Applying evidence to support ethical decisions: Is the placebo really powerless?

Using placebos in day-to-day practice is an ethical problem. This paper summarises the available epidemiological evidence to support this difficult decision. Based on these data we propose to differentiate between placebo and “knowledge framing”. While the use of placebo should be confined to experimental settings in clinical trials, knowledge framing — which is only conceptually different from placebo — is a desired, expected and necessary component of any doctor-patient encounter. Examples from daily practice demonstrate both, the need to investigate the effects of knowledge framing and its impact on ethical, medical, economical and legal decisions. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

A Short Measure of the Revised Reinforcement Sensitivity Theory – RSQ17

The need for a research and practical tool, such as a short, reliable, and valid personality assessment test, suggests researchers to create shortened versions of original instruments. Reinforcement sensitivity questionnaire (RSQ) was created in line with some basic premises of revised Reinforcement sensitivity theory, which proposes three motivational and emotional systems: Behavioral inhibition system (BIS), responsible for scanning environment for potential threats, Behavioral activation system (BAS), responsible for aproaching behavior, and the Fight/Flight/Freeze system (FFFS), responsible for behavior in the present threat. RSQ comprises five scales: BIS, BAS, Fight, Flight, and Freeze. The aim of this study was to develop a short version of RSQ, which would be beneficial to both research and practical purposes. Item response theory analyses were used for item selection. The study comprised two samples of participants, whereby Sample 1 (N = 837, 34.6% male, aged 18 – 82, M = 31.63, SD = 13.54) served as the derivation sample, while Sample 2 (818 participants, 43.6% male, 18?75 years, M = 29.65, SD = 12.52) served as validation sample. Factorial validity of the short RSQ was examined on both Sample 1 and Sample 2. Convergent and divergent validity of the short RSQ was examined using RST-PQ, Jackson-5, BIS/BAS scales, and Big Five Inventory. The results point to satisfactory internal consistency, factorial validity, and construct validity of the short RSQ, suggesting that it is an adequate measure for research settings or other contexts which require the use of short personality questionnaires.     

Prediction of end-of-life fears in COPD – hoping for the best but preparing for the worst

Objective: The diagnosis of a life-threatening illness can trigger end-of-life fears. Early studies show that end-of-life fears play an important role in chronic obstructive pulmonary disease (COPD). However, predictors of these fears have not yet been identified. This study investigated the relevance of socio-demographic variables, illness severity, psychological distress and disease-specific anxieties as predictors of end-of-life fears in COPD.

Design: A total of 131 COPD patients participated at two time points. Regression and mediation analyses, as well as cross-lagged panel analyses were conducted.

Main outcome measures: The participants completed questionnaires assessing end-of-life fears (Multidimensional Orientation toward Dying and Death Inventory), psychological distress (Hospital Anxiety and Depression Scale), and disease-specific anxieties (COPD Anxiety Questionnaire). Pulmonary function and a 6-min walk test served as measures of illness severity.

Results: Illness severity was not predictive of end-of-life fears. However, gender and psychological distress explained incremental variance. When disease-specific anxieties were included as additional predictors, psychological distress was no longer significant. Cross-lagged panel analyses mostly supported these results. Moreover, disease-specific anxieties mediated the association between psychological distress and end-of-life fears.

Conclusion: Administration and intensity of end-of-life care (especially concerning end-of-life fears) in COPD patients should be based not only on illness severity, but rather on psychological distress and disease-specific anxieties.     

