The treatment of depression in older adults in the primary care setting: an evidence-based review.

The objective of this study was to conduct an evidence-based review of treatments for depression in older adults in the primary care setting. A literature search was conducted using PsycINFO and Medline to identify relevant, English language studies published from January 1994 to April 2004 with samples aged 55 and older. Studies were required to be randomized controlled trials that compared psychosocial interventions conducted within the primary care setting with "usual care" conditions. Eight studies with older adult samples met inclusion criteria and were included in the review. Two treatment models were evident: Geriatric Evaluation Management (GEM) clinics and an approach labeled integrated health care models. Support was found for each model, with improvement in depressive symptoms and better outcomes than usual care; however, findings varied by depression severity, and interventions were difficult to compare. Further efforts to improve research and clinical care of depression in the primary care setting for older adults are needed. The authors recommend the use of interdisciplinary teams and more implementation of psychosocial treatments shown to be effective for older adults.     

Children’s causal reasoning: Counterfactual thinking occurs for ‘negative’ outcomes only

Harris, German and Mills (Children’s use of counterfactual thinking in causal reasoning. Cognition, 61 (1996), 223–259), following Mackie, argue that children make explicit use of counterfactual thinking in arriving at causal judgments. They showed that children as young as 3, in explaining simple mishap events, made reference to courses of action that a protagonist had rejected, when that course of action would have prevented the observed outcome. It is hypothesized here that such counterfactual thinking might have been invoked by the ‘negative’ mishaps rather than as part of the causal reasoning process. Although the generation of counterfactuals in explanation was replicated using mishap outcomes such as those used by Harris et al., counterfactual thinking was not evident in children’s explanations of ‘positive’ outcomes. These results undermine the view that a counterfactual thinking process, as indexed by reference to possible actions rejected by a protagonist, is necessary for causal reasoning. Alternative characterizations of the relationship between causals and counterfactuals are discussed.     

Stress reactivity and exercise training in premenopausal and postmenopausal women.

Examined the influence of ovarian function on psychophysiological stress responses and determined if aerobic exercise reduced stress reactivity. Fifty premenopausal and postmenopausal women initially were subjected to a public speaking task and an ice-on-the-forehead procedure, during which time their blood pressure and heart rate were monitored and continuous blood samples were obtained. Subjects also underwent aerobic fitness evaluations with a maximum-exercise treadmill test. Subjects were then randomly assigned to a 12-week exercise program of either aerobic exercise (e.g., walking and jogging at a prescribed exercise intensity) or non-aerobic strength and flexibility training and were then reevaluated. Results indicated that postmenopausal women exhibited lower resting epinephrine levels but greater epinephrine reactivity to the speaking task compared to the premenopausal women. There were no differences between premenopausal and postmenopausal women with respect to cardiovascular or catecholamine responses during the cold challenge. Premenopausal and postmenopausal women also achieved comparable improvements in aerobic fitness. However, results of the mental stress testing were complex and provided only partial support for the role of aerobic exercise in reducing stress responses.     

A developmental dissociation between category and function judgments about novel artifacts

Two studies investigated the relative importance of information about intended design and current use on judgments about the function (Experiment 1) or category (Experiment 2) of novel artifacts in preschool children and adults. Adults assigned function and name on the basis of information about design across all conditions, while children’s decisions about function dissociated from decisions about category. Function judgments (in both 4 and 6-year-olds) were neutral between design and current use, both when the current use was idiosyncratic (e.g. performed by just one agent) and conventional (performed by many people; Experiment 1). By contrast, where category judgments were required for the very same objects (Experiment 2), children named according to design intentions - but only if the alternate function was idiosyncratic. Judging function and assigning category are thus cognitive tasks that draw on different information across development, a fact that should be captured by theories of developing artifact concept structure.     

Is Socrates free? The Theaetetus as case study

Most scholars agree that Plato’s concept of freedom, to the extent he has one, is ‘intellectualist’: true freedom is submission to the rule of reason through philosophical knowledge of rational order. Surprisingly, though, there are few explicit linkages of philosophy and freedom in Plato. Socrates is called many things in the dialogues, but not ‘free’. I aim to understand why by studying the Theaetetus, heretofore ignored in discussions of Platonic freedom. By examining the Digression (172c-177c) and Socrates’ ‘dream’ about wholes and parts (201c-206c), I show that describing freedom as ‘rule of reason’ simplifies what, for Plato, is a more tangled skein. In the Digression, philosophers are free in occupying a comprehensive standpoint transcending all limited and partial perspectives. Socrates’ dream, however, shows that logos cannot completely account for the knowledge of complex wholes or for itself as such a whole. Philosophical freedom cannot mean comprehensive discursive knowledge, then, since reason lacks a comprehensive grasp of itself. Socrates dreams of the rational whole, but is aware of why it remains only a dream, rather than wakeful knowledge. This awareness constitutes a freedom attained, not in total liberation from the confines of the partial human perspective, but within those confines.     

BEHAVIOR MANAGEMENT OF INFANT SLEEP DISTURBANCE

Using a nonconcurrent multiple baseline design, we evaluated the effects of extinction and stimulus control on nighttime sleep disturbances exhibited by 7 infants. Results showed that frequency and duration of night wakings decreased for all subjects, with corresponding improvements reflected through changes in responses to the sleep behavior scale. Observed improvements maintained at 3 and 24 months posttreatment.     

Are dietary restraint scales valid measures of moderate- to long-term dietary restriction? Objective biological and behavioral data suggest not

Prospective studies indicate that elevated scores on dietary restraint scales predict bulimic symptom onset, but experiments indicate that assignment to dietary restriction interventions reduces bulimic symptoms. One possible explanation for the inconsistent findings is that the dietary restraint scales used in the former studies are not valid measures of dietary restriction. The authors previously found that dietary restraint scales were not inversely correlated with objective measures of short-term caloric intake (E. Stice, M. Fisher, & M. R. Lowe, 2004). In this follow-up report, 3 studies indicated that the Three-Factor Eating Questionnaire dietary restraint scale was not correlated with doubly labeled water estimated energy intake over 2-week periods or with observationally measured caloric intake over 3 months. Results from this study and others suggest that dietary restraint scales may not be valid measures of moderate- to long-term dietary restriction and imply the need to reinterpret findings from studies that have used dietary restraint scales.