Due to evidence that traumatic experience impacts the brain, the body (concerning sensory sensitivity), and the mind, a recent study that attempted to answer the question of whether the effects of CSA can be reversed by using a multidisciplinary approach consisting of dual treatments: hyperbaric & psychotherapy, was conducted. Its results showed that in addition to improvement of brain functionality, symptoms of distress were significantly reduced. The current paper aims to present the process as experienced by the 40 female childhood (...) sexual abuse survivor participants. Data included participants’ daily journals and drawings, and participants’ summaries presented verbally and written, 6-months after the study ended. A phenomenological analysis was used. Results showed three phases, the initial phase – remembering the trauma from both physical and cognitive aspects, the second phase - physiological relaxation as well as positive memories emerge; and, the third phase – bouncing back to life. The results are discussed in light of the study theoretical model and Lev-Wiesel (2014) childhood sexual abuse conceptualization. (shrink)

To the woman, God said, “I will greatly multiply your pain in child bearing; in pain you shall bring forth children, yet your desire shall be for your husband, and he shall rule over you.”Genesis 3:16There is now a well-established body of literature documenting the pervasive inadequate treatment of pain in this country. There have also been allegations, and some data, supporting the notion that women are more likely than men to be undertreated or inappropriately diagnosed and treated for (...) their pain.One particularly troublesome study indicated that women are more likely to be given sedatives for their pain and men to be given pain medication. Speculation as to why this difference might exist has included the following: Women complain more than men; women are not accurate reporters of their pain; men are more stoic so that when they do complain of pain, “it's real”; and women are better able to tolerate pain or have better coping skills than men. (shrink)

Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients. PubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were (...) examined to identify further eligible studies. Forty two articles were identified as eligible. Seventeen used an implicit measure, to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals’ attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care. The evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics. Our findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed. (shrink)

Introduction: Alcohol approach bias, the tendency to automatically move toward alcohol cues, has been observed in people who drink heavily. However, surprisingly, some alcohol-dependent patients demonstrate an alcohol avoidance bias. This inconsistency could be explained by the clinical or demographic profile of the population studied, yet this has not been examined in approach bias modification trials to date. We aimed to determine the proportion of patients with an approach or avoidance bias, assess whether they differ on (...) demographic and drinking measures, and to examine the clinical correlates of approach bias.Method: These research questions were addressed using baseline data from 268 alcohol-dependent patients undergoing inpatient withdrawal treatment who then went on to participate in a trial of ABM.Results: At trial entry, 155 had an alcohol approach bias and 113 had an avoidance bias. These two groups did not differ on any demographic or relevant drinking measures. Approach bias was significantly and moderately associated with total standard drinks consumed in the past 30 days but no other indices of alcohol consumption or problem severity.Conclusion: Whilst the majority of alcohol-dependent patients showed an alcohol approach bias, those with an avoidance bias did not differ in demographic or clinical characteristics, and the strength of approach bias related only to recent consumption. Further research is needed to develop more accurate and personally tailored measures of approach bias, as these findings likely reflect the poor reliability of standard approach bias measures. (shrink)

Every year medical researchers make contact with a large number of cancer survivors with the aim of evaluating cancer treatment. For this reason we decided to investigate how Swedish cancer survivors perceived their participation in research studies focusing on the long-term consequences of being a survivor of gynaecological or urinary bladder cancer. Data were collected by means of two study-specific postal questionnaires, both consisting of questions covering physical symptoms, well-being and the experience of being a cancer survivor. (...) Both questionnaires also included questions evaluating the participants’ experience of being research subjects. The questionnaires were developed in close co-operation with cancer survivors. The study population consisted of 1068 cancer survivors. Of these, 95% (n=1003) reported that they thought the study was valuable and 54% (n=559) that they had been positively affected by participating. Four per cent (n=39) expressed that they had been negatively affected by their participation in the study. The vast majority of the cancer survivors thought that participating in their particular study was valuable. (shrink)

When ethical decisions have to be taken in critical, complex medical situations, they often involve decisions that set the course for or against life-sustaining treatments. Therefore the decisions have far-reaching consequences for the patients, their relatives, and often for the clinical staff. Although the rich psychology literature provides evidence that reasoning may be affected by undesired influences that may undermine the quality of the decision outcome, not much attention has been given to this phenomenon in health care or ethics consultation. (...) In this paper, we aim to contribute to the sensitization of the problem of systematic reasoning biases by showing how exemplary individual and group biases can affect the quality of decision-making on an individual and group level. We are addressing clinical ethicists as well as clinicians who guide complex decision-making processes of ethical significance. Knowledge regarding exemplary group psychological biases (e.g. conformity bias), and individual biases (e.g. stereotypes), will be taken from the disciplines of social psychology and cognitive decision science and considered in the field of ethical decision-making. Finally we discuss the influence of intuitive versus analytical (systematical) reasoning on the validity of ethical decision-making. (shrink)

