Diagnostic Work through Evidence-Based Guidelines: Avoiding Gaps Between Development and Implementation of a Guideline for Problem Behaviour in Elderly Care

Diagnostic work is the reflexive work of figuring out what issues are at stake and determining the scope for action. This work is not generally accommodated by evidence-based guidelines, which generally promote a uniform, predefined approach to solving healthcare problems that risk narrowing the opportunities for diagnostic work in healthcare practice. Consequently, guidelines are often criticised as too general to solve situated, individual healthcare problems and gaps between guidelines and their implementation are often reported. The Netherlands has developed a guideline for problem behaviour in elderly care, explicitly designed for diagnostic work, thus stimulating a situated approach. Relational problem behaviour is highly embedded in its context. The guideline stimulates diagnostic work, which helps to unravel problem behaviour and is opening alternatives in elderly care. Diagnostic work does not transfer guideline development problems to healthcare practice, but simply structures the decision-making process without giving a predefined answer. Diagnostic work is thus important to consider in order to avoid a gap between guideline development and implementation.     

母亲抑郁情绪对幼儿内化问题的影响：有调节的中介模型

采用问卷法对298名6个月婴儿的母亲进行为期8个月的追踪,通过交叉滞后回归以及多层回归分析探究母亲抑郁情绪与母亲教养压力的准因果关系,母亲抑郁情绪与幼儿内化问题间的有调节的中介效应。结果表明：（1）母亲抑郁情绪与母亲教养压力存在准因果关系,母亲抑郁情绪可显著正向预测母亲的教养压力。（2）母亲感受到的教养压力对母亲抑郁情绪与幼儿内化问题的关系具有部分中介效应。母亲抑郁情绪不仅对幼儿内化问题产生直接影响,也可通过母亲的教养压力对幼儿内化问题产生间接影响。不过这一中介模型受母亲受教育程度的调节。只有在母亲受教育程度低时,教养压力对母亲抑郁情绪与幼儿内化问题的中介作用才成立,母亲较高的受教育程度可以明显减弱由于母亲抑郁情绪对幼儿内化问题的影响。这在一定程度上揭示了母亲抑郁情绪对幼儿内化问题的影响机制,对缓解母亲抑郁水平高的幼儿的内化问题提供理论和参考价值。     

Effects of telephone support on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease: a meta-analysis

The aim of this meta-analysis was to evaluate the effects of disease education or pulmonary rehabilitation programs assisted with telephone support on physical capacity and quality of life (QOL) in chronic obstructive pulmonary disease (COPD) patients. A systematic search of PubMed, Embase, Web of Science and The Cochrane Library was conducted until May 2017. Randomized controlled trials (RCTs) examining the effects of telephone-assisted intervention versus a control group on exercise tolerance and QOL in patients with COPD were included. Two independent authors assessed the methodological quality of the trials using the Cochrane risk of bias tool. A meta-analysis was conducted with the Revman5.3 to quantify the effects of telephone-assisted interventions on walking capacity and QOL. In total, 10 studies involving 1037 participants were included. Due to the effect of telephone-assisted interventions, statistically significant results were found on Saint-George’s Respiratory Questionnaire (SGRQ) symptom scores [standard mean difference (SMD) ?.18, 95% confidence interval (CI) ?.33, ?.03, p-value .02)], SGRQ impact scores [SMD ?.35, 95% CI ?.60, ?.10, p-value .006)], SGRQ activity scores [SMD ?.30, 95% CI ?.45, ?.15, p-value < .0001)], SGRQ total score [SMD ?.36, 95% CI ?.51, ?.21, p-value < .00001)]. The effects on 6-min walk test (6MWT) and all Chronic Respiratory Questionnaire (CRQ) subscales were not significant (p > .05) based on the insufficient evidence. In conclusion, the role of telephone-assisted interventions in the management of COPD remains equivocal. Some encouraging results were seen with regard to SGRQ symptom, SGRQ impact, SGRQ activity and SGRQ total score. We believe that more methodologically rigorous large-scale randomized controlled trials are necessary to answer this study question.     

