Doctors,Patients, and Nudging in the Clinical Context—Four Views on Nudging and Informed Consent

In an analysis of recent work on nudging we distinguish three positions on the relationship between nudging founded in libertarian paternalism and the protection of personal autonomy through informed consent. We argue that all three positions fail to provide adequate protection of personal autonomy in the clinical context. Acknowledging that nudging may be beneficial, we suggest a fourth position according to which nudging and informed consent are valuable in different domains of interaction.     

The protection of patients’ rights in clinical trials

The Helsinki Declaration is a very important document regarding the protection of patients’ rights in clinical trials and one of the fundamental sources of operational principles for every ethics committee. Although they have been updated, the international guidelines for ethics committees continually fail to address certain issues pertaining to the protection of patients’ rights in clinical trials. These issues include, most significantly, the method of electing ethics committees (a free, secret ballot should be preferred to direct appointment), the avoidance of conflict of interest during the election of ethics committee members, and the necessary insurance coverage for the participants of clinical trials. Polish law should, on the other hand, be developed in such way as to not limit the effectiveness of ethics committees in protecting patients’ rights in clinical trials. The ideal solution would be to draft a uniform law concerning not only clinical trials, but all medical experiments. The opinions of experts who have been reviewing medical research projects for several years may prove to be especially valuable in this setting. This paper was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005. The author is Chairman, Bioethics Committee of the Warsaw Regional Chamber of Physicians and Dentists.     

Early child grammars: qualitative and quantitative analysis of morphosyntactic production

This article reports on a series of 5 analyses of spontaneous production of verbal inflection (tense and person–number agreement) by 2-year-olds acquiring French as a native language. A formal analysis of the qualitative and quantitative results is developed using the unique resources of Optimality Theory (OT; Prince & Smolensky, 2004). It is argued that acquisition of morphosyntax proceeds via overlapping grammars (rather than through abrupt changes), which OT formalizes in terms of partial rather than total constraint rankings. Initially, economy of structure constraints take priority over faithfulness constraints that demand faithful expression of a speaker's intent, resulting in child production of tense that is comparable in level to that of child-directed speech. Using the independent Predominant Length of Utterance measure of syntactic development proposed in Vainikka, Legendre, and Todorova (1999), production of agreement is shown first to lag behind tense then to compete with tense at an intermediate stage of development. As the child's development progresses, faithfulness constraints become more dominant, and the overall production of tense and agreement becomes adult-like.     

Factors Moderating Children's Adjustment to Parental Separation: Findings From a Community Study in England

Research findings show that there is marked variability in children's response to parental separation, but few studies identify the sources of this variation. This prospective longitudinal study examines the factors modifying children's adjustment to parental separation in a community sample of 5,635 families in England. Children's behavioral/emotional problems were assessed when children were aged 47 and 81 months; marital quality, maternal depression, socioeconomic circumstances, and demographic variables were assessed prior to the separation from maternal report. Results indicated that 346 mothers separated from their partners in the 3-year period. Preseparation differences were found for measures of family process and parent risk factors, with effect sizes ranging from small to trivial. Parental separation was associated with a significant but modest increase in behavioral/emotional problems, independent of marital quality, maternal depression, socioeconomic circumstances, and demographic variables. Moderation analyses showed that children of cohabiting parents had a greater increase in adjustment problems following parental separation than children of married parents. Further research elucidating the factors that moderate children's adjustment to parental separation is needed to improve our understanding of who may most likely benefit from preventive interventions.     

The structure of vocational interests in Filipino adolescents

The structure of vocational interests was investigated in Filipino high school students (N = 503), who rated their interest in 303 culture-relevant occupational titles and 93 major fields of study. Item-level principal components analyses identified general interest, prestige, and sex-type dimensions, rather than Prediger's (1982) People/Things and Data/Ideas dimensions. Additional factor analyses were conducted to derive scales that measure more specific interests, including Unskilled/Semiskilled Labor, Male-dominated, Engineering/Technology, Science, Medical, Arts, Commerce, Government/Law, and Education. The interest scales showed some resemblance or overlap with Holland's types, and gender differences on the scales conformed to expectations. However, the relationships among the scales and occupations were better accounted for by prestige and sex-type than by People/Things and Data/Ideas dimensions or by Holland's circular model. Developmental, cultural, educational, and economic factors that might account for Filipino students' focus on prestige and sex-type were discussed.     

Efficacy of self-administered treatments for pathological academic worry: A randomized controlled trial

Research on treatments for reducing pathological worry is limited. In particular, academic worry is a common theme in generalized anxiety disorder (GAD) samples as well as non-clinical student samples. Given the high cost of anxiety disorders to society, research is needed to examine the efficacy of self-administered treatments designed to reduce pathological worry. The primary goal of this study was to investigate the benefits of three self-administered interventions for reducing academic worry. College students (N = 113) experiencing clinically significant academic worry were randomized to either: (a) worry exposure (WE); (b) expressive writing (EW); (c) relaxation consisting of pulsed audio-photic stimulation (APS); or (d) waitlist control (WLC). Participants were instructed to practice their interventions three times per week for one month and completed home practice logs online to track treatment adherence. Academic worry, general anxiety, and perceived stress were assessed at baseline and post-treatment. Academic worry and general anxiety were also assessed at a three-month follow-up. Those assigned to the WE and APS conditions showed significant improvement relative to EW and WLC at post-treatment. All treatment conditions showed continued improvement by follow-up, with no between-group differences. Treatment and public health implications are discussed.     

学校群体性癔症的处理

从安徽泗县疫苗事件出发,结合文献分析,作者阐述了群体性癔症的特点、发生的一般过程及处理方法。