Illness representations and matching labels with symptoms

Three studies are reported that show that health-relevant information (e.g., blood pressure [BP] or symptoms) initiates an active cognitive search process that results in the construction of an illness representation. Study 1 showed that informing subjects that their BP was elevated affected two attributes of illness representation: identity (label and symptoms), and time line or expected chronology of the health threat. Subjects given a high-BP reading reported symptoms commonly associated with high BP, especially if they attributed the high-BP reading to stress. Study 2 showed that the active search process uses causal information (a third attribute of representations) to give meaning to symptoms. Specifically, subjects used environmental cues to interpret whether familiar, unfamiliar, and ambiguous symptoms were due to illness or to stress. In Study 3 we showed that the constructive process, initiated by a high-BP reading, is directed by prior beliefs about the time line for developing high BP and by the presence of external cues about the stressfulness of the subject's daily life. Subjects who believed BP was labile and that they were under high daily stress or who believed BP was stable and that they were under low daily stress reported more symptoms. The significance of these findings for understanding how people process diagnostic labels and symptom information involved in the construction of illness representations is discussed.     

Germ-line gene therapy and the clinical ethos of medical genetics

Although the ability to perform gene therapy in human germ-line cells is still hypothetical, the rate of progress in molecular and cell biology suggests that it will only be a matter of time before reliable clinical techniques will be within reach. Three sets of arguments are commonly advanced against developing those techniques, respectively pointing to the clinical risks, social dangers and better alternatives. In this paper we analyze those arguments from the perspective of the client-centered ethos that traditionally governs practice in medical genetics. This perspective clarifies the merits of these arguments for geneticists, and suggests useful new directions for the professional discussion of germ-line gene therapy. It suggests, for example, that the much discussed prospect of germ-line therapy in human pre-embryos may always be more problematic for medical genetics than adult germ-line interventions, even though the latter faces greater technical difficulties.     

School-Based Secondary Prevention for Children with Disruptive Behavior: Initial Outcomes

First through fourth graders from 22 suburban elementary schools were screened for cross-setting disruptive behavior as eligibility criteria for participation in a longitudinal secondary prevention study aimed at reducing the risk for serious externalizing behavioral disorders. Three hundred nine subjects participated in either a multicomponent competence enhancement intervention (MCEI) or an information/attention control (IAC) condition over a 2-year period. Following baseline measurements, initial intervention effects were assessed at the end of intervention Year 1, at the beginning of intervention Year 2 (fall of the next school year), and at the end of intervention Year 2. Multisource assessments were not supportive of the efficacy of the MCEI over the IAC condition. Children in both groups rated themselves as improved over time in terms of increased adaptive skills and decreased school problems and internalizing symptoms. Teacher and parent ratings of externalizing behavior did not yield evidence of positive change, but teachers noted improved problem solving and observers noted a decrease in behavioral interference in both groups over time, possibly as a result of maturation.     

Solution-focused Couples Therapy Groups: An Empirical Study

The professional literature contains numerous theoretical and case study articles regarding the development and use of solution-focused therapy. However, as with many models of systems-oriented therapy in use with couples, very little has been subjected to empirical investigation. This project was designed to make a contribution to the empirical literature regarding the effectiveness of solution-focused therapy in use with couples' groups. This study utilized pre-test comparisons of treatment and comparison groups, and examined pre- to post-test changes in the scores of the treatment group couples. Twenty-three treatment group couples participated in a six-week solution-focused couples therapy (SFCT) group. A separate group of thirteen couples served as a comparison group. The Dyadic Adjustment Scale (DAS) was used to assess changes in the couples' relationships. Scores on the Marital Status Inventory (MSI), as a pre-test measure indicating the couples' likelihood of divorce, indicated no significant differences between groups. The remaining analyses revealed significant improvement in DAS scores. Self-reports from the couples involved indicate improvement in a variety of areas after completing the six-week solution-focused couples group therapy process.     

Probability spaces,hilbert spaces,and the axioms of test theory

A branch of probability theory that has been studied extensively in recent years, the theory of conditional expectation, provides just the concepts needed for mathematical derivation of the main results of the classical test theory with minimal assumptions and greatest economy in the proofs. The collection of all random variables with finite variance defined on a given probability space is a Hilbert space; the function that assigns to each random variable its conditional expectation is a linear operator; and the properties of the conditional expectation needed to derive the usual test-theory formulas are general properties of linear operators in Hilbert space. Accordingly, each of the test-theory formulas has a simple geometric interpretation that holds in all Hilbert spaces.     

Organizational Coverups: Factors Influencing the Discipline of Information Gatekeepers1

This study examines factors that influence the severity of discipline administered to a subordinate information gatekeeper who is guilty of covering up an event and concealing and distorting information. Undergraduate business students read one of eight versions of a case depicting faulty upward communication, in which three variables-the superior-subordinate dependency relationship, the subordinate's motivation, and the subordinate's remorse-were manipulated. Unethicality of the offense was evaluated to be quite high across all experimental conditions, yet mild discipline was recommended when the superior was highly dependent on his subordinate and when the subordinate acted out of altruism for his superior. Probability of reoccurrence of the infraction was judged lowest when the offending subordinate displayed remorse. These findings are interpreted as representing a pragmatic orientation toward discipline based on perceived costs or benefits to the administrator. Conditions that increase the vulnerability of decision-makers to faulty upward communication are discussed.