Medical explanations and lay conceptions of disease and illness in doctor–patient interaction

Hilary Putnam’s influential analysis of the ‘division of linguistic labour’ has a striking application in the area of doctor–patient interaction: patients typically think of themselves as consumers of technical medical terms in the sense that they normally defer to health professionals’ explanations of meaning. It is at the same time well documented that patients tend to think they are entitled to understand lay health terms like ‘sickness’ and ‘illness’ in ways that do not necessarily correspond to health professionals’ understanding. Drawing on recent philosophical theories of concept possession, the article argues that this disparity between medical and lay vocabulary implies that it is, in an important range of cases, easier for doctors to create a communicative platform of shared concepts by using and explaining special medical expressions than by using common lay expressions. This conclusion is contrasted with the view that doctors and patients typically understand each other when they use lay vocabulary. Obviously, use of expressions like ‘sickness’ or ‘illness’ does not necessarily lead to poor communication, but it is important that doctors have an awareness of how patients interpret such terms.

Assessment and treatment of high-risk challenging behavior of adolescents with autism in an aquatic setting

Aquatic-based activities produce positive skill and health benefits for individuals with Autism Spectrum Disorder (ASD); however, aquatic contexts, such as the pool, introduce the risk of injury and drowning. This risk is heightened when individuals with ASD engage in challenging behavior in the pool context. The purpose of the study was to evaluate the effects of differential reinforcement without extinction for 2 participants diagnosed with ASD who engaged in challenging behavior when asked to transition from the pool. The treatment successfully decreased participants' transition latencies and challenging behavior during transitions from the pool for up to 2 months following treatment. Lifeguard staff rated the procedures as highly acceptable and helpful, and noted high degrees of satisfaction with improvements for each participant's behavior.     

Visual problem solving in the absence of lexical semantics: Evidence from dementia

A case of dissociation between visual and praxic skills and linguistic, referential, and semantic skills is described in a case of dementia. Testing revealed that her visual processing was intact and that she was capable of a wide range of visually based tasks. These included copying geometric figures and block designs; matching items on the basis of number, color, or relative size, matching upper and lower case letters, sequencing numerals, orienting pictures, coins, and letters appropriately, and solving problems based on the identification of geometric patterns or on the identification of logical sequences based on pattern alternation, number, and size increases. In contrast, she was completely incapable of matching pictures on the basis of their semantic or referential meaning; similarly she had lost all comprehension of language. It was argued that this case demonstrates the capacities of a visual system cut off from all symbolic and semantic processes. When examined with other case studies this case provides information about the nature of and interaction between modality-specific perceptual processing and semantic processing, and information about the various cognitive factors involved in visual gnosis. The CT scan indicated frontal atrophy and marked anterior temporal atrophy, a pattern that is consistent with Pick's disease. The case was discussed in terms of the correlation between the pattern of observed strengths and deficits and the neurological pattern of atrophy.     

Teaching students with autism spectrum disorder to tolerate haircutting

We describe intervention with 2 adolescent male students who had autism spectrum disorder (ASD) and resisted haircutting performed by care providers at a residential school. The students were exposed to a graduated hierarchy of steps including the presence of hair clippers, and increased duration of hair clippers against their scalp and hair. Edible reinforcement was presented contingent on completion of a step without interfering behavior. Both students learned to tolerate all of the steps in the graduated hierarchy and a full haircut with maintenance at 2-, 4-, and 6-month follow-up. The study supports previous tolerance-training research with children and youth who have intellectual and developmental disabilities and resist personal care and hygiene routines.     

Increasing compliance with wearing a medical device in children with autism

Health professionals often recommend the use of medical devices to assess the health, monitor the well-being, or improve the quality of life of their patients. Children with autism may present challenges in these situations as their sensory peculiarities may increase refusals to wear such devices. To address this issue, we systematically replicated prior research by examining the effects of differential reinforcement of other behavior (DRO) to increase compliance with wearing a heart rate monitor in 2 children with autism. The intervention increased compliance to 100% for both participants when an edible reinforcer was delivered every 90 s. The results indicate that DRO does not require the implementation of extinction to increase compliance with wearing a medical device. More research is needed to examine whether the reinforcement schedule can be further thinned.     

Contentieux des professionnels de santé avec les caisses d’assurance maladie (décisions 2019 suite)

This article examines current case law, emanating from the Cassation Court and the Courts of Appeal, and extending over the period from April 2019 to July 2019.     

Taking Care of Each Other: How Can We Increase Compliance with Personal Protective Measures During the COVID-19 Pandemic in Chile?

In the context of the COVID-19 pandemic, personal protective measures (e.g., social distancing, handwashing, and mask wearing) have been adopted as a cornerstone to limit the spread of the disease. Yet, the effectiveness of these measures depends on people's levels of adherence. In this article, we apply social-psychological research to the study of compliance with personal protective measures during the COVID-19 pandemic in Chile. We consider three possible models underlying adherence: (1) sociodemographic and socioeconomic factors, (2) instrumental factors, and (3) normative factors. We draw on data from a longitudinal nonrepresentative panel study (Study 1, n = 32,304) and a cross-sectional representative survey (Study 2, n = 1,078) to explore the impact of these different factors on personal protective measures compliance. Findings show the strongest support for the role of instrumental and normative factors, in that people who comply with protective measures report to a greater extent that relatives and friends comply too and tend to perceive high risk of COVID-19. We finish by proposing policy recommendations to promote effective strategies to contain the spread of the virus.     

Some effects of praise during the escape condition of the functional analysis

Many researchers provide praise for complying with demands during the escape condition of the functional analysis (FA). However, praise may function as a reinforcer for some individuals which may reduce the aversiveness of task presentation or increase behavior that competes with problem behavior (e.g., compliance with demands). In general, this may result in lower or less stable levels of problem behavior and decrease the efficiency of the FA. Thus, the purpose of the current study was to evaluate some effects of praise on the rate of problem behavior and compliance during the escape condition of the FA in children diagnosed with autism spectrum disorder. We found that praise did not affect the rate of problem behavior but did increase compliance in three of five subjects. The results of the study and implications for the assessment of problem behavior are discussed.