Risk and Trust in Public Health: A Cautionary Tale

The leading ethical position on placebo-controlled clinical trials is that whenever proven effective treatment exists for a given condition, it is unethical to test a new treatment for that condition against placebo. Invoking the principle of clinical equipoise, opponents of placebo-controlled trials in the face of proven effective treatment argue that they (1) violate the therapeutic obligation of physicians to offer optimal medical care and (2) lack both scientific and clinical merit. We contend that both of these arguments are mistaken. Clinical equipoise provides erroneous ethical guidance in the case of placebo-controlled trials, because it ignores the ethically relevant distinction between clinical trials and treatment in the context of clinical medicine and the methodological limitations of active-controlled trials. Placebo controls are ethically justifiable when they are supported by sound methodological considerations and their use does not expose research participants to excessive risks of harm.     

Roles of Leisure in Coping with Stress Among University Students: A Repeated-Assessment Field Study

This article reports findings of a study to examine the effects of leisure coping on various stress coping outcomes including: immediate outcomes (perceived coping effectiveness, perceived satisfaction with coping outcomes, and perceived stress reduction) and distal or long-term outcomes (physical and mental ill-health and psychological well-being), above and beyond the contributions of general coping - coping not directly associated with leisure. A repeated-assessment field design was used to examine ways in which university students cope with stressors in their daily lives. The study found that leisure coping beliefs (leisure-generated dispositional coping resources) significantly predicted lower levels of mental and physical ill-health and greater levels of psychological well-being above and beyond the effects of general coping. Also, the use of leisure coping strategies (situation-specific stress coping strategies through leisure) was significantly associated with higher levels of perceived coping effectiveness and stress reduction when the effects of general coping were taken into account. Significant contributions of specific leisure coping dimensions were found as well.     

Development of behavioural problems in children adopted from Romania to the Netherlands,after a period of deprivation

A longitudinal study was conducted among 72 Romanian adoptive children (41 boys, 31 girls) in the Netherlands, who, according to the parents and medical records, had all experienced a period of some degree of deprivation before their adoption. The children were on average 2 years and 9 months old at adoption. Parents filled out the Child Behavioural Checklist twice. On average there was little change in scores between the two measurements, and correlations were high. Some children displayed a marked improvement, or worsening of problems. The change in CBCL scores was not related to age or health on arrival into the adoptive family. Children who received special education at the first measurement (31%) improved significantly more on Total Problems than children who didn't. The same applied to professional help, the 46 children (64%) for whom professional help was engaged improved significantly more than the other 26 children. It appears to be effective to engage educational and psychological help for these (severely) deprived children at an early stage.     

Design as a Tool for Family Evolutionary Guidance

This article begins by describing the impact of systems science on the field of marriage and family therapy, discussing that systems concepts are broadly disseminated but have become diluted. The author describes the educational program at a marriage and family therapy graduate institute where students utilize social systems design in their research projects as well as their work with clients. The article outlines the specifications of the Idealized Systems Design (ISD) teaching system, its relationship with the larger institution, as well as its purposes and systemic functions. Application of ISD to the field of marriage and family therapy is emphasized, demonstrating its use in helping facilitate individual, family, and community health as a research tool as well as a set of intervention tools for the practicing therapist.     

How Regulatory Orientation and Feelings of Gratitude Shape Online Review Helpfulness

Online review helpfulness ratings are an important indicator of the impact of online reviews. Often times, helpfulness is explained in terms of observable qualities of online reviews that predict helpfulness ratings. This research proposes that focusing on the psychological processes that underlie helpfulness voting informs a better understanding of what shapes review helpfulness ratings. Specifically, because goal orientation influences information processing, consumers’ regulatory orientation interacts with review valence to determine review helpfulness. When review valence and regulatory orientation match, consumers are more likely to express helpfulness through voting. The findings show that this effect occurs at least in part because matching review valence and regulatory orientation instills feelings of gratitude towards the reviewer. As a consequence, consumers are more likely to reward the reviewer with a helpfulness vote to express their feeling of gratitude through actions. However, when reviewers actively state expectations of reciprocal behavior by readers, gratitude is reduced and so is the likelihood that a review receives a helpfulness vote. Evidence from five studies using review data and online experiments show support for these effects.     

