Problems with prioritization: exploring ethical solutions to inequalities in HIV care

Enormous gaps between HIV burden and health care availability in low-income countries raise severe ethical problems. This article analyzes four HIV-priority dilemmas with interest across contexts and health systems. We explore principled distributive conflicts and use the Atkinson index to make explicit trade-offs between health maximization and equality in health. We find that societies need a relatively low aversion to inequality to favor treatment for children, even with large weights assigned to extending the lives of adults: higher inequality aversion is needed to share resources equally between high-cost and low-cost treatment; higher inequality aversion is needed to favor treatment rather than prevention, and the highest inequality aversion is needed to favor sharing treatment between urban and rural regions rather than urban provision of treatment. This type of ethical sensitivity analysis may clarify the ethics of health policy choice.     

Automatic and effortful processing of self-statements in depression

Clark and Beck (1999) and Williams et al. (1997) have come up with quite different conclusions regarding which cognitive processes are most affected by negative self-schemata and negative knowledge structures. In order to increase the understanding of differences in effortful and automatic processing in depression, we compared never depressed (ND), previously depressed (PD) and clinically depressed (CD) individuals on free recall, recognition and fabrication of positive and negative self-statements. The results showed that: (i) overall NDs and PDs recalled more positive self-statements than CDs, whereas CDs correctly recognized more negative self-statements than NDs and PDs; and (ii) CDs and PDs fabricated more negative than positive self-statements, whereas no difference was obtained for NDs. The results seem to be in line with Clark and Beck's suggestions. However, there are several aspects of the present findings that make the picture more complicated.     

Ethnic variations in the initial phase of mental health treatment: a study of Sami and non-Sami clients and therapists in northern Norway

Several studies indicate that mental health and mental health service vary with ethnicity. Ethnically linked social differences affect these results. We examined the multiethnic population in northern Norway where social inequalities between the Sami and the non-Sami population are not prominent. Clients (N=347) and therapists (N=32) in outpatient treatments reported demographics, ethnicity and the therapeutic alliance. Clients also reported pretreatment psychosocial status, service utilization and the type of help requested. Therapist recorded clinical and diagnostic assessments and treatment plans. The Sami and non-Sami client groups were similar in demographics and pretreatment psychosocial characteristics. However, the therapists prescribed more sessions and more socially focused interventions when clients were Sami. Verbal therapy was more often used by the non-Sami therapists. Alliance ratings were positively correlated only between Sami therapists and their clients, and Sami therapists rated the largest initial clinical improvement. Clinics located in the high Sami density areas offered their clients more therapy sessions, than in clinics in the high non-Sami density areas. Ethnic similarity between client and therapist were associated with more frequent use of medication and less frequent use of verbal therapy.     

Explanatory limitations of the HKB model: incentives for a two-tiered model of rhythmic interlimb coordination

The HKB model for rhythmic interlimb coordination has highlighted the importance of coordinative stability and loss of stability, and introduced, with this focus, a new set of explanatory constructs. However, the phenomenological character of both parts of this model (i.e., the potential and the associated system of coupled oscillators) precludes an understanding of how the observed stability characteristics are related to more specific (e.g., biomechanical and neurophysiological) aspects of the movement system. A two-tiered model (involving a distinction between 'neural' and 'effector' dynamics) is discussed that offers handles for addressing such underpinnings of the identified coordination dynamics. The promise of the model in this regard is illustrated by two recent studies showing how explicit accounts of the effector dynamics may help disclose why (and how) particular properties of the peripheral system affect the overall coordination dynamics.     

Primed word-fragment completion and successive memory test performance in normal aging

Young and old subjects were investigated to examine whether: the effects of priming are influenced by aging; there is independence between primed word-fragment completion and recognition performances; and the dependence between different tests is influenced by aging. A successive test paradigm was employed involving repeated assessment of to-be-remembered words by means of recognition and primed word-fragment completion. The results show that implicit memory declines with increasing age, and that correlations between different memory tests decrease with age. The outcome suggests that age-related memory decline involves several forms of memory, including primed word-fragment completion, and is reflected in correlations between measures of implicit and explicit memory.     

