degree with brothers' ratings of probands' aggression (median correlation = .22). Probands' ratings showed limited agreement with judges' symptom ratings (median correlation = .16) and young adult follow-up examiners' ratings (median correlation = .14). These findings are not accounted for solely by changes in informants, nor by the course of ADHD psychopathology. They suggest some stability but limited internal consistency and validity for retrospective ADHD ratings by probands and brothers.