As algorithms have become ubiquitous in consequential domains, societal concerns about the potential for discriminatory outcomes have prompted urgent calls to address algorithmic bias. In response, a rich literature across computer science, law, and ethics is rapidly proliferating to advance approaches to designing fair algorithms. Yet computer scientists, legal scholars, and ethicists are often not speaking the same language when using the term ‘bias.’ Debates concerning whether society can or should tackle the problem of algorithmic bias are (...) hampered by conflations of various understandings of bias, ranging from neutral deviations from a standard to morally problematic instances of injustice due to prejudice, discrimination, and disparate treatment. This terminological confusion impedes efforts to address clear cases of discrimination. -/- In this paper, we examine the promises and challenges of different approaches to disambiguating bias and designing for justice. While both approaches aid in understanding and addressing clear algorithmic harms, we argue that they also risk being leveraged in ways that ultimately deflect accountability from those building and deploying these systems. Applying this analysis to recent examples of generative AI, our argument highlights unseen dangers in current methods of evaluating algorithmic bias and points to ways to redirect approaches to addressing bias in generative AI at its early stages in ways that can more robustly meet the demands of justice. (shrink)

Work in philosophy of religion exhibits at least four symptoms of poor health: it is too partisan, too polemical, too narrow in its focus, and too often evaluated using criteria that are theological or religious instead of philosophical. Our diagnosis is that, because of the emotional and psychosocial aspects of religion, many philosophers of religion suffer from cognitive biases and group influence. We support this diagnosis in two ways. First, we examine work in psychology on cognitive biases and their affective (...) triggers. This work supports the view that, while cognitive biases are no doubt a problem in all inquiry and in all areas ofphilosophy, they are particularly damaging to inquiry in philosophy of religion. Second, we examine work in social and evolutionary psychology on religious sociality and its attendant emotions. This work establishes that the coalitional features of religion are correlated with group bias, and we contend that this bias is also harmful to inquiry in philosophy of religion. We close by offering both a prognosis and recommendations for treatment. (shrink)

Growing literature has linked attention bias variability to the experience and treatment of posttraumatic stress disorder. Unlike assessments of attention bias in only one direction, A...

In this paper, I argue that instead of primarily paying attention to the nature of implicit attitudes that are taken to cause implicit discrimination, we should investigate how discrimination can be implicit in itself. I propose to characterize implicit discrimination as unintentional discrimination: the person responds to facts unintentionally and often unconsciously which are, given their end, irrelevant and imply unfair treatment. The result is a unified account of implicit bias that allows for the different ways in which (...) it can display itself and can be explained. Furthermore, the view can account for the central characteristics of implicit bias: (1) that it is, for a variety of reasons, difficult to control, (2) that we are not necessarily unconscious of implicit bias but not properly conscious either, and (3) that we can unintentionally discriminate regardless of whether we claim to care about fairness. (shrink)

Animal welfare scientific literature has accumulated rapidly in recent years, but bias may exist which influences understanding of progress in the field. We conducted a survey of articles related to animal welfare or well being from an electronic database. From 8,541 articles on this topic, we randomly selected 115 articles for detailed review in four funding categories: government; charity and/or scientific association; industry; and educational organization. Ninety articles were evaluated after unsuitable articles were rejected. The welfare states of animals (...) in new treatments, conventional treatments or control groups with no treatment were classified as high, medium or low according to one or more. More articles were published in which the welfare of animals in new treatments was better than that of animals in the conventional or no treatment groups, demonstrating a positive result bias. Failure to publish studies with negative or inconclusive results may lead to other scientists unnecessarily repeating the research. The authors’ assessments of the welfare state of the groups were similarly rated high, medium or low, and it was found that new treatments were rated lower if the research was funded by industry, and higher when funded by charities, with government funding agencies intermediate. These differences were not evident in the Five Freedoms assessment, demonstrating an authors’ assessment bias that appeared to support the funding agencies’ interests. North American funded publications rated the welfare of animals in New treatments higher and those in a Conventional or No Treatment lower, compared with European-funded publications. It is concluded that preliminary evidence was provided of several forms of publication bias in animal welfare science. (shrink)

The concept of equipoise is considered by many to be part of the ethical justification for using human subjects in clinical research. In general, equipoise indicates some uncertainty about the relative merits of the experimental intervention compared to existing treatments. Relieving this uncertainty gives scientific value to an experiment, thereby making the risks to human subjects in the trial acceptable, other considerations notwithstanding. But characterizing equipoise remains controversial since Freedman’s groundbreaking publication on the subject. We offer a new account of (...) equipoise that draws on and extends an option Freedman discarded. After establishing the importance of some account of equipoise as part of ethically justified clinical trials, we revisit Freedman’s distinction between clinical and theoretical equipoise. We raise concerns about Freedman’s preferred clinical equipoise and then rehabilitate theoretical equipoise. In particular, we use a variety of arguments from epistemology to show how Freedman was too hasty in rejecting theoretical equipoise. In addition, we argue that theoretical equipoise is a subspecies of epistemic equipoise, which we characterize as a form of uncertainty that is the result of the possibility of error. This type of uncertainty can best be alleviated by research, which produces beliefs supported by strong statistical evidence, which is a key aim of clinical trials. Further, this type of uncertainty can explain why even clinicians with more firsthand experience with an intervention than their peers, and who may not be in theoretical equipoise, could still justifiably support a trial designed to ameliorate the possibility of error due to cognitive bias. (shrink)

