Caregiver Attitudes About Patients Told They Have Alzheimer's Disease After Truth Disclosure

We wished to determine caregiver attitudes about telling patients they have Alzheimer's disease (AD). At a clinic visit, the patient, caregiver, and other family members were informed of the diagnosis of AD in a frank discussion. Caregivers accompanying patients to the Memory Disorders Clinic (MDC) were interviewed in a postvisit telephone survey 3–12 months after the truth disclosure visit. Of the 37 caregivers of a consecutive series of AD clinic patients we contacted, 35 agreed to the interview. Of those caregivers interviewed, 68.6% agreed that it had been a good idea to tell the patient the diagnosis, although 11.4% disagreed. 74.3% thought that the truth disclosure had not been too upsetting; 20% disagreed. Caregivers with more education were more likely to agree that patients should be informed. Neither the relationship of the caregiver to the patient, the patient's age, sex, education level, nor degree of dementia were predictive of the caregiver's attitude about informing the patient. Most Caregivers agreed with disclosing the diagnosis. Only a small group of patients were judged very upset after hearing the diagnosis. Even for those patients, caregivers generally felt that an honest discussion of the diagnosis had been helpful.     

Medical Informatics and the Concept of Disease

This paper attempts to address the general questionwhether information technologies, as applied in thearea of medicine and health care, have or are likelyto change fundamental concepts regarding disease andhealth. After a short excursion into the domain ofmedical informatics I provide a brief overview of someof the current theories of what a disease is from amore philosophical perspective, i.e. the ``valuefree' and ``value laden' view of disease. Next, Iconsider at some length, whether health careinformatics is currently modifying fundamentalconcepts of disease. To this question I will answerlargely in the negative, and I will provide the sketchof some arguments from current research programs inmedical informatics why I think this is the case. Thisargumentation is supported by a detailed account ofhow the disease profile for beriberi heart disease,used in one of the major medical informaticsdiagnostic programs, QMR (and its ancestorINTERNIST-1), was developed, and why at least thisprogram essentially follows received views oftraditional medicine.The one main exception to theconformity of this program to ``received' views of adisease occurs when the program's designers need tofine-tune a disease definition. This fine-tuning is tocomport with the expert's perspective on the disease,including his or her epistemic values, as well as theprogram's other resources for diagnosing components ofa disease.     

Plague God Image in the Clinic1

This paper selects four dreams before and during COVID-19 which constellated the Plague God image in Chinese culture. The author argues that this shows evidence that the origins of the modern psyche, although hidden, are preserved and living within the ancient anima mundi.     

COVID-19 Vaccination Acceptance: A Case of Interplay Between Political and Health Dimensions

Vaccines are essential for the eradication of diseases. Yet for many reasons, individuals do not embrace them completely. In the COVID-19 pandemic and with the possibility of the Brazilian population's immunization against the disease, both political and health-related dimensions might have had a role in individual COVID-19 vaccination acceptance. In two studies (n = 974), we tested the hypothesis that participants' vaccination acceptance is related to their past vote in the 2018 Brazilian presidential election (being or not being a Jair Bolsonaro voter) and their different levels of perceived vulnerability to disease (PVD). We further tested whether Bolsonaro's opposition or ambiguous messages towards vaccination (vs. control) increased vaccination rejection among those who have (vs. have not) voted for him and who are low (vs. high) in PVD. Results show that Bolsonaro (vs. non-Bolsonaro) voters accepted less vaccination, with higher rejection rates when participants expressed low (vs. high) PVD. Also, when primed either with Bolsonaro's opposed or ambiguous messages towards COVID-19 vaccination, such participants accepted less vaccines (vs. participants primed with neutral information). These findings are the first to show that the COVID-19 vaccine acceptance is related to their past vote and leadership influence but also different levels of perceived vulnerability to disease.     

Cluster analysis reveals distinct patterns of saccade impairment and their relation to cognitive profiles in Parkinson's disease

Saccade performance has been reported to be altered in Parkinson's disease (PD), however, with a large variability between studies as both motor and cognitive impairment interfere with oculomotor control. The aim of this study was to identify different patterns in saccade alterations in PD using a data-driven approach and to explore their relationship with cognitive phenotypes. Sixty-one participants with PD and 25 controls performed eye-tracking (horizontal and vertical prosaccades, antisaccades) and neuropsychological testing. Hierarchical cluster analysis was applied to the eye-tracking data to subsequently compare the clusters based on demographical, clinical and cognitive characteristics. The three identified clusters of saccade alterations differed in cognitive profiles from healthy controls, but not in PD-related motor symptoms or demographics. The rate of directive errors in the antisaccade task was increased in clusters 1 and 2. Further, cluster 1 was defined by a general disinhibition of reflexive saccades and executive dysfunction in the neuropsychological evaluation. In cluster 2, prolonged saccade latencies and hypometria were accompanied by multidomain cognitive impairment. The cluster 3 showed increased antisaccade latency and vertical hypometria despite lack of evidence for cognitive impairment. Our results suggest that there may be at least two opposing patterns of saccade alterations associated with cognitive impairment in PD, which may explain some of the contradictory results of previous studies.     