Development of spatial memory and spatial orientation in preschoolers and primary school children

The present study addresses the question of what kind of information children use when orientating in new environments, if given proximal and distal landmarks, and how spatial memory develops in the investigated age groups. Ten 5-year-old, ten 7-year-old and ten 10-year-old children were presented with the ‘Kiel Locomotor Maze’, containing features of the Radial Arm Maze and the Morris Water Maze, in order to assess spatial memory and orientation. Children had to learn to approach baited locations only. Task difficulty was equated with respect to the children's age. Training was given until the children reached criterion. During testing, the maze configuration and response requirements were systematically altered, including response rotation, cue rotation, cue deletion and response rotation with cue deletion in order to assess the spatial strategies used by the children. During training and testing, working-memory errors (WM), reference-memory errors (RM) and working-reference memory errors (WR) were recorded. As expected, no difference between age groups appeared during training, thus confirming comparable task difficulty across age groups. During testing, age groups differed significantly with regard to the orientation strategy used. The 5-year-olds were bound to a cue strategy, orientating towards local, proximal cues. The 10-year-olds mastered all tasks, thus displaying a place strategy, being able to use distal cues for orientation, and were even able to do so after being rotated 180°. The 7-year-olds proved to be at an age of transition: five of them were bound to a cue strategy, five children were able to adopt a place strategy. The differences in the orientation strategies used by children of different age groups was reflected by the sum of errors they made, also by RM. WM were found to be rare, especially in older children. We conclude that preschoolers use a cue strategy, that the development of place strategies occurs during primary school age and seems to be complete by the age of 10 years.     

Sleepiness and days of recovery

In the literature recovery after work is taken for granted – one has 16 h off between work bouts and one has 36 h off each weekend. However, the situation for those working irregular work hours may be quite different because of night work, long shifts, or long sequences of working days. Strictly speaking we don't have any scientific support for theories on how recovery days should be patterned. This paper, therefore, brings together data from a series of our own studies that involve irregular work hours, with the specific purpose of looking at the recovery process. The results show that for the average normal office week worker two days of recovery are normally sufficient. For those who work long shifts in long sequences three days are needed for normalization, whereas 12 h shifts in 2–3 day sequences seem not to cause accumulated fatigue. Interestingly, fatigue/sleepiness is often at its peak during the first day of recovery – not the last day of the working week. Air crew and oil rig workers take a longer time to recover, probably because of too much adjustment of the biological clock. As a rule, long haul air crew is usually much more fatigued than short haul crew during their days off, despite the fact that long haul flying is voluntary and opted for by those who fly it. Also train drivers are affected during their days off by their irregular work hours – in particular backwards rotating schedules seem to cause accumulation of fatigue. The results suggest that one day of recovery never is sufficient, two days usually is, whereas 3–4 days are necessary after periods of severely disturbed circadian rhythmicity.     

Socialization and cognition in children between the age of 18 and 24 months

A cross-cultural study of mother–child dyads was set up to test the hypothesis that sociocultural differences, mediated by variations of maternal intervention, influence the way in which the child manipulates objects and, thereby, his cognitive and social competences. Two series of observations were conducted with three groups of children aged 18–24 months (15 from the American middle class, 15 from French families and 15 from North African families—the last two groups both underprivileged): (a) ‘naturalistic’ observations of two systems of interaction (child–mother and child–children interaction) showed that each child is characterized by one type of object manipulation (protected, induced, activated or autonomous) and that maternal intervention varies with the sociocultural background; assessment of the child's behavioural sequences unravelled his strategies for solving and avoiding conflicts with his peers; (b) observations of the child with a standardized material permitted an evaluation of his cognitive competences for spontaneous problem-solving. Regarding the assumptions of our hypothesis, the results furnish the following conclusions: (1) social and cognitive competences are related to the object manipulation type. In all samples, children characterized by ‘activated’ and ‘autonomous’ manipulation obtain the better results; (2) maternal intervention differs among the samples depending on the sociocultural background; these differences (limitation and physical contact) do not correspond to differences in types of manipulation; (3) type of manipulation is an interactive construction; it characterizes the functioning of the mother–child dyad and its prevailing dynamics between permanence and change. ©1997 by John Wiley & Sons, Ltd.     

The human sense of the head's polarity is influenced by changes in the magnitude of gravity

The present investigation concerns the integrity of a primary mental function, the egocentric frame of reference and the sense of polarity of one's own head. The visually perceived eye level (VPEL) and the subjective antero-posterior axis of the head were measured by means of a visual indicator in darkness during two stimulus conditions: static pitch (sagittal-plane) tilting in the 1-g environment and gondola centrifugation (2G). It is demonstrated that an increase in the magnitude of the gravitoinertial (G) force, acting in the direction of the head and body long (z) axis, causes a substantial change not only in the VPEL but also in the perceived direction of the antero-posterior axis of the head.