The burden of filial piety: A qualitative study on caregiving motivations amongst family caregivers of patients with cancer in Singapore

Objective. This study explores (1) the motivations and challenges facing family caregiving for cancer in Singapore and (2) suggests a possible framework to guide culturally sensitive future work on caregivers.

Design. Twenty caregivers of patients being treated for cancer at a public hospital in Singapore were interviewed. A semi-structured interview format and inductive thematic analysis were used to analyse the data. Caregivers were asked about their motivations for caregiving and the challenges they faced.

Results. Caregivers’ motivations grouped into three categories: personal value and fulfilment, giving care because of societal expectations such as filial piety, and practical need. Challenges were grouped into interpersonal challenges, disclosure and finding balance. Caregivers with different primary motivations varied in their responses to these challenges. More autonomous caregivers cited learning points and reprioritised more effectively than less autonomous caregivers, who reported more internal conflict and less control over their situation.

Conclusions. In Singapore and Asia, sociocultural values of family caregiving are not uniformly experienced as positive, and may be burdensome for caregivers who give care primarily for extrinsic motivations. As family caregiving needs increase, targeted psychosocial support for caregivers with less autonomous behavioural orientations may pre-empt caregiver burnout and burden.     

The two-factor model of self-reported mood: a cross-cultural replication

The cross-cultural stability of a two-factor model of self-reported mood was studied in Israel. Sixty women and 25 men filled out a 58-adjective Mood Check List, everday for 45 consecutive days. Replicatory factor analyses demonstrated that the two-factor model of mood is applicable to both Israeli men and women and that this structure is consistent across American and Israeli cultures. Three implications of these findings are discussed. Replication of this structure in a diversified and unique culture, such as Israel, coupled with a previous replication in Japan (Watson, Clark, & Tellegen, 1984), is interpreted as lending considerable support to the assertion that this model of mood is cross-culturally consistent. Theoretical formulations and empirical findings derived and discovered in the U.S. can now be employed in planning and interpreting mood studies in Israel. The results of such studies can be incorporated within the general body of knowledge accumulating on this topic in the U.S.     

Temporal integration of acoustic and cutaneous stimuli shown in the blink reflex

Temporal integration of pairs of brief blink-eliciting acoustic and cutaneous stimuli was investigated to determine if there was integration of stimuli from different modalities. Reflexes elicited by a tone burst or by a brief electrical shock to the supraorbital nerve followed by a second tone burst or shock at short stimulus onset asynchronies (SOAs) were larger and faster than control reflexes elicited by a single stimulus identical to the lead stimulus of the stimulus pairs. Reflex amplitude was augmented at longer SOAs where there was no effect on latency. Temporal integration was evident for all stimulus pairs, showing that it is due, at least in part, to processes that occur outside specific sensory pathways. Heterogeneous stimulus pairs produced greater reflex enhancement than did homogeneous stimulus pairs. This finding was examined further in Experiment 2, which showed that reflex enhancement with pairs of acoustic pulses was unaffected by the frequency of the second stimulus, suggesting that sensory masking was not acting to suppress reflex expression with acoustic pulse pairs. Integration of reflexogenic acoustic stimuli shown in the blink reflex is restricted to shorter intervals than is integration of acoustic stimuli shown by psychophysical procedures, suggesting that the two methods reflect different aspects of stimulus processing. Integration of reflexogenic stimuli may result from summation of activity associated more directly with reflex expression than with perceptual awareness.     

Neuroscience and Brain Death Controversies: The Elephant in the Room

The conception and the determination of brain death continue to raise scientific, legal, philosophical, and religious controversies. While both the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1981 and the President’s Council on Bioethics in 2008 committed to a biological definition of death as the basis for the whole-brain death criteria, contemporary neuroscientific findings augment the concerns about the validity of this biological definition. Neuroscientific evidentiary findings, however, have not yet permeated discussions about brain death. These findings have critical relevance (scientifically, medically, legally, morally, and religiously) because they indicate that some core assumptions about brain death are demonstrably incorrect, while others lack sufficient evidential support. If behavioral unresponsiveness does not equate to unconsciousness, then the philosophical underpinning of the definition based on loss of capacity for consciousness as well as the criteria, and tests in brain death determination are incongruent with empirical evidence. Thus, the primary claim that brain death equates to biological death has then been de facto falsified. This conclusion has profound philosophical, religious, and legal implications that should compel respective authorities to (1) reassess the philosophical rationale for the definition of death, (2) initiate a critical reappraisal of the presumed alignment of brain death with the theological definition of death in Abrahamic faith traditions, and (3) enact new legislation ratifying religious exemption to death determination by neurologic criteria.     