Support groups for parents with an adult child suffering from bipolar disorder

Confronted with the disconcerting behaviour exhibited by their children, parents of bipolar patients are in severe distress. Research focuses on the study of the ‘burden’ that the pathology puts on caregivers, owing to their experience of depression, sometimes combined with the presence of hostile attitudes and negative affects. In France, parents of adult patients encounter an initial specific difficulty: they are not systematically included in the care management system. Thanks to the initiative of an association of psychiatrists and psychoanalysts, the authors set up a psychoanalytic support group for the parents of ‘bipolar’ adults. The diagnosis of a bipolar disorder is established by a psychiatrist within a medical structure. Support groups for parents do exist in France, but their experiences have not led to scientific publications on this specific topic. Existing publications focus on other types of pathology and other therapeutic approaches. In this article, we will highlight how this type of psychoanalytic support group, with operating rules based on the theoretical work of Anzieu, can help parents of patients with bipolar disorders. Group participants accepted the principle of a research study that maintained their anonymity. We collected and analysed qualitative data from the first year of the group, so we highlight the specific difficulties of these parents, faced with chronic disease. The relevance of our qualitative study also resides in the data collected over a period of time, enabling us to see the progress made, and encouraging us to reflect on the place of psychoanalytic groups for parents, as well as on the care management of this pathology.     

亲子关系对贫困儿童问题行为的影响

以247名贫困儿童为被试进行问卷调查,构建家庭社会经济地位和亲子关系对贫困儿童问题行为的多重中介模型,得到抑郁、自我控制的中介作用。结果显示,亲子关系和社会经济地位分别通过中介路径影响贫困儿童问题行为,与亲子关系有关的中介路径为91.25%,与抑郁有关的中介效应为57.60%,与自我控制有关的中介效应为57.15%. 结论：良好的亲子关系或成为贫困儿童的保护因子;应关注贫困儿童心理健康,增加有效心理疏导机制;注重培养贫困儿童的自我控制能力。     

Sikh millennials of the ‘kirtan generation’ in the making of an ‘American Sikhism’

ABSTRACT

This essay focuses on the millennial generation of Sikhs in the United States. Based on extended ethnographic research in Sikh communities, the author explores the role of Sikh millennials in the making of an ‘American Sikhism’, the contours of which are taking shape having followed after the explosive growth of gurdwara communities – and the educational, social, and other resources they provide – which were largely made possible by the affluence of Sikh communities beginning with the previous ‘Brain Drain’ generation. In particular, the author discusses this ‘kirtan generation’ of Sikhs, educated in gurdwara schools, and their growing leadership of Sikh communities.     

Action‐semantic and syntactic deficits in subjects at risk for Huntington's disease

Frontostriatal networks play critical roles in grounding action semantics and syntactic skills. Indeed, their atrophy distinctively disrupts both domains, as observed in patients with Huntington's disease (HD) and Parkinson's disease, even during early disease stages. However, frontostriatal degeneration in these conditions may begin up to 15 years before the onset of clinical symptoms, opening avenues for pre‐clinical detection via sensitive tasks. Such a mission is particularly critical in HD, given that patients’ children have 50% chances of inheriting the disease. Against this background, we assessed whether deficits in the above‐mentioned domains emerge in subjects at risk to develop HD. We administered tasks tapping action semantics, object semantics, and two forms of syntactic processing to 18 patients with HD, 19 asymptomatic first‐degree relatives, and sociodemographically matched controls for each group. The patients evinced significant deficits in all tasks, but only those in the two target domains were independent of overall cognitive state. More crucially, relative to controls, the asymptomatic relatives were selectively impaired in action semantics and in the more complex syntactic task, with both patterns emerging irrespective of the subjects’ overall cognitive state. Our findings highlight the relevance of these dysfunctions as potential prodromal biomarkers of HD. Moreover, they offer theoretical insights into the differential contributions of frontostriatal hubs to both domains while paving the way for innovations in diagnostic procedures.     

Increasing the salience of fluency cues does not reduce the recognition memory impairment in Alzheimer's disease!

