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.     

Correspondence between children's and adults' ratings of stimulant-induced changes in ADHD behaviours in a crossover trial with medication-naive children

Correspondence between children's and adults' ratings of changes in ADHD behaviours was investigated in a paediatric ADHD stimulant crossover trial. Thirty-one children completed an ADHD self-report scale each week, and comparisons were made with an ADHD questionnaire completed by adults (combined parent and teacher ratings). Children's and adults' ratings demonstrated good internal consistency, were significantly associated with the assessment of ADHD behaviours in the placebo condition and showed comparable responsiveness to stimulants at the group level. Furthermore, a large and significant correlation was detected between the two sets of informants' ratings of changes from placebo to both methylphenidate and dextroamphetamine high-dosage conditions, but not from placebo to low-dosage conditions. Agreement in the categorization of best stimulant condition for individual children was significant, but modest from a clinical perspective. The results indicate that children's ratings correspond adequately with adults' ratings, and thus appear to be a complementary outcome measure.     

Improving conditional discrimination learning and memory in five-year-old children: Differential outcomes effect using different types of reinforcement

Previous studies have demonstrated that discriminative learning is facilitated when a particular outcome is associated with each relation to be learned. When this training procedure is applied (the differential outcomes procedure; DOP), learning is faster and better than when the typical common outcomes procedure or nondifferential outcomes (NDO) is used. Our primary purpose in the two experiments reported here was to assess the potential advantage of DOP in 5-year-old children using three different strategies of reinforcement in which (a) children received a reinforcer following a correct choice (“ + ”), (b) children lost a reinforcer following an incorrect choice (“ ? ”), or (c) children received a reinforcer following a correct choice and lost one following an incorrect choice (“ + / ? ”). In Experiment 1, we evaluated the effects of the presence of DOP and different types of reinforcement on learning and memory of a symbolic delayed matching-to-sample task using secondary and primary reinforcers. Experiment 2 was similar to the previous one except that only primary reinforcers were used. The results from these experiments indicated that, in general, children learned the task faster and showed higher performance and persistence of learning whenever differential outcomes were arranged independent of whether it was differential gain, loss, or combinations. A novel finding was that they performed the task better when they lost a reinforcer following an incorrect choice (type of training “ ? ”) in both experiments. A further novel finding was that the advantage of the DOP over the nondifferential outcomes training increased in a retention test.     

Expand Positive Learning Opportunities and Results

Students with emotional disturbance (ED) experience the worst outcomes of any group of pupils in the public schools. We suggest that at least part of the reason is that the services they receive while in school are inadequate to meet their needs. Although applied research has resulted in a number of effective practices, they are not used in the majority of America's schools. Barriers to the implementation of such practices are described, and recommendations for improving programs and outcomes for these students are offered.     

Long Term Outcomes to Family Caregiver Empowerment

The Vanderbilt Caregiver Empowerment Project evaluated a training program designed to enhance empowerment of caregiver and their subsequent involvement in the mental health treatment of their children. The intervention utilized a multi-component parent training curriculum that was designed to enhance: (a) knowledge of the service system; (b) skills needed to interact with the mental health system; and (c) the caregiver' s mental health services self-efficacy designed to improve caregivers beliefs in their ability to collaborate with service providers. The resulting increased empowerment was hypothesized to increase caretaker involvement, which should affect service use and ultimately the mental health status of the child. A randomized design was used to test the effectiveness of this model with caregivers of children receiving mental health services. The results one-year after the training replicated the intermediate outcomes of the project conducted 3-months after the training. The initial training continued to significantly influence the parent's knowledge and mental health services self-efficacy. However, the intervention had no effect on caregiver involvement in treatment, service use or the mental health status of the children.     

Perceived career barriers and vocational outcomes among university undergraduates: Exploring mediation and moderation effects

This study explores the role of perceived internal and external career barriers on undergraduates' vocational outcomes, such as academic major satisfaction and vocational identity commitment. Moreover, it tests career adaptability as a moderator in the barriers-vocational outcomes link. The study was carried out in three public universities in Lithuania. In total, 288 first and second year undergraduate students took part in it. Results demonstrated internal but not external barriers to be negatively associated with undergraduates' vocational outcomes.     

The influence of satisfaction and promotability on the relation between career adaptability and turnover intentions

This study examined the relation between career adaptability (CA), promotability, and career satisfaction (CS), and their impacts on turnover intentions (TI). Eight hypotheses were proposed. Based on data collected from a sample of 431 employees in Macau, career adaptability was significantly and positively related to both promotability and CS after controlling for the influences of demographic variables including age, gender, education and tenure. CA, promotability and CS were also significantly and negatively linked to TI. The results further revealed that promotability and CS mediated the effect of CA on TI. The study contributed new insights that may inform career development and retention of employees. Practical implications on how to retain employees were discussed.     

Dynamic testing of learning potential in adults with cognitive impairments: A systematic review of methodology and predictive value

Dynamic testing includes procedures that examine the effects of brief training on test performance where pre‐ to post‐training change reflects patients’ learning potential. The objective of this systematic review was to provide clinicians and researchers insight into the concept and methodology of dynamic testing and to explore its predictive validity in adult patients with cognitive impairments. The following electronic databases were searched: PubMed, PsychINFO, and Embase/Medline. Of 1141 potentially relevant articles, 24 studies met the inclusion criteria. The mean methodological quality score was 4.6 of 8. Eleven different dynamic tests were used. The majority of studies used dynamic versions of the Wisconsin Card Sorting Test. The training mostly consisted of a combination of performance feedback, reinforcement, expanded instruction, or strategy training. Learning potential was quantified using numerical (post‐test score, difference score, gain score, regression residuals) and categorical (groups) indices. In five of six longitudinal studies, learning potential significantly predicted rehabilitation outcome. Three of four studies supported the added value of dynamic testing over conventional testing in predicting rehabilitation outcome. This review provides preliminary support that dynamic tests can provide a valuable addition to conventional tests to assess patients’ abilities. Although promising, there was a large variability in methods used for dynamic testing and, therefore, it remains unclear which dynamic testing methods are most appropriate for patients with cognitive impairments. More research is warranted to further evaluate and refine dynamic testing methodology and to further elucidate its predictive validity concerning rehabilitation outcomes relative to other cognitive and functional status indices.     

Influence of Time in Treatment and Follow-Up Duration on Methadone Treatment Outcomes

Data for 422 methadone treatment clients in the National Treatment Improvement Evaluation Study (NTIES) were analyzed. Clients maintained continuously in methadone treatment for longer than 12 months and clients who leftbetween 3–12 months were compared with clients treated for less than 3 months. Additionally, clients treated for 3–12 months who had short follow-up periods (6-month average) were compared with 3–12-month clients with long follow-up periods (11-month average). Positive treatment outcomes includinglower drug use, reduced risk of viral infectionand sexually transmitted disease (through needle sharing and multiple sex partners), and less criminality wereassociated with both longer duration treatment and shorter follow-up periods. The findings suggested that continuous methadone treatment of 12 or more months is optimal, whereas stays of less than3 months may be ineffective. Furthermore, stays of 3–12 months are likelyto be beneficial over a relatively short time span, for example 6 months.