Is cognitive behaviour therapy for chronic fatigue syndrome also effective for pain symptoms?

Patients with chronic fatigue syndrome (CFS) frequently report chronic pain symptoms. Cognitive behavioural therapy (CBT) for CFS results in a reduction of fatigue, but is not aimed at pain symptoms. In this study, we tested the hypothesis that a successful treatment of CFS can also lead to a reduction of pain. The second objective was to explore possible mechanisms of changes in pain. The third objective was to assess the predictive value of pain for treatment outcome. Data from two previous CBT studies were used, one of adult CFS patients (n=96) and one of adolescent CFS patients (n=32). Pain severity was assessed with a daily self-observation list at baseline and post-treatment. The location of pain in adults was assessed with the McGill Pain Questionnaire (MPQ). Patients were divided into recovered and non-recovered groups. Recovery was defined as reaching a post-treatment level of fatigue within normal range. Recovered adult and adolescent CFS patients reported a significant reduction of pain severity compared to non-recovered patients. Recovered adult patients also had fewer pain locations following treatment. The decrease in fatigue predicted the change in pain severity. In adult patients, a higher pain severity at baseline was associated with a negative treatment outcome.     

Assessment and Decision-Making in Early Childhood Education and Intervention

Assessment within the fields of early childhood education and early childhood intervention is guided by the deductive-psychometric model, which is a framework for legitimizing constructs that arise from theories. An alternative approach, termed the inductive-experimental model, places significantly more restrictions on what constitutes a legitimate construct. In this paper, the utility of these two assessment models, one more generative and one more restrictive, are evaluated within the context of a Head Start setting. Given the pragmatic goal of informing instruction, we argue for the superiority of the more restrictive approach. Implications for early childhood intervention are also discussed.     

Parents’ Perceptions of Functioning in Families Having a Child with a Genetic Condition

In a study of families having a child with a genetic condition, patterns of family functioning were identified through cluster analysis of families with two spouses. Patterns were based on both parents’ assessments of family satisfaction and hardiness, as measured respectively by the Family APGAR and Family Hardiness Index. The validity and clinical significance of the clusters were supported by demonstrating that cluster membership distinguished between parental reports of their own quality of life and their child’s functional status, as measured by the Quality of Life Index and the Functional Status II, respectively. The clusters were non-categorical in the sense that they did not depend on the type of genetic condition. These findings point to the importance of addressing family functioning as part of genetic counseling.     

Correlates of Maternal and Paternal Adjustment to Chronic Childhood Disease

This study investigated the correlates of psychosocial adjustment in mothers and fathers of children with chronic disease. Participants were 20 mothers and 15 fathers of children with cystic fibrosis, 11 mothers and 9 fathers of children with muscular dystrophy, 18 mothers and 9 fathers of children with asthma, 13 mothers and 8 fathers of children with Type 1 diabetes and 19 mothers and 11 fathers of healthy children. Questionnaires relating to the variables of interest were used. Poorer levels of adjustment were associated with lower levels of social support and family cohesion for mothers and coping by understanding the child’s medical situation, more family life events and lower family cohesion for fathers. These findings suggest that the correlates associated with maternal and paternal psychological adjustment to chronic childhood disease differ. These differences are important to consider when providing care to children with chronic disease and their families.     

Intrahippocampal administration of A beta(1-40) impairs spatial learning and memory in hyperglycemic mice

Age-related neurodegenerative dementia, particularly Alzheimer's disease (AD), may be exacerbated by several interacting risk factors including genetic predisposition, beta amyloid (A beta) protein accumulation, environmental toxins, head trauma, and abnormal glycolytic metabolism. We examined the spatial learning and memory effects of A beta(1-40) administration on hyperglycemic mice by their performance in the Morris water maze. Chronic hyperglycemia was induced in male C57BL/6J mice to mimic diabetes mellitus by intraperitoneal injection of streptozotocin (STZ), which specifically destroys pancreatic beta-islet cells. Ten days after STZ treatment, intrahippocampal infusion of vehicle, monomer, or oligomer A beta(1-40) was given to these hyperglycemic mice. Our results demonstrate that in comparison with vehicle or monomer A beta(1-40), oligomer A beta(1-40) induced significant deficits of spatial learning and memory in hyperglycemic mice. Apoptotic signals were identified in the CA1 and dentate gyrus of hippocampus in hyperglycemic mice. A beta accumulation, oxidative stress, and apoptosis in the CA1 region were more intensive in hyperglycemic mice than that in normoglycemic mice after acute treatment with oligomer A beta(1-40) peptide treatment. These results indicate that CA1 apoptosis was enhanced by oxidative stress resulting from accumulation of A beta. Considered together, these findings suggest that hyperglycemic mice are more vulnerable to the A beta-induced-oxidative stress than normal subjects. We therefore propose that A beta accumulation would be enhanced by hyperglycemia, and the oxidative stress caused by A beta accumulation would in turn enhance the AD symptoms.     