In Alzheimer's disease (AD), it is now well established that recollection is impaired from the beginning of the disease, whereas findings are less clear concerning familiarity. One of the most important mechanisms underlying familiarity is the sense of familiarity driven by processing fluency. In this study, we attempted to attenuate recognition memory deficits in AD by maximizing the salience of fluency cues in two conditions of a recognition memory task. In one condition, targets and foils have been created from the same pool of letters (Overlap condition). In a second condition, targets and foils have been derived from two separate pools of letters (No‐Overlap condition), promoting the use of letter‐driven visual and phonetic fluency. Targets and foils were low‐frequency words. The memory tasks were performed by 15 patients with AD and 16 healthy controls. Both groups improved their memory performance in the No‐Overlap condition compared to the Overlap condition. Patients with AD were able to use fluency cues during recognition memory as older adults did, but this did not allow to compensate for dysfunction of recognition memory processes.     

In which direction to move? Facilitative and interference effects of gestures on problem solver's thinking

Recent research shows that co-speech gestures can influence gesturers’ thought. This line of research suggests that the influence of gestures is so strong, that it can wash out and reverse an effect of learning. We argue that these findings need a more robust and ecologically valid test, which we provide in this article. Our results support the claim that gestures not only reflect information in our mental representations, but can also influence gesturer's thought by adding action information to one's mental representation during problem solving (Tower of Hanoi). We show, however, that the effect of gestures on subsequent performance is not as strong as previously suggested. As opposed to what previous research indicates, gestures' facilitative effect through learning was not nullified by the potentially interfering effect on subsequent problem-solving performance of incompatible gestures. To conclude, using gestures during problem solving seems to provide more benefits than costs for task performance.     

Sexual Harassment,Racial Harassment,and Well-Being among Asian American Women: An Intersectional Approach

ABSTRACT

Harassment of Asian American (AA) women has received little attention in popular culture and academic research despite their long legacy of sexualized racial stereotyping (e.g., Geisha, sexually submissive; Shimizu, 2007) and additional risk of mistreatment due to their membership in both marginalized gender and racial groups (Beale, 1970 Beale, F. (1970). Double jeopardy: To be Black and female. In T. C. Bambara (Ed.), The Black woman: An anthology (pp. 90–100). New York: New American Library. [Google Scholar]; Settles & Buchanan, 2014 Settles, I. H., & Buchanan, N. T. (2014). Intersectionality: Multiple categories of identity and difference. In V. Benet-Martinez and Y. Hong (Eds.), The Oxford Handbook of Multicultural Identity (pp. 160–180). New York, NY: Oxford University Press, Inc. [Google Scholar]). This study addresses this dearth of research using an intersectional theoretical framework to comprehensively examine sexual and racial harassment with a sample of AA women. Results validated the underlying factor structure of the Sexual Experiences Questionnaire (Fitzgerald, Gelfand, & Drasgow, 1995 Fitzgerald, L. F., Gelfand, M. J., & Drasgow, F. (1995). Measuring sexual harassment: Theoretical and psychometric advances. Basic and Applied Social Psychology, 17, 425–445. doi:10.1207/s15324834basp1704_2[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) and the Racial Acts, Crimes, and Experiences Scale (RACES; Bergman & Buchanan, 2008 Bergman, M., & Buchanan, N. T. (2008). Development of the Racial Acts, Crimes, and Experiences Survey (RACES). Unpublished instrument. [Google Scholar]) for AA women. Additionally, our results replicated previous research indicating that participants often reported experiencing behaviors that constitute harassment, but did not label them as such. This supports the use of behavioral measures over items that require individuals to label their experiences as harassment. Finally, we examined the associations between these forms of harassment and two indicators of psychological well-being, depression, and posttraumatic stress (PTS). Our results found that gender harassment was associated with more depression, whereas unwanted sexual attention, sexual coercion, and racial harassment were associated with increased PTS. This supports the utility of including both sexual and racial harassment in providing a more nuanced understanding of AA women’s harassment experiences overall and the relationship of harassment to psychological well-being. We discuss theoretical and clinical implications of these findings.