Medical Education for Social Justice: Paulo Freire Revisited

Although social justice is an integral component of medical professionalism, there is little discussion in medical education about how to teach it to future physicians. Using adult learning theory and the work of Brazilian educator Paulo Freire, medical educators can teach a socially-conscious professionalism through educational content and teaching strategies. Such teaching can model non-hierarchical relationships to learners, which can translate to their clinical interactions with patients. Freirian teaching can additionally foster professionalism in both teachers and learners by ensuring that they are involved citizens in their local, national and international communities.     

Canavan disease: a white matter disorder

Breakdown of oligodendrocyte-neuron interactions in white matter (WM), such as the loss of myelin, results in axonal dysfunction and hence a disruption of information processing between brain regions. The major feature of leukodystrophies is the lack of proper myelin formation during early development or the onset of myelin loss late in life. These early childhood WM diseases are described as hypomyelination or dysmyelination arising from a primary block in normal myelin synthesis because of a genetic mutation expressed in oligodendrocytes, or failure in myelination secondary to neuronal or astroglial dysfunctions (van der Knaap 2001 Dev. Med. Child Neurol. 43:705-712). Here, we describe the pathophysiological parameters of Canavan disease (CD), caused by genetic mutations of the aspartoacylase (ASPA) gene, a metabolic enzyme restricted in the central nervous system (CNS) to oligodendrocytes. CD presents pathophysiological dysfunctions similar to diseases caused by myelin gene mutations, such as Pelizaeus-Merzbacher disease (PMD) and several animal models, such as myelin deficient rat (md), jimpy (jp), shiverer (sh), and quaking (qk viable) mutant mice. These single gene mutations have pleiotropic effects, whereby the alteration of one myelin gene expression disrupts functional expression of other oligodendrocyte genes with an outcome of hypomyelination/dysmyelination. Among all of the known leukodystrophies, CD is the first disorder, which was approved and tested for the adeno-associated virus vector (AAV)-ASPA gene therapy (Leone et al. 2000 Ann. Neurol. 48:27-38; Janson et al. 2001 Trends Neurosci. 24:706-712) without much success following the first two attempts. ASPA gene delivery attempts in animal models have shown a lowering of N-acetyl L-aspartate and a change in motor functions, while sponginess of the WM, a characteristic of CD remained unchanged (Matalon et al. 2003 Mol. Ther. 7 (5, Part 1):580-587; McPhee et al. 2005 Brain Res. Mol. Brain Res. 135:112-121) even with better viral serotype and delivery of the gene during early phase of development (Klugmann et al. 2005 Mol. Ther. 11:745-753). While different approaches are being sought for the success of gene therapy, there are pivotal developmental questions to address regarding the specific regions of the CNS and cell lineages that become the target for the onset and progression of CD symptoms from early to late stages of development.     

“The interviewer is a machine!” Investigating the effects of conventional and technology-mediated interview methods on interviewee reactions and behavior

Despite the growing number of organizations interested in the use of asynchronous video interviews (AVIs), little is known about its impact on interviewee reactions and behavior. We randomly assigned participants (N = 299) from two different countries (Switzerland and India) to a face-to-face interview, an avatar-based video interview (with an avatar as a virtual recruiter), or a text-based video interview (with written questions) and collected data on a set of self-rated and observer-rated criteria. Overall, we found that whereas participants reported more negative reactions towards the two asynchronous interviews, observer ratings revealed similar performance across the three interviews and lower stress levels in the two AVIs. These findings suggest that despite technology-mediated interview methods still not being well-accepted, interviewees are not at a disadvantage when these methods are used in terms of how well interviewees perform and how stressed they appear to external observers. Implications are discussed.     

