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.     

Father responsivity: couple processes and the coconstruction of fatherhood

Forty in-depth interviews of heterosexual parents of children 5 five years of age and younger are analyzed using a qualitative grounded theory approach to understand how couples coproduce fatherhood within their day-to-day relationships and in social, cultural, and economic contexts. The analysis identifies the construct "responsivity" as a central process through which, to varying degrees, fathers are aware of the needs of their wives and children and able to take an active part in meeting them. Three groups of fathers are examined according to their level of responsivity: low, moderate, and high. Factors influencing degree of father responsivity include gender constructions, power and the wife's influence, attunement, work schedules, and emotional tradeoffs. Implications for practice are suggested.     

Aging and visual search: automatic and controlled attentional bias to threat faces

Using a visual search paradigm, we investigated how age affected attentional bias to emotional facial expressions. In Experiments 1 and 2, participants searched for a discrepant facial expression in a matrix of otherwise homogeneous faces. Both younger and older adults showed a more effective search when the discrepant face was angry rather than happy or neutral. However, when the angry faces served as non-target distractors, younger adults' search was less effective than happy or neutral distractor conditions. In contrast, older adults showed a more efficient search with angry distractors than happy or neutral distractors, indicating that older adults were better able to inhibit angry facial expressions. In Experiment 3, we found that even a top-down search goal could not override the angry face superiority effect in guiding attention. In addition, RT distribution analyses supported that both younger and older adults performed the top-down angry face search qualitatively differently from the top-down happy face search. The current research indicates that threat face processing involves automatic attentional shift and a controlled attentional process. The current results suggest that age only influenced the controlled attentional process.     

Appearance of symmetry, beauty, and health in human faces

Symmetry is an important concept in biology, being related to mate selection strategies, health, and survival of species. In human faces, the relevance of left-right symmetry to attractiveness and health is not well understood. We compared the appearance of facial attractiveness, health, and symmetry in three separate experiments. Participants inspected front views of faces on the computer screen and judged them on a 5-point scale according to their attractiveness in Experiment 1, health in Experiment 2, and symmetry in Experiment 3. We found that symmetry and attractiveness were not strongly related in faces of women or men while health and symmetry were related. There was a significant difference between attractiveness and symmetry judgments but not between health and symmetry judgments. Moreover, there was a significant difference between attractiveness and health. Facial symmetry may be critical for the appearance of health but it does not seem to be critical for the appearance of attractiveness, not surprisingly perhaps because human faces together with the human brain have been shaped by adaptive evolution to be naturally asymmetrical.     

Children of the Affluent: Challenges to Well-Being

Growing up in the culture of affluence can connote various psychosocial risks. Studies have shown that upper-class children can manifest elevated disturbance in several areas-such as substance use, anxiety, and depression-and that two sets of factors seem to be implicated, that is, excessive pressures to achieve and isolation from parents (both literal and emotional). Whereas stereotypically, affluent youth and poor youth are respectively thought of as being at "low risk" and "high risk," comparative studies have revealed more similarities than differences in their adjustment patterns and socialization processes. In the years ahead, psychologists must correct the long-standing neglect of a group of youngsters treated, thus far, as not needing their attention. Family wealth does not automatically confer either wisdom in parenting or equanimity of spirit; whereas children rendered atypical by virtue of their parents' wealth are undoubtedly privileged in many respects, there is also, clearly, the potential for some nontrivial threats to their psychological well-being.     

“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.     

Perfectionism, life events, and depressive symptoms: A test of a diathesis-stress model

The present research tested the hypothesis that perfectionists who experience stress are vulnerable to depression, in part because negative life events represent a failure to maintain control over negative outcomes. In Study 1, 215 subjects completed the Multidimensional Perfectionism Scale (MPS) and control measures. The MPS assesses self-oriented, other-oriented, and socially prescribed perfectionism. It was confirmed that self-oriented and other-oriented perfectionism were associated with both higher desire for control and greater perceived personal control. Study 2 examined whether trait levels of perfectionism moderate the link between life stress and symptoms of depression. In addition, prospective analyses investigated whether perfectionism accounts for changes in levels of depressive symptomatology over time. Two samples comprised of 374 students (Sample 1) and 173 students (Sample 2) completed the MPS and measures of major life stress and depression symptoms. Subjects in Sample 2 completed these measures at two timepoints separated by a three-month interval. Regression analyses indicated that self-oriented perfectionism and life stress interact significantly to produce higher levels of depressive symptomatology. Moreover, in Sample 2, self-oriented perfectionism at Time 1 was associated with increases in depression symptoms three months later for those individuals who had experienced a major life event. The results provide support for diathesis-stress models, which maintain that perfectionists exposed to life stress are vulnerable to symptoms of depression. The results are discussed in terms of their implications for the study of personality, stress, and vulnerability to symptoms of depression. This research was supported by grants #410-89-0335, #410-91-8056, and #410-93-1256 from the Social Sciences and Humanities Research Council of Canada awarded to the authors.