IMPACT OF JOINT ATTENTION ON SOCIAL‐COMMUNICATION SKILLS IN INTERNATIONALLY ADOPTED CHILDREN

Internationally adopted (IA) children have often experienced early adversity and are at risk for long‐term deficiencies in multiple developmental domains. This study examined the association between IA children's joint attention (JA) soon after arrival and later cognitive, communicative, and socioemotional competency 6 months’ postadoption. We expected a child's initial JA would positively predict later cognitive, communication, and social ability. IA children (n = 63) adopted from Eastern Europe were seen soon after their arrival into the United States to assess their JA. Their socioemotional competency, social communication, and cognitive abilities were measured at a follow‐up session 6 months’ postadoption. We found that higher order JA was positively associated with measures of social relatedness. Furthermore, individual hierarchical regressions of each measure of JA (higher order JA, initiating JA, responding to JA, and initiating behavior requests [BR]) considered with age‐at‐adoption showed that each measure was an independent and positive predictor of Mullen outcomes in the receptive and expressive language domains. These results suggest that JA may be a sensitive predictor of subsequent functioning in the social, communicative, and cognitive domains. Thus, assessing JA soon after arrival has the potential to identify at‐risk IA children, and interventions targeting JA may support those children in overcoming the negative impacts of early adversity.     

THE OTHER SIDE OF SILENCE: RACHEL CARSON'S VIEWS OF ANIMALS

Abstract The publication of Rachel Carson's Silent Spring, a compelling blend of stories, natural history, human values, and biological facts, in 1962 was instrumental in launching the modern environmental movement. We consider Carson's attitude toward animals in Silent Spring and in her other writings. Carson favored responsible stewardship and was more of an animal welfarist and environmentalist/conservation biologist who privileged ecosystems and species than an animal activist who privileged individuals, and she did not advocate an animal‐rights agenda. There is clear tension in Carson's writings. Often she seems troubled by attempting to come across as a moderate and practical scientist, and some of her words, when considered out of context, could lead one to label her as an animal‐rightist. While some of Carson's writing favors human‐centered interests, she did not believe that only humans counted. Her warnings about silent springs must be taken seriously, perhaps even more seriously than when they were penned more than four decades ago. Carson was a passionate and extremely influential activist and if a world of persons like her were in charge of our global environmental policies, we and our fellow animals would be in much better shape than we currently are.     

Some Legal Issues Patients May Face While in Therapy

This article on forensic family therapy touches upon a few of the major germane ethical and legal dicta which regulate and circumscribe psychotherapy practice. Differences between ethical and legal rulings are delineated. Some of the problems which may confront and even engulf individuals, couples, and families during their life cycle and which bring them into the orbit of the legal and/or judicial systems before, during, or after the period of assessment and treatment are explored. Some issues that have received the least coverage in the family forensic literature are highlighted; and some of the areas that have been accorded a great deal of attention elsewhere are mentioned only briefly. A short commentary on the forensic family professionals’ potential role in each arena of practice is provided.     

Environmental Contributions to Adolescent Delinquency: A Fresh Look at the Shared Environment

Few genetically-informative studies have attempted to explicitly identify the shared environmental (i.e., those environmental influences that contribute to sibling similarity) factors now known to contribute to adolescent delinquency. The current study therefore examined whether the parent-child relationship served as one source of these shared environmental influences. Participants were 610 adoptive and biological families from the Sibling Interaction and Behavior Study (SIBS). Parents and adolescents reported on their parent-child conflict and parental involvement with child, and adolescents reported on their own delinquent behaviors. We employed structural equation modeling and supplementary multilevel modeling, finding consistent evidence that the association between delinquency and the parent-child relationship is at least partially shared environmental in origin. Such findings provide an important extension of previous twin studies, as they suggest that passive genotype-environment correlations do not explain earlier findings of shared environmental influences on this association.     

Farting as a defence against unspeakable dread

This paper describes some features of the behaviour of a severely disturbed adopted latency boy. Peter was born premature, suffered several early hospitalizations and surgical operations, and at 2 months of age was removed from his mother's care by Social Services for neglect and abandonment.
Although his subsequent development has been clouded by a series of losses and sudden changes of caregivers, Peter has maintained an unexpected desire to relate, showing considerable innate resilience. When feeling endangered, Peter had developed a defensive olfactive container using his bodily smell and farts to envelop himself in a protective cloud of familiarity against the dread of falling apart, and to hold his personality together.
In the paper Fordham's views of development and Anzieu's concept of psychic envelopes constitute the theoretical underpinning. Bion's concepts of beta- and alpha-elements are discussed in relation to Jung's views on symbolic development and psychological containment.