Caught in a bad romance: perfectionism, conflict, and depression in romantic relationships

According to the social disconnection model, perfectionistic concerns (i.e., harsh self-scrutiny, extreme concern over mistakes and others' evaluations, and excessive reactions to perceived failures) confer vulnerability to depressive symptoms indirectly through interpersonal problems. This study tested the social disconnection model in 226 heterosexual romantic dyads using a mixed longitudinal and experience sampling design. Perfectionistic concerns were measured using three partner-specific self-report questionnaires. Conflict was measured as a dyadic variable, incorporating reports from both partners. Depressive symptoms were measured using a self-report questionnaire. Perfectionistic concerns and depressive symptoms were measured at Day 1 and Day 28. Aggregated dyadic conflict was measured with daily online questionnaires from Days 2 to 15. Data were analyzed using structural equation modeling. There were four primary findings: (a) Dyadic conflict mediated the link between perfectionistic concerns and depressive symptoms, even when controlling for baseline depressive symptoms; (b) depressive symptoms were both an antecedent and a consequence of dyadic conflict; (c) perfectionistic concerns incrementally predicted dyadic conflict and depressive symptoms beyond neuroticism (i.e., a tendency to experience negative emotions) and other-oriented perfectionism (i.e., rigidly demanding perfection from one's partner); and (d) the relationships among variables did not differ based on gender. As the most rigorous test of the social disconnection model to date, this study provides strong support for this emerging model. Results also clarify the characterological and the interpersonal context within which depressive symptoms are likely to occur.     

Workplace Bullying and Intention to Leave Among Schoolteachers in China: The Mediating Effect of Affective Commitment1

Workplace bullying includes behaviors such as harassing, offending, or socially excluding the target. This study examines whether the relationship between workplace bullying and intention to leave is mediated by affective commitment. Based on data from 142 schoolteachers in China, a partial least squares analysis revealed that affective commitment partially mediates the effect of bullying on intention to leave. Furthermore, the direct effect of bullying on intention to leave is stronger than the indirect effect. Theoretical and practical implications include that awareness needs to be raised about what constitutes bullying behavior and that more emphasis needs to be placed on preventing bullying in the workplace.     

Neurophysiologic markers of primary motor cortex for laryngeal muscles and premotor cortex in caudal opercular part of inferior frontal gyrus investigated in motor speech disorder: a navigated transcranial magnetic stimulation (TMS) study

Transcranial magnetic stimulation studies have so far reported the results of mapping the primary motor cortex (M1) for hand and tongue muscles in stuttering disorder. This study was designed to evaluate the feasibility of repetitive navigated transcranial magnetic stimulation (rTMS) for locating the M1 for laryngeal muscle and premotor cortical area in the caudal opercular part of inferior frontal gyrus, corresponding to Broca’s area in stuttering subjects by applying new methodology for mapping these motor speech areas. Sixteen stuttering and eleven control subjects underwent rTMS motor speech mapping using modified patterned rTMS. The subjects performed visual object naming task during rTMS applied to the (a) left M1 for laryngeal muscles for recording corticobulbar motor-evoked potentials (CoMEP) from cricothyroid muscle and (b) left premotor cortical area in the caudal opercular part of inferior frontal gyrus while recording long latency responses (LLR) from cricothyroid muscle. The latency of CoMEP in control subjects was 11.75 ± 2.07 ms and CoMEP amplitude was 294.47 ± 208.87 µV, and in stuttering subjects CoMEP latency was 12.13 ± 0.75 ms and 504.64 ± 487.93 µV CoMEP amplitude. The latency of LLR in control subjects was 52.8 ± 8.6 ms and 54.95 ± 4.86 in stuttering subjects. No significant differences were found in CoMEP latency, CoMEP amplitude, and LLR latency between stuttering and control-fluent speakers. These results indicate there are probably no differences in stuttering compared to controls in functional anatomy of the pathway used for transmission of information from premotor cortex to the M1 cortices for laryngeal muscle representation and from there via corticobulbar tract to laryngeal muscles.     

Psychological predictors for health-related quality of life and disability in persons with chronic obstructive pulmonary disease (COPD)

Objective: Individuals with chronic obstructive pulmonary disease (COPD) exhibit low physical and mental health-related quality of life (HRQL) and high susceptibility to disability. We investigated the influence of psychological factors on HRQL and disability in COPD individuals recruited from the general population. In line with Leventhal’s common sense model, we expected psychological factors to be associated with HRQL and disability even after controlling for medical status.