Contagious Disease and Self-Defence

This paper gives a self-defence account of the scope and limits of the justified use of compulsion to control contagious disease. It applies an individualistic model of self-defence for state action and uses it to illuminate the constraints on public health compulsion of proportionality and using the least restrictive alternative. It next shows how a self-defence account should not be rejected on the basis of past abuses. The paper then considers two possible limits to a self-defence justification: compulsion of the non-culpable and over-inclusive compulsion. The paper claims that objections to compelling the non-culpable do not greatly restrict the scope of the self-defence justification. The over-included are, however, innocent bystanders, and methods such as compulsory quarantine, vaccination, and screening are not justified in self-defence. I am grateful to Julian Lamont, Jeff McMahan and Debbie Tseung for their help with this paper. An earlier version was given at the School of Public Health, the University of Texas at Houston; the Auckland Regional Public Health Service; and a conference at the School of Population Health, the University of Auckland. My thanks to the audiences for their comments.     

The Significance of the Concept of Disease for Justice in Health Care

In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a justified claim on health care resources, the impact of the philosophical debate on the concept of disease is still relatively minor. This is surprising, because how we conceive of disease determines the amount of justified claims on health care resources. Therefore, the severity of scarcity depends on our interpretation of the concept of disease. I want to defend a specific combination of a theory of disease with a theory of distributive justice. A naturalist account of disease, together with sufficientarianism, is able to perform a gate-keeping function regarding entitlements to medical treatment. Although this combination cannot solve all problems of justice in health care, it may inform rationing decisions as well.     

童年期母亲教养方式与11岁儿童学校适应的关系

通过问卷调查法追踪考察了童年早期到中期母亲教养方式的稳定性和变化,以及童年早中期母亲教养方式对11岁儿童学业成绩和学校适应的预测作用。结果发现儿童从2岁到7岁,母亲教养方式在保护担忧、控制两个维度上出现了显著变化,在其余维度上没有发现显著变化。儿童2岁和7岁时,性别能显著预测其11岁时的学校适应问题。儿童2岁时,母亲鼓励和控制的教养方式能显著预测11岁时儿童的学业成绩及害羞焦虑、挫折耐受性、同伴交往等行为和社交问题。儿童7岁时,母亲保护和控制的教养方式能显著预测儿童11岁时的学业成绩、学习问题及害羞焦虑、挫折耐受性、果敢社交等行为和社交问题。     

Mindfulness-based cognitive therapy as a treatment for chronic depression: A preliminary study

This pilot study investigated the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT), a treatment combining mindfulness meditation and interventions taken from cognitive therapy, in patients suffering from chronic-recurrent depression. Currently symptomatic patients with at least three previous episodes of depression and a history of suicidal ideation were randomly allocated to receive either MBCT delivered in addition to treatment-as-usual (TAU; N = 14 completers) or TAU alone (N = 14 completers). Depressive symptoms and diagnostic status were assessed before and after treatment phase. Self-reported symptoms of depression decreased from severe to mild levels in the MBCT group while there was no significant change in the TAU group. Similarly, numbers of patients meeting full criteria for depression decreased significantly more in the MBCT group than in the TAU group. Results are consistent with previous uncontrolled studies. Although based on a small sample and, therefore, limited in their generalizability, they provide further preliminary evidence that MBCT can be used to successfully reduce current symptoms in patients suffering from a protracted course of the disorder.     

Relationships between personal beliefs and treatment acceptability, and preferences for behavioral treatments

Background

The literature on preferences for behavioral interventions is limited in terms of understanding treatment-related factors that underlie treatment choice. The objectives of this study were to examine the direct relationships between personal beliefs about clinical condition, perception of treatment acceptability, and preferences for behavioral interventions for insomnia.

Methods

The data set used in this study was obtained from 431 persons with insomnia who participated in a partially randomized clinical trial and expressed preferences for treatment options. The data were collected at baseline. Logistic regression was used to examine the relationships between personal beliefs and treatment acceptability, and preferences. The relationships between personal beliefs and perception of treatment acceptability were explored with correlational analysis.

Results

Perception of treatment acceptability was associated with preferences. Persons viewing the option as convenient tended to choose that option for managing insomnia. Personal beliefs were not related to preferences. However, beliefs about sleep promoting behaviors were correlated with perceived treatment effectiveness.

Conclusions

Perception of treatment acceptability underlies expressed preferences for behavioral interventions. Personal beliefs about insomnia are not directly associated with preferences. Importance is highlighted for providing information about treatment options and exploring perception of each option's acceptability during the process of treatment selection.