The perceived vulnerability to disease scale: Cross-cultural measurement invariance and associations with fear of COVID-19 across 16 countries

Using cross-sectional data from N = 4274 young adults across 16 countries during the COVID-19 pandemic, we examined the cross-cultural measurement invariance of the perceived vulnerability to disease (PVD) scale and tested the hypothesis that the association between PVD and fear of COVID-19 is stronger under high disease threat [that is, absence of COVID-19 vaccination, living in a country with lower Human Development Index (HDI) or higher COVID-19 mortality]. Results supported a bi-factor Exploratory Structural Equation Modeling model where items loaded on a global PVD factor, and on the sub-factors of Perceived Infectability and Germ Aversion. However, cross-national invariance could only be obtained on the configural level with a reduced version of the PVD scale (PVD-r), suggesting that the concept of PVD may vary across nations. Moreover, higher PVD-r was consistently associated with greater fear of COVID-19 across all levels of disease threat, but this association was especially pronounced among individuals with a COVID-19 vaccine, and in contexts where COVID-19 mortality was high. The present research brought clarity into the dimensionality of the PVD measure, discussed its suitability and limitations for cross-cultural research, and highlighted the pandemic-related conditions under which higher PVD is most likely to go along with psychologically maladaptive outcomes, such as fear of COVID-19.     

Use of the Beck Depression Inventory-II with Adolescent Psychiatric Outpatients

To provide information on the use of the Beck Depression Inventory-II (BDI-II) with adolescents, the BDI-II was administered to 105 male and 105 female outpatients between 12 and 18 years old who were seeking psychiatric treatment. The internal consistency of the BDI-II was high (coefficient = .92). The mean BDI-II total score of the girls was approximately 5 points higher than that of the boys (p < .001), and age (years) was positively correlated with the BDI-II total scores (r = .18, p < .01). An iterated principal-factor analysis identified three factors, but only the Cognitive and Somatic-Affective factors were generalizable.     

Changes in achievement goals and competence perceptions across the college semester

We investigated the relationship between changes in perceptions of competence and changes in achievement goals across a college semester for students enrolled in an introductory psychology course. Two types of competence perceptions were examined: self-efficacy for learning and normative perceived ability. Changes in normative perceived ability were predicted to relate to changes in performance goals, but not mastery goals. Because mastery goals rely on self-referent standards to evaluate ability, we predicted changes in self-efficacy for learning would relate to changes in mastery goals. We also expected changes in self-efficacy for learning to relate to changes in performance goals because learning can lead to the demonstration of superior competence. The predictions were supported for mastery and performance-approach goals, but not for performance-avoidance goals. Very little change in performance-avoidance goals was observed. Scores on the first course exam also predicted change in performance-approach goals, with this effect partially mediated by competence perceptions.     

The Effects of Personal Agency on Regret

In this paper, we examine the role of personal agency as a key antecedent of regret that individuals experience when the outcome of their decision is unfavorable. In contrast to previous research that documents its exacerbating role, we find that personal agency mitigates regret under certain circumstances. A series of experimental studies show that personal responsibility for the decision may attenuate subjective perceptions of the extent of failure and mitigate regret. However, when the superior outcome of the foregone option is known and the failure of the chosen option is irreversible, personal agency may amplify regret. We also find that subjective failure perceptions mediate the relationship between personal agency and regret levels. Copyright © 2012 John Wiley & Sons, Ltd.     

Conceptualizing Attachment Trauma: Exploring Emotional Vulnerabilities among Disaster Affected Children of Gujarat

This study compares attachment trauma and psychological adjustment of child survivors of an earthquake and social violence in Gujarat (n = 127). In particular it explores attachment style/s associated with the two disaster traumas and tries to explicate, what these tell us about the particular vagaries of trauma. Results show larger number of insecurely attached children in the disaster trauma sample and the dismissing attachment style dominates particularly in the earthquake sample whereas in the riots sample one can see a presence of what can be termed as a ‘mixed attachment’ style-vacillation between dismissing and preoccupied states of mind. The implications of these findings for a conceptualization of attachment trauma are discussed in details.