Fragility,uncertainty, and healthcare

Medicine seeks to overcome one of the most fundamental fragilities of being human, the fragility of good health. No matter how robust our current state of health, we are inevitably susceptible to future illness and disease, while current disease serves to remind us of various frailties inherent in the human condition. This article examines the relationship between fragility and uncertainty with regard to health, and argues that there are reasons to accept rather than deny at least some forms of uncertainty. In situations of current ill health, both patients and doctors seek to manage this fragility through diagnoses that explain suffering and provide some certainty about prognosis as well as treatment. However, both diagnosis and prognosis are inevitably uncertain to some degree, leading to questions about how much uncertainty health professionals should disclose, and how to manage when diagnosis is elusive, leaving patients in uncertainty. We argue that patients can benefit when they are able to acknowledge, and appropriately accept, some uncertainty. Healthy people may seek to protect the fragility of their good health by undertaking preventative measures including various tests and screenings. However, these attempts to secure oneself against the onset of biological fragility can cause harm by creating rather than eliminating uncertainty. Finally, we argue that there are good reasons for accepting the fragility of health, along with the associated uncertainties.     

The heart of control: Proactive cognitive control training limits anxious cardiac arousal under stress

Research and theory suggest that anxious people employ cognitive control on a relatively late and transient basis. This tendency may impair emotion regulation that depends on early, persistent implementation of cognitive control. We examined whether anxious people could be trained to apply cognitive control proactively (i.e., in advance of goal-related action) and whether such training limited anxiety’s rise during stress. In Study 1, 96 high trait-anxious participants completed proactive or reactive training followed by the Trier Social Stress Test (TSST) with measurement of subjective anxiety, heart rate, and skin conductance level (SCL). In Study 2, 59 high trait-anxious participants completed a proactive or no-instruction training for 4 days and then completed the TSST. For Study 2 but not Study 1, the proactive versus control training was associated with lower stress-related increases in subjective anxiety and heart rate, but not sympathetically mediated SCL. Exercising proactive control may leverage the parasympathetic nervous system to inhibit the escalation of anxious arousal during stress.     

Toward an Understanding of (Em)Power(Ment) for HIV/AIDS Prevention with Adolescent Women

Adolescent females, particularly urban and low-income youth of color, are at particular risk for HIV infection. This article uses an empowerment perspective to consider the degree to which intrapersonal and interpersonal power dynamics in heterosexual relations have an impact on condom use among high-risk youth. Participants in this study were 333 African American and European American urban youth, ages 14–19 years, who were heterosexually active. Measures focused on interpersonal and intrapersonal factors thought to be associated with condom use. This model was most useful in predicting condom use among women and least useful in predicting condom use among male participants. Implications for empowerment theory and future research are discussed.     

Rational Suicide: An Empirical Investigation of Counselor Attitudes

This study investigated attitudes of mental health counselors toward rational suicide. Over 80% of respondents were moderately supportive of the idea that people can make well‐reasoned decisions that death is their best option, and further, they identified a consistent set of criteria to evaluate such decisions. Additionally, analyses revealed that as the scenario moved from client, to friend, to self, rational suicide seemed to gain in acceptability for these professionals. Implications for training and practice in light of the apparent responsibilities with suicidal clients defined in the 1995 American Counseling Association's Code of Ethics and Standards of Practice are discussed.     

Normative studies with the Scale for Interpersonal Behaviour (SIB): II. US students. A cross-cultural comparison with Dutch data.

The Scale for Interpersonal Behaviour (SIB), a multidimensional, self-report measure of state assertiveness, was administered to a nationwide sample of 2375 undergraduates enrolled at 11 colleges and universities across the USA. The SIB was developed in the Netherlands for the independent assessment of both distress associated with self-assertion in a variety of social situations and the likelihood of engaging in a specific assertive response. This is done with four factorially-derived, first-order dimensions: (i) Display of negative feelings (Negative assertion); (ii) Expression of and dealing with personal limitations; (iii) Initiating assertiveness; and (iv) Praising others and the ability to deal with compliments/praise of others (Positive assertion). The present study was designed to determine the cross-national invariance of the original Dutch factors and the construct validity of the corresponding dimensions. It also set out to develop norms for a nationwide sample of US students. The results provide further support for the reliability, factorial and construct validity of the SIB. Compared to their Dutch equivalents, US students had meaningfully higher distress in assertiveness scores on all SIB scales (medium to large effect sizes), whereas differences on the performance scales reflected small effect sizes. The cross-national differences in distress scores were hypothesized to have originated from the American culture being more socially demanding with respect to interpersonal competence than the Dutch, and from the perceived threats and related cognitive appraisals that are associated with such demands.     

Development of hand preferences in marmosets (Callithrix jacchus) and effects of aging

The authors investigated the development of unimanual hand use and hand preferences during feeding in 15 marmosets (Callithrix jacchus), ages birth to 51-70 months. Bimanual hand use was common at 1-2 months, but by 5-8 months unimanual holding had developed and so had significant hand preferences. Half of the marmosets preferred to pick up and take food to the mouth with the left hand, and half preferred the right hand. Individuals maintained the same hand preference at all ages examined. Significant relationships were also found between the postures adopted during feeding and the direction of hand preferences displayed by juvenile marmosets. There was a positive correlation between increased suspension and increased left-hand preference, and a negative correlation between increased feeding in a tripedal posture and increased left-hand preference. These results are discussed in terms of motor development and hemispheric specialization.     

Variables related to pro-choice attitudes among undergraduates

Pro-choice attitudes among undergraduates were assessed to determine the extent of anti-abortion sentiments during President Reagan's first term in office, which was marked by his support of the anti-abortion issue as well as by increased media coverage of the right-to-life movement. Self-administered questionnaires were completed by 840 participants enrolled in introductory psychology classes at a university in central Texas during the week prior to the presidential election of 1984. Students were asked if they would approve or disapprove of abortion under four different circumstances. Results indicated that the majority of both males and females were in favor of allowing abortion under all four conditions.