Gay Identity and HIV Risk for Black and Latino Men Who Have Sex with Men

Strong gay identity among white men who have sex with men (MSM) has been associated with decreased HIV risk, but data for black and Latino MSM (BLMSM) are inconclusive. We examined gay identity and HIV risk among BLMSM to inform social and structural HIV intervention strategies. BLMSM were administered a computerized survey as part of an HIV research study during 2011–2012 conducted in New York City. We used a brief scale of Gay Identity Questionnaire. After data analysis, Stage I (not fully accepting) and Stage II (fully accepting) gay identity were determined based on participant responses. We used logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association between gay identity with HIV risk and social determinant factors. Among 111 self-identified BLMSM (median age = 32 years, 68.4% with some college or higher education), 34.2% reported receptive anal sex without condoms in the previous three months. Gay Identity Questionnaire Scale assessment indicated that 22 (19.8%) were Stage I, and 85 (76.6%) were Stage II in this BLMSM sample. Stage II gay identity was more likely seen among BLMSM with high involvement in the gay community (aOR 3.2; CI 1.00, 10.26) and less likely among BLMSM who exchanged sex for food or shelter (aOR 0.15; CI 0.02, 0.98). Fully accepting gay identity may be protective for BLMSM as it relates to transactional sex; these factors warrant further research and consideration as part of HIV prevention strategies.     

Perceptions of ADHD Among Diagnosed Children and Their Parents: A Systematic Review Using the Common-Sense Model of Illness Representations

Research on children and parents’ experiences of ADHD has grown in recent years, attracting attention to their subjective perception of ADHD as a disorder. Theoretical accounts of illness perception suggest that it is multi-dimensional, consisting of at least five core constructs (see the common-sense model of illness representations or CSM: Leventhal et al., in: Rachman (ed) Medical psychology, Pergamon, New York, vol 2, pp 7–30, 1980, in: Baum, Taylor, Singer (eds) Handbook of psychology and health: social psychological aspects of health, Earlbaum, Hillsdale, vol 4, pp 219–252, 1984). We suggest that the application of CSM in children/adolescents with ADHD and their parents may play an important role in understanding their coping behavior, treatment adherence, and emotional well-being. A systematic search identified 101 eligible studies that investigated the perception of ADHD among diagnosed children/adolescents and their parents. In general, these studies support the existence of the multiple facets of illness representations proposed by the CSM in both diagnosed youngsters and parents indicating substantial variability among both parents and youngsters on each of these facets. The comprehensive assessment of the representations of ADHD indicates imbalance attention to the different representations of ADHD in the literature; disproportional research attention has been paid to the perceived effectiveness of treatment (i.e., treatment control dimension) compared to other illness representations (e.g., timeline, consequence, and coherence), despite research showing their relevance to treatment adherence among other implications. The review identifies the limitation of existing relevant research, needed foci for future studies, specific testable hypotheses, and potential clinical implications of the multifaceted representations of ADHD among youngsters and carers alike.     

Callous-Unemotional Traits,Relational and Social Aggression,and Interpersonal Maturity in a Sample of Behaviorally Disordered Adolescents

The authors examined the degree to which callous-unemotional traits and narcissism predict relational aggression, social aggression, and prosocial skills in a sample of 79 adolescent offenders (13–18 years old; 26% girls; 74% boys) attending a school for youth with behavior disorders in the Mid-Atlantic United States. Narcissism made a significant contribution to the prediction of both relational aggression and social aggression, accounting for most of the unique variance in the prediction of these indirect forms of aggression. Conversely, callous-unemotional traits—but not narcissism—made a significant contribution to the prediction of lower prosocial skills. Furthermore, in contrast to the large number of studies indicating gender differences in the expression of aggression, no significant gender differences in the present study were found.