Lifestyle changes are related to reductions in depression in persons with elevated coronary risk factors

This observational study investigates whether persons with elevated coronary risk factors (CRFs >3 and/or diabetes) and depression [i.e., ≥16 on the Center for Epidemiological Scale – Depression (CES-D)] can make changes in health behaviours over 3 months and improve depressive symptoms and other CRFs. Analyses were based on data from 310 men and 687 women enrolled in the high-risk arm of the Multisite Cardiac Lifestyle Intervention Program, targeting diet (10% fat), exercise (3 h per week) and stress management (7 h per week). As expected, at study entry, depressed persons had a more adverse medical status, consumed more dietary fat and practiced less stress management than non-depressed persons. To examine 3-month changes, participants were grouped into (1) depressed persons who became non-depressed (CES-D ≤ 16, n = 248; 73%), (2) persons who remained or became depressed (CES-D >16, n = 76) and (3) non-depressed persons who remained non-depressed (n = 597). All persons, regardless of group, met program goals. The greatest improvements (i.e., diet, exercise, perceived stress, hostility and mental health) were observed in Group 1 relative to Groups 2 and 3, which did not differ from each other. Comprehensive lifestyle changes appear to be feasible and beneficial for initially depressed persons with elevated CRFs.     

Illness perceptions and distress in women at increased risk of breast cancer

Variation in the levels of distress in women at increased risk of breast cancer has been reported, yet there is limited understanding of the factors that are associated with heightened distress in this population. This study took a theoretical approach using Leventhal's Self Regulatory Model (SRM) to understand variation in distress levels. The study examined the associations between perceptions of breast cancer and distress in women at increased risk of breast cancer, and a comparison sample with no experience of the disease in their social environment. Questionnaire data from 117 women at increased risk of breast cancer and 100 comparison women were analysed. Women at increased risk of breast cancer showed comparable levels of general distress but significantly higher levels of cancer specific distress than the comparison group. There were few differences in illness perceptions between the samples, although a number of cognitive perceptions of breast cancer were related to both general and cancer specific distress in the increased risk sample, but not in the comparison sample. The results suggest that the SRM provides a useful framework to explore the psychological response to genetic risk. Further research is required in this population to examine illness perceptions in more detail, validate quantitative measures of illness perceptions, and examine interactions between risk perception and the SRM constructs.     

When the risks are low: the impact of absolute and comparative information on disturbance and understanding in US and UK samples

When Klein, W. M. gave participants absolute and comparative risk information (crossed experimentally) they were more disturbed by being above than below average, but not by being at higher rather than lower risk. The current experiment tests whether Klein's findings extend to situations involving lower risk figures more typical of genuine health risks, assesses participants’ understanding of the information, and directly compares responses of US and UK samples. Participants were presented with hypothetical information about comparative and absolute risks of deep vein thrombosis. There was a main effect of absolute risk information on disturbance and precaution intentions in the US sample, but no effects of comparative information on these measures in either sample. Understanding was poor among participants receiving both pieces of risk information. Future studies should include measures of understanding to establish whether people are failing to understand what they are told or failing to respond systematically to what they understand. Practically, the findings caution against providing comparative risk information when communicating low risk figures.     

Juggling roles and expectations: dilemmas faced by women talking to relatives about cancer and genetic testing

Health professionals do not inform their patients’ kin about BRCA1/2 test results or genetic testing without their written consent. Thus, the onus is on women attending genetic counselling to talk to relatives about the family history and their potential increased risk. This communication process within the family is largely unexplored and provides the focus of the present study. Fifteen healthy women attending a genetics clinic for predictive testing were interviewed prior to receiving their test result and again 6 months later. A grounded theory approach was used. Findings illustrate the dilemmas women faced in juggling social roles and expectations, which had an impact on communication within the family in the context of predictive genetic testing. Tensions between responsibilities towards themselves and others and their fulfilment of social roles had an impact on who women informed and on how they did so. These factors should be considered when assigning patients the role of information provider.     

