Many of the same fundamental principles and regulations that govern civilian biomedical research also apply to research conducted by the US Military. Despite these similarities, the conduct of research by the US Military has additional requirements designed to preserve service members' informed consent rights, ethical standards and information that may be deemed classified. Furthermore, there are also additional rules and regulations associated with potential research to be done in a combat setting. Before conducting battlefield research, many unique circumstances must be considered to include: (1) the current legal and regulatory requirements for advanced informed consent (2) the tactical situations, and the ability to adequately document in the "austere" environment (3) the need to provide improved drugs and devices for combat casualty care and (4) the special nature of the superior-subordinate relationship. This paper discusses historical background, regulatory oversight, ethical implications and release of information as it pertains to research conducted by the US Military. 相似文献
We randomized, at two sites, 210 patients with Rome II diagnosed irritable bowel syndrome (IBS), of at least moderate severity, to one of three conditions: group-based cognitive therapy (CT; n=120), psychoeducational support groups (n=46) as an active control, or intensive symptom and daily stress monitoring (n=44). One hundred eighty-eight participants completed the initial treatment. Those in symptom monitoring were then crossed over to CT. For an intent to treat analysis on a composite GI symptom measure derived from daily symptom diaries, both CT and the psychoeducational support groups were significantly more improved than those in the intensive symptom monitoring condition, but the CT and psychoeducational support group did not differ. Among treatment completers on the same composite measure of GI symptoms, again, both CT and psychoeducational support groups were statistically superior to symptom monitoring but did not differ on the symptom composite, or on any other measure. On individual IBS symptoms, both CT and psychoeducational support were statistically superior to symptom monitoring on reductions in abdominal pain and tenderness and for flatulence. Patient global ratings at the end of treatment showed the two active conditions statistically superior to symptom monitoring on change in Bowel Regularity, with CT superior to symptom monitoring on reduction in overall pain and in improvement in sense of well-being. Three-month follow-up data on 175 patients revealed maintenance of significant improvement or continued significant improvement on all IBS symptoms, including the McGill Pain Questionnaire. Group CT and psychoeducational support groups continued not to differ on any measure. We thus conclude that group CT is not superior to an attention placebo control condition. 相似文献
Responses to the Kessler Psychological Distress Scale (K10) and the Mental Health Index-5 (MHI-5) mental health subscale of the Medical Outcomes Study Short Form (SF-36) survey cover broadly similar constructs. The aim of this paper is to use the equipercentile method to produce a concordance between K10 and MHI-5 across the whole score distribution. Comparisons were made using survey data from the Australian Longitudinal Study on Women’s Health (ALSWH) and the Household, Income and Labour Dynamics in Australia (HILDA) survey, which used both the K10 and the MHI-5 measures at the same time for the same participants. Agreement was assessed with Bland-Altman plots. The differences between MHI-5 scores and transformed K10 scores were assessed with paired t-tests. For the ALSWH data there is good agreement between MHI-5 scores and scores equated from the K10. The mean of the differences is −0.15 with standard deviation 10.8. Using the ALSWH transformation on the HILDA data for different age groups and genders, the mean differences ranged from 0.43 to 3.38 with corresponding standard deviations of 11.1 to 9.9. The concordance table was very similar to one obtained by the more complicated item response theory method. The results suggest that longitudinal surveys of the same respondents that previously used MHI-5 could adopt the K10 (or vice versa) without loss of comparability.
Marriage has significantly changed since Becker proposed his specialization model yet some scholars maintain that specialization characterizes modern couples. Specialization occurs when one partner, traditionally the man, concentrates on market work while the other partner, traditionally the woman, focuses on nonmarket work such as housework or childcare. Using innovative time diary data from primarily highly-educated, White, dual-earner U.S. couples, we examine how couples manage their time in market and household work and leisure across a momentous, gendered life course turning point—the transition to parenthood. We find little evidence of specialization, but stronger evidence of nonspecialization where both partners concurrently engaged in market work or leisure. Yet gender still mattered. Men enjoyed more leisure time, particularly on nonworkdays, whereas their partners performed more nonmarket work. Our study is the first known to uncover exactly what men were doing while women performed additional minutes of housework and childcare. On nonworkdays, fathers engaged in leisure 47% and 35% of the time during which mothers performed childcare and routine housework, respectively. Mothers engaged in leisure only about 16% to 19% of the time that fathers performed childcare and routine housework. In sum, although our study challenges economic theories of specialization by suggesting that nonspecialization is the norm for new parents’ time among highly-educated, dual-earner couples, persistent gender inequalities continue to characterize family work and leisure time. 相似文献
In the context of efforts to regulate emotion during chronic stressors, both dispositional response tendencies (affect intensity, negative and positive expressivity) and stressor‐related coping through emotional approach (processing and expressing emotions) are relevant to adjustment. In women with metastatic breast cancer (N = 103), contributions of self‐reported emotional processing and expression related to cancer, as well as dispositional expressivity to adaptive outcomes across 3 months were examined. In the context of high dispositional expressivity, an increase in emotional expression predicted improvements in depressive symptoms and life satisfaction. Emotional processing at study entry predicted increased depressive symptoms and intrusive thoughts, and declining life satisfaction among highly expressive women. Increasing emotional processing predicted improved depressive symptoms in the context of high expressivity. Increases in emotional approach coping were associated with a more arduous cancer experience. Findings highlight the importance of the person‐situation fit in linking emotion‐related constructs to adjustment during unremitting stressors. 相似文献
This study examined the effects of the Boys Town In-Home Family Program (BT-IHFP) on parenting skills, family functioning, and child behavior for at-risk families involved with child protective services. The BT-IHFP is designed as a home-based, family-centered alternative to out-of-home placement with the goal of improving family functioning, keeping families together, and preventing further involvement with child protective services. The model uses a hands-on cognitive-behavioral approach, promotes family engagement, provides 24/7 services to families, and links families to community resources. While it is essential to examine ultimate, long-term outcomes such as family preservation, it is also important to investigate the proximal and intermediate outcomes that address the key changes in behavior that support successful long-term outcomes. The goals of this study were to (1) examine the pre-post change of proximal and intermediate outcomes and (2) examine if improvements in parenting skills, parental roles, and parental stress (proximal outcomes) will be related to improvements in child behavior at home, child behavior at school, and family functioning (intermediate outcomes). Inspecting intake and discharge data for 44 families, 94% were intact at discharge and significant pre-post improvements were found in proximal and intermediate outcomes. These findings suggest that this six-week intensive BT-IHFP holds promise for teaching at-risk families skills to promote positive family functioning. 相似文献