Misapplying autonomy: why patient wishes cannot settle treatment decisions

Theoretical Medicine and Bioethics - The principle of autonomy is widely recognized to be of utmost importance in bioethics; however, we argue that this principle is often misapplied when one fails...     

On the Informativeness of Information System Ontologies

Philosophia - The current (still limited) use of the notion of informativeness in the domain of information system ontologies seems to indicate that such ontologies are informative if and only if...     

The Partners for Life Program: A Couples Approach to Cardiac Risk Reduction

Morbidity and mortality are reliably lower for the married compared with the unmarried across a variety of illnesses. What is less well understood is how a couple uses their relationship for recommended lifestyle changes associated with decreased risk for illness. Partners for Life compared a patient and partner approach to behavior change with a patient only approach on such factors as exercise, nutrition, and medication adherence. Ninety‐three patients and their spouses/partners consented to participate (26% of those eligible) and were randomized into either the individual or couples condition. However, only 80 couples, distributed across conditions, contributed data to the analyses, due to missing data and missing data points. For exercise, there was a significant effect of couples treatment on the increase in activity and a significant effect of couples treatment on the acceleration of treatment over time. In addition, there was an interaction between marital satisfaction and treatment condition such that patients who reported higher levels of marital distress in the individuals condition did not maintain their physical activity gains by the end of treatment, while both distressed and nondistressed patients in the couples treatment exhibited accelerating gains throughout treatment. In terms of medication adherence, patients in the couples treatment exhibited virtually no change in medication adherence over time, while patients in the individuals treatment showed a 9% relative decrease across time. There were no condition or time effects for nutritional outcomes. Finally, there was an interaction between baseline marital satisfaction and treatment condition such that patients in the individuals condition who reported lower levels of initial marital satisfaction showed deterioration in marital satisfaction, while non satisfied patients in the couples treatment showed improvement over time.     

Differential Item Functioning of the Symptoms of Major Depression by Race and Ethnicity: An Item Response Theory Analysis

This study examines the psychometric properties, and particularly differential item functioning (DIF) due to racial and ethnic group, of the criteria for a major depressive episode using a large sample (N?=?1,063) of outpatients seeking treatment for mood and anxiety disorders. DIF was evaluated using multiple group confirmatory factor analysis. Item thresholds fell along a continuum with the core features of depressed mood and anhedonia, along with fatigue, being endorsed at lower levels of depression, and change in appetite and suicidal ideation endorsed at more severe levels of depression. Item discriminations, reflecting an item’s ability to discriminate between lower and higher levels of depression, were highest for depressed mood and anhedonia, and lowest for change in appetite and suicidal ideation. When examining model fit among the racial groups we did not find differences in symptom functioning, providing support for the use of these symptoms across diverse groups. This is of particular importance given the paucity of studies examining this question using a semi-structured clinician administered instrument to a clinical sample.