Methods: Individuals with COPD (n = 502; 59.7 years old; GOLD grades were I: 3%, II: 17%, III: 34%, IV: 46%) were assessed through an online survey administered via COPD patient organisations in Germany. Individuals filled in the Short Form Health Survey (SF-12), COPD Assessment Test, Patient Health Questionnaire (modules: GAD-2, PHQ-15, PHQ-9), Brief Illness Perception Questionnaire, a questionnaire that assesses causal illness attributions, and the internal illness-related locus of control scale of the ‘KKG questionnaire for the assessment of control beliefs about illness and health’. Multiple linear regressions were calculated.

Results: The investigated factors explained high variances (disability = 56%, physical HRQL = 28%, mental HRQL = 63%, p ≤ .001). Better mental health, more optimistic illness perceptions, attribution to psychological causes, and stronger internal locus of control were associated with lower disability and better HRQL. Comorbid somatic symptoms contributed to high disability and low quality of life.

Conclusion: Psychological factors, such as illness perception, attribution and internal locus of control, were associated with disability and HRQL. These factors should be considered when designing treatments for individuals with COPD, and adequate interventions should be provided to enhance illness understanding and self-management skills.     

An Imperfect Match? Crime‐related Context Influences Fingerprint Decisions

Research suggests that fingerprint interpretation is vulnerable to contextual influence. Specifically, as contextual information increases in emotional intensity, people appear to increase the rate at which they deem fingerprint pairs to share the same source. We investigated three alternative explanations for this finding: (i) that participants who complete multitrial experiments might make more matches over time; (ii) that the provision of any additional information could influence decision‐making; and (iii) that the effect could be limited to dichotomous response options. In Experiment 1, participants forced to make a match or non‐match decision on 96 fingerprint pairs made more matches when pairs were preceded by crime‐related photographs, relative to neutral photographs or no photographs. In Experiment 2, where an ‘unsure’ option was available, crime‐related context did not influence matches but decreased non‐matches. Further research is necessary to determine the relative contributions of emotionality and motivation to these effects. Copyright © 2015 John Wiley & Sons, Ltd.     

Automatic perceptual simulation of first language meanings during second language sentence processing in bilinguals

Research supports the claim that, when understanding language, people perform mental simulation using those parts of the brain which support sensation, action, and emotion. A major criticism of the findings quoted as evidence for embodied simulation, however, is that they could be a result of conscious image generation strategies. Here we exploit the well-known fact that bilinguals routinely and automatically activate both their languages during comprehension to test whether this automatic process is, in turn, modulated by embodied simulatory processes. Dutch participants heard English sentences containing interlingual homophones and implying specific distance relations, and had to subsequently respond to pictures of objects matching or mismatching this implied distance. Participants were significantly slower to reject critical items when their perceptual features matched said distance relationship. These results suggest that bilinguals not only activate task-irrelevant meanings of interlingual homophones, but also automatically simulate these meanings in a detailed perceptual fashion. Our study supports the claim that embodied simulation is not due to participants' conscious strategies, but is an automatic component of meaning construction.     

Moral Particularism and Epistemic Contextualism: Comments on Lance and Little

Do we need defeasible generalizations in epistemology, generalizations that are genuinely explanatory yet ineliminably exception-laden? Do we need them to endow our epistemology with a substantial explanatory structure? Mark Lance and Margaret Little argue for the claim that we do. I will argue that we can just as well do without them – at least in epistemology. So in the paper, I am trying to very briefly sketch an alternative contextualist picture. More specifically, the claim will be that although an epistemic contextualist should commit himself to epistemic holism he can nevertheless appeal to epistemic principles other than defeasible generalizations in order to provide his epistemology with a structure.