Motor imagery vividness and symptom severity in Parkinson's disease

Motor imagery (MI), the mental simulation of movement in the absence of overt motor output, has demonstrated potential as a technique to support rehabilitation of movement in neurological conditions such as Parkinson's disease (PD). Existing evidence suggests that MI is largely preserved in PD, but previous studies have typically examined global measures of MI and have not considered the potential impact of individual differences in symptom presentation on MI. The present study investigated the influence of severity of overall motor symptoms, bradykinesia and tremor on MI vividness scores in 44 individuals with mild to moderate idiopathic PD. Linear mixed effects modelling revealed that imagery modality and the severity of left side bradykinesia significantly influenced MI vividness ratings. Consistent with previous findings, participants rated visual motor imagery (VMI) to be more vivid than kinesthetic motor imagery (KMI). Greater severity of left side bradykinesia (but not right side bradykinesia) predicted increased vividness of KMI, while tremor severity and overall motor symptom severity did not predict vividness of MI. The specificity of the effect of bradykinesia to the left side may reflect greater premorbid vividness for the dominant (right) side or increased attention to more effortful movements on the left side of the body resulting in more vivid motor imagery.     

Psychological impact of coronavirus-related social isolation in Colombia after a year of lockdown

Several repercussions of the COVID-19 pandemic and its subsequent isolation period have been reported worldwide. In this paper, we analyze the behavioral and emotional effects of 1 year of coronavirus-related lockdown in Colombia. A cross-sectional correlational design was used on a sample of 1853 participants from different regions, and with different levels of education, income, and employment situations. We applied the fear of coronavirus scale, the use of preventive behaviors scale, and a scale to measure pleasant and unpleasant emotions based on the circumplex model of affect. Our data shows that women, participants who were unemployed during the lockdown, and participants that study or work in legal, computational, or related fields, have been more affected in terms of unpleasant emotions. In addition, we observed a trend towards a relation between higher income and educational levels with lower degrees of fear, higher degrees of pleasant emotions, and a greater use of preventive behaviors related to the pandemic.     

Safety first,but for whom? Shifts in risk perception for self and others following COVID-19 vaccination

Vaccines can affect the mind as well as the body. Research on the psychological impact of vaccines has largely focused on risk-related judgments and behaviors involving the recipient. Here, we extend this work to risk-related judgments of others. In a prospective cohort study involving three samples and two timepoints (N = 588 adults), we tested competing hypotheses about the effects of receiving a COVID-19 vaccine on perceived risks to the unvaccinated: (1) a self/other differentiation hypothesis (vaccination will lead to estimation of lower risk for the self but higher risk for others) versus (2) a self/other correspondence hypothesis (vaccination will lead to estimation of lower risk from contracting COVID-19 for both self and others). Results revealed risk estimates as well as preferences for COVID-related social policies more consistent with the former hypothesis. We discuss potential psychological mechanisms and implications of these findings.     

Electrocortical signs of arousal in response to darkness and the assessment of type A behavior in professional drivers with and without cardiovascular disease

Background and Aims  In night driving, the fatal accident rate is about four times that in daytime. There is a lack of published studies of the effect of darkness on electrocortical responses in professional drivers (PD). Aim: Assessing relations between electroencephalographic (EEG) reactions to enforced darkness reminiscent of night driving, and untoward behavioral response patterns, notably Type A behavior. Methods  PD: 13 with ischemic heart disease, 12 hypertensives (HTN), 10 borderline hypertensives and 34 normotensives, and 23 non-PD controls. Five minutes of electroencephalographic recording with eyes closed, and subsequently 3 minutes exposure to darkness. EEG parameters were: alpha abundance, amplitude and frequent. Type A behavior (TAB) was assessed by observation and by questionnaire. Results  Alpha abundance diminished significantly for darkness compared to spontaneous recording for all groups. No between-group differences were found for EEG. There were no significant differences in EEG between drivers with IHD or HTN taking versus not taking centrally active β-blockers. Drivers with IHD were the only group to show significant increase in dominant α frequency at darkness. The IHD group also had the highest TAB questionnaire scores and the heaviest exposure to professional driving. Type A scores were significantly correlated with dominantt alpha frequency during darkness. Low availability of attachment and special driving hazards best predicted TAB scores in driven. There was a significance between group difference with respect to Symbolic Aversiveness at the work place comparing each driver group with the non-PD control group. Conclusions  Exposure to darkness reminiscent of night driving can elicit central arousal, in conflict with circadian rhythm, and in combination with other driving hazards which contribute to symbolic aversiveness, the essence of driving. And low availability of social attachment could contribute to sustained, and in turn to the development of Type A behavior in professional drivers.     

第三次医学革命与理论思维

第三次医学革命是指我们站在传染病世界危机的边缘上,各国无一幸免。传染病仍是世界范围内的第一位死亡原因。来自首次感染和重复感染的威胁是抗生素耐药菌惊人的增长。现在理论思维已从机遇思维转向逆向思维。