Conflict or harmony? Clinical research and the medical press in Russia

The author relates conditions for conducting clinical trials in Russia, current experiences of ethics committees, areas where conflicts of interest can occur regarding publishing the results of clinical trials in medical journals and the state of medical journalism in Russia today. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002. The author is a science editor of Meditsynskaya Gazeta.     

Conflict of interest and its significance in science and medicine Warsaw,Poland, 5–6 April, 2002

This article summarizes the April 5–6, 2002 conference on Conflict of Interest and Its Significance in Science and Medicine. Several themes are identified and addressed, including the globalization of science, the widespread presence of conflicts, the increased interest and involvement in conflict of interest by a number of organizations, the difference between academic research and research conducted by industry, and the tension between science and medicine. At the heart of the matter lies objectivity in research and the need for transparency to ensure objectivity. Several future activities were discussed, including the need to share specific examples of how conflict has been managed, and the need for behavioral research to provide a sound empirical understanding of the best ways to provide informed consent for research subjects. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Conflict of interest in medical research in Estonia

An area where conflicts of interest can take place in Estonia is in the conduct of clinical trials. The paper lists the main areas where such conflicts of interest can occur. The author also briefly discusses Estonia’s current position with regard to regulating genetic information and the commencement of the Estonian Genome Project. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Conflict of interest and its significance in science and medicine: a view from Eastern Europe

Conclusions  Continued scientific and medical progress in Central and Eastern Europe depends on the development of an atmosphere that is conducive to implementing the changes that are necessary to bring better health and longer lives for everyone. Privatization and commercialization are threatening the objectivity of clinical research and the availability of health care because uncontrolled market mechanisms focused on profit are nurturing conflict of interest that generate bias and unreliability into research and medicine. Changes are needed that address the following:

Cross-Cultural Generalizability of CBCL Syndromes Across Three Continents: From the USA and Holland to Australia

The study asked how well Achenbach's 8-factor cross-informant model for the Child Behavior Checklist (Achenbach, 1991a, 1991b, 1991c) fits clinic data in the USA, Holland, and Australia. DeGroot et al.'s Dutch 8-factor model (DeGroot, Koot, & Verhulst 1994) was also tested for its cross-cultural generalizability. Achenbach's matched clinical sample data (N = 2110) were analyzed and contrasted with the previously reported Dutch findings (N = 2335), as well as a new data set collected on clinic referred children and adolescents in Australia (N = 2237). Confirmatory factor analyses supported the Dutch as much as the American model in the USA, Holland, and Australia. Although about 90% of items showed convergent validity across models and countries, the attention and especially the social problems factor found least support. Most double loadings in the current models were not upheld. Instead, additional analyses discovered a number of unmodelled loadings including many cross-loadings. This led to the redefinition of the social problems factor as a mean aggression factor (with associated social problems) whereas the original aggression factor focuses on emotional acting out and the delinquent factor describes an evasive, covert type of antisocial behavior. Overall most support was obtained for the withdrawn, somatic, anxious/depressed, thought problems, and aggressive factors.     

Pediatric Health-Related Quality-of-Life Measurement Technology: Intersections between Science, Managed Care, and Clinical Care

The demand for health care outcomes assessment is increasing, driven by the proliferation of managed care as a form of health care financing. Providers, consumers, and payers can use health care outcomes to improve the efficiency and quality of care, spur performance improvement, and demonstrate accountability. This review introduces health outcomes and focuses on one particular outcome—pediatric health-related quality of life (HRQOL), exemplified by the PedsQL, a brief, practical, reliable, valid, and responsive measure of pediatric HRQOL. HRQOL measurement has the potential, in pediatric clinical practice, to improve assessment, clinical management, and treatment evaluation if practical, conceptual, and empirical challenges are addressed. These issues are discussed and directions for future research are described that would demonstrate the value of HRQOL measurement in pediatric clinical settings.     

Learning from within: Therapists' actions in daily clinical practice

The integration of theories and techniques is part of family therapists' daily practice, raising the need to understand which resources are used in this professional's clinical actions. Our aim is to reflect on the use of theoretical and technical resources by family therapists in their daily practice. We developed an inquiry process inspired by collaborative action research and social constructionism. Couple and family therapy sessions were conducted by two family therapists, and we developed subsequent dialogs with them focused on describing theoretical and technical inspirations for their actions. Next, we named four categories of actions in this process: exploratory actions, actions for the construction of relational visions, actions for the construction of communication, and actions for family orientation. The therapists-participants referred to many theoretical and technical resources that inspired their practice. For them, the choice of using one or another resource was based on the demands of the interactive moment, which involves their relational and embodied responses to what was experienced in the sessions. We argue that epistemological coherence is not something that guides the therapist's practice a priori, but something that can be achieved by talking about and reflecting on their actions. This article can contribute to clinical practice and training in family therapy by presenting an interesting reflexive process that can be useful to enhance practice in couple and family therapy (FAPESP, Process n. 2015/21316–1).     

The many-worlds theory of consciousness

This paper sketches a new and somewhat heterodox metaphysical theory of consciousness: the “many-worlds theory”. It drops the assumption that all conscious subjects’ experiences are features of one and the same world and instead associates different subjects with different “first-personally centred worlds”. We can think of these as distinct “first-personal realizers” of a shared “third-personal world”, where the latter is supervenient, in a sense to be explained. This is combined with a form of modal realism, according to which different subjects’ first-personally centred worlds are all real, though only one of them is present for each subject. The theory offers a novel way of capturing the irreducibly subjective nature of conscious experience without lapsing into solipsism. The paper also looks at some scientific theories of consciousness, such as integrated information theory, through the proposed lens and reconsiders the hard problem of consciousness.     

Milieu therapy for neglected children: Treatment in a caring relationship

The central thesis of this paper is that treatment of neglected children can better take place in a caring relationship than in psychotherapy or analysis. In order to create the basis for this idea, Part 1 introduces a milieu therapy for neglected children, developed by the author. In Part 2 of the article, it is proposed that treatment in a caring relationship is in line with the child's dependence on a caring person. It is also argued that the traditional distinction between problems in the child's environment and internal psychological difficulties seems imprecise. Instead, it is proposed that a problem has both an external and an internal aspect. This supports the idea that it may be possible to solve problems that are traditionally considered internal through environmental strategies, for example milieu therapy. The article is hypothesis-generating and builds upon clinical experience inspired by works of, among others, Erikson, Bowlby, Winnicott, and Fonagy and collaborators. Part 1 of the article is the first presentation in English of the main points of the author's books on milieu therapy. The ideas in Part 2 are published here for the first time.