Health care need: three interpretations

The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need, the three interpretations provide a starting-point for further debate of what the concept means in its specific application. We discuss combined interpretations, the meaning of grading needs, and compare needs-based priority setting to social welfare maximisation.     

Common fronto-parietal activity in attention, memory, and consciousness: shared demands on integration?

Fronto-parietal activity has been frequently observed in fMRI and PET studies of attention, working memory, and episodic memory retrieval. Several recent fMRI studies have also reported fronto-parietal activity during conscious visual perception. A major goal of this review was to assess the degree of anatomical overlap among activation patterns associated with these four functions. A second goal was to shed light on the possible cognitive relationship of processes that relate to common brain activity across functions. For all reviewed functions we observed a consistent and overlapping pattern of brain activity. The overlap was most pronounced for the bilateral parietal cortex (BA 7 and BA 40; close to the intraparietal sulcus), and dorsolateral prefrontal cortex (right BA 9 and left BA 6). The common fronto-parietal activity will be discussed in terms of processes related to integration of distributed representations in the brain.     

The predictive validity of nonverbal communicative skills in infants with perinatal hazards

This study investigated the predictive validity to 5 years of age of nonverbal communicative skills administered at 13 months. Subjects (N = 103) were Norwegian infants with birthweight below 1501 gms. The predictors included infant competence assessed by the Early Social-Communication Scales (ESCS). Cognitive competence at 2 years was measured by the Bayley Mental Development Scale, and at 3 and 5 years by the Stanford-Binet Intelligence Scale: Fourth Edition (SB:FE). Language competence at 2 and 3 years was assessed by the Reynell Developmental Language Scales, and at 5 years by a verbal comprehension factor derived from the SB:FE. Partial correlations and multiple regression analyses suggest that the infants' initiation of communication was related to cognitive ability and language skills up to 5 years of age. In particular, joint attention was the most consistent predictor of the subsequent competencies. The Bayley cognitive index was overruled as a predictor when used in combination with initiation of joint attention.     

The role of enactment in implicit and explicit memory

Enactment during the encoding of simple imperatives has been found to improve substantially performance on conceptually driven explicit-memory tests. In two experiments the effect of this manipulation on a conceptually driven implicit test (category association) was studied. A conceptually driven explicit test (free recall) was also included. In Experiment one three different study conditions (enactment with real objects, reading, and generation) were considered. In Experiment two there were two study conditions (enactment with imaginary objects and reading). Compared to reading, generation was found to improve the performance on both free recall and category association, whereas enactment affected free recall only. In a final experiment subjects imagined that they performed the tasks, and this manipulation was found to improve the memory performance on both tests. Taken together, this pattern of results is interpreted as suggesting that free recall and category association have a process in common that is sensitive to semantic processing at study (promoted by generation and imagery, but not by enactment), and that free recall involves a retrieval process in addition that is facilitated by a rich encoding environment (provided by enactment).     

Chain of Care for Patients with Intentional Self‐Harm: An Effective Strategy to Reduce Suicide Rates?

Chain of care for patients with intentional self‐harm was important in the Norwegian national action plan to prevent suicide. In this study there were two aims: (1) to calculate the potential effects of chain of care on reducing suicide rates, and (2) to assess whether suicide rates decreased more in areas where chain of care had been implemented than in other areas. We observed no differences in changes in suicide rates between areas with and without the intervention. The calculated potential effects of chain of care on national suicide rates were very small, even under unrealistically favorable conditions.     

Testing the Work Environment Hypothesis of Bullying on a Group Level of Analysis: Psychosocial Factors as Precursors of Observed Workplace Bullying

The present paper scrutinises the work environment hypothesis of bullying by examining relationships between psychosocial factors at work and bullying within departments on a group level of analysis, as compared to the many studies executed on an individual level of analysis. Relationships between quantitative demands, job control, role demands, leadership behaviour and social climate, and observed bullying were studied in a convenience sample consisting of 276 departments with a total of 4,064 respondents. Between‐group bivariate correlations showed relatively strong relationships (r > .52) between the predictors social climate, leadership behaviour, and role demands, respectively, and observed bullying in the department. A two‐factor higher‐level model was formulated for the independent variables yielding two latent factors reflecting an interpersonal domain and a task‐oriented domain, where the former was strongly associated with observed bullying at a group level of analysis (Beta =?.73), while the last factor yielded an insignificant contribution. The results confirm that a poor social work environment exists within departments in which bullying takes place, hence, yielding further support to the work environment hypothesis. In line with the present results, future studies on workplace bullying should include a group level of analysis.     

The impact of optimality on maternal sensitivity in mothers with substance abuse and psychiatric problems and their infants at 3 months

The main aim of this study was to investigate the predictive validity of four different optimality indexes, as well as infant perinatal status, in relation to maternal sensitivity in interaction at 3 months. The four optimality indexes comprised items related to substance abuse, psychiatric condition, relational experience and socioeconomic status (SES). Maternal sensitivity in mother-infant interaction was assessed in two different groups of mothers. One group consisted of mothers with substance abuse and psychiatric problems who underwent treatment during pregnancy. The other group of mothers had neither substance abuse nor psychiatric problems. The expectant mothers were interviewed in the third trimester of pregnancy. Medical records and meconium were obtained from the infants at birth. Three months after birth, maternal sensitivity in mother-infant interaction was assessed. Altogether 79 mother-infant dyads participated in the study. The mothers' optimality associated with relational experiences, as well as the infants' perinatal status were found to predict maternal sensitivity in mother-infant interaction at 3 months. The SES index was also significantly related to maternal sensitivity. The relation between group and maternal sensitivity was mediated by the mothers' optimality associated with relational experiences. This study points to the importance of addressing the mothers' own relational experiences and their current representations of motherhood during treatment, in order to support and enhance maternal sensitivity.