Social aspects of career choice from the perspective of habitus theory

The concept of habitus designates a cognitive structure that is socially embedded and can give valuable insight into the social influences on career choice. A study investigating the relationship of habitus to career choice is presented in a sample of Icelandic youth aged 19–22 (N = 476). Measures of habitus were developed on the basis of reported cultural and leisure activities. The analysis of leisure and cultural items progressed in two steps: factor analysis and cluster analysis. The clusters constitute the four different habitus groups: Pop and fashion, Sports and rock, Music, and Literature. Correspondence factor analysis showed that the habitus groups (clusters) were related to other social variables, such as gender and class; validating habitus theory. Additionally, habitus measures were strongly linked to career variables, such as occupational perception and preferred future occupation. The results support previous research in showing that habitus theory is relevant to career counseling theory and can be a basis of understanding the relationship between social structure and career choice.     

The Feasibility OF Collectives' Actions

Orthodox decision theory gives no advice to agents who hold two goods to be incommensurate in value because such agents will have incomplete preferences. According to standard treatments, rationality requires complete preferences, so such agents are irrational. Experience shows, however, that incomplete preferences are ubiquitous in ordinary life. In this paper, we aim to do two things: (1) show that there is a good case for revising decision theory so as to allow it to apply non-vacuously to agents with incomplete preferences, and (2) to identify one substantive criterion that any such non-standard decision theory must obey. Our criterion, Competitiveness, is a weaker version of a dominance principle. Despite its modesty, Competitiveness is incompatible with prospectism, a recently developed decision theory for agents with incomplete preferences. We spend the final part of the paper showing why Competitiveness should be retained, and prospectism rejected.     

Perceptions of alcohol risk among people on antiretroviral treatment in South Africa: a qualitative study

This study explored perceptions of alcohol abuse risk among people on antiretroviral treatment (ART) who self-identified as alcohol users. Twenty six people receiving ART from an out-patient setting were interviewed on their alcohol abuse risk perception. Data were thematically analysed. Findings suggest participants developed routines to drink alcohol around the times they took their antiretroviral medications to reduce adverse impact. They also reported alcohol abuse risk reduction strategies such as reducing alcohol use because of the event of an HIV positive diagnosis and/or getting on antiretroviral treatment, and alcohol use reduction following health education or counselling by health care staff. These findings suggest a need for alcohol interventions tailored to ART patients.     

Thirty Years Later: An Oncologist Reflects on Kubler-Ross's Work

As compared with conventional vaccine production systems, plant-made vaccines (PMVs) are said to enjoy a range of advantages including cost of production and ease of storage for distribution in developing countries. In this article, we introduce the science of PMV production, and address ethical issues associated with development and clinical testing of PMVs within three interrelated domains: PMVs as transgenic plants; PMVs as clinical research materials; and PMVs as agents of global health. We present three conclusions: first, while many of the ethical issues raised by PMVs are familiar, PMVs add a new dimension to old issues, and raise some novel issues for ethicists and policy-makers; secondly, it is premature to promise broad applicability of PMVs across the developing world without having demonstrated their feasibility; thirdly, in particular, proponents of PMVs as a solution to global health problems must, as a condition of the ethical conduct of their research, define the commercial feasibility of PMVs for distribution in the developing world.     

Dynamics of Peer Victimization in Early Adolescence

ABSTRACT

This study addressed the stability of victimization across four consecutive years from Grades 4 to 7, and the concurrent correlates, short-term consequences, and predictors of victimization in early adolescence. Participants were 600 students (49% girls) enrolled in 10 elementary schools in Grades 4-5 and 2 middle schools in Grades 6-7 in an ethnically diverse school system. Data collection included peer nominations, self-reports, and teacher reports in each year. Victimization was highly stable across all years, including the transition from elementary to middle school. Both concurrent and short-term consequences showed that victimized 6th graders, especially girls, experienced significantly greater maladaptive outcomes than their nonvictim counterparts. For both genders, risk factors for adolescent victimization included externalizing and internalizing behaviors, while protective factors included academic and peer sociability elements. Implications for prevention and intervention are discussed.