Purpose The online economy has not resolved the issue of racial bias in its applications. While algorithms are procedures that facilitate automated decision-making, or a sequence of unambiguous instructions, bias is a byproduct of these computations, bringing harm to historically disadvantaged populations. This paper argues that algorithmic biases explicitly and implicitly harm racial groups and lead to forms of discrimination. Relying upon sociological and technical research, the paper offers commentary on the need for more workplace diversity within high-tech (...) industries and public policies that can detect or reduce the likelihood of racial bias in algorithmic design and execution. Design/methodology/approach The paper shares examples in the US where algorithmic biases have been reported and the strategies for explaining and addressing them. Findings The findings of the paper suggest that explicit racial bias in algorithms can be mitigated by existing laws, including those governing housing, employment, and the extension of credit. Implicit, or unconscious, biases are harder to redress without more diverse workplaces and public policies that have an approach to bias detection and mitigation. Research limitations/implications The major implication of this research is that further research needs to be done. Increasing the scholarly research in this area will be a major contribution in understanding how emerging technologies are creating disparate and unfair treatment for certain populations. Practical implications The practical implications of the work point to areas within industries and the government that can tackle the question of algorithmic bias, fairness and accountability, especially African-Americans. Social implications The social implications are that emerging technologies are not devoid of societal influences that constantly define positions of power, values, and norms. Originality/value The paper joins a scarcity of existing research, especially in the area that intersects race and algorithmic development. (shrink)

This article is about how rape survivors prepare themselves for courtroom appearances. Through it, the author attempts to take research on rape processing beyond a focus on the affective responses of rape “victims” have to the behavior of legal personnel and toward an investigation of the agency of rape survivors. The study builds on law and society research about lay litigants' efforts to use the U.S. civil court system, linguistic research about witnesses involvement in courtroom interaction, and the existing literature (...) on rape processing. It is based on face-to-face interviews with 32 survivors and 12 courtroom observations. The analysis is inductive; the presentation is ethnographic. The author explicates six types of preparation for court: appearance work, role rehearsal, emotion work, team building, role research, and case enhancement. The author discusses how survivors' perceptions of what the criminal justice process entails are reflected in the different preparation activities, and the author offers policy implications regarding the treatment of rape survivors in the criminal justice system. (shrink)

Animal welfare scientific literature has accumulated rapidly in recent years, but bias may exist which influences understanding of progress in the field. We conducted a survey of articles related to animal welfare or well being from an electronic database. From 8,541 articles on this topic, we randomly selected 115 articles for detailed review in four funding categories: government; charity and/or scientific association; industry; and educational organization. Ninety articles were evaluated after unsuitable articles were rejected. The welfare states of animals (...) in new treatments, conventional treatments or control groups with no treatment were classified as high, medium or low according to one or more. More articles were published in which the welfare of animals in new treatments was better than that of animals in the conventional or no treatment groups, demonstrating a positive result bias. Failure to publish studies with negative or inconclusive results may lead to other scientists unnecessarily repeating the research. The authors’ assessments of the welfare state of the groups were similarly rated high, medium or low, and it was found that new treatments were rated lower if the research was funded by industry, and higher when funded by charities, with government funding agencies intermediate. These differences were not evident in the Five Freedoms assessment, demonstrating an authors’ assessment bias that appeared to support the funding agencies’ interests. North American funded publications rated the welfare of animals in New treatments higher and those in a Conventional or No Treatment lower, compared with European-funded publications. It is concluded that preliminary evidence was provided of several forms of publication bias in animal welfare science. (shrink)

Aims: Attentional bias, alcohol craving, and anxiety have important implications in the development and maintenance of alcohol use disorder. The current study aims to test the effectiveness of a Virtual Reality Cue-Exposure Therapy to reduce levels of alcohol craving and anxiety and prompt changes in AB toward alcohol content.Method: A 49-year-old male participated in this study, diagnosed with severe AUD, who also used tobacco and illicit substances on an occasional basis and who made several failed attempts to cease substance (...) misuse. The protocol consisted of six VR-CET booster sessions and two assessment sessions over the course of 5 weeks. The VR-CET program consisted of booster therapy sessions based on virtual reality exposure to preferred alcohol-related cues and contexts. The initial and final assessment sessions were focused on exploring AB, alcohol craving, and anxiety using paper-and-pencil instruments and the eye-tracking and VR technologies at different time points.Results: Pre and post assessment sessions indicated falls on the scores of all instruments assessing alcohol craving, anxiety, and AB.Conclusions: This case report, part of a larger project, demonstrates the effectiveness of the VR-CET booster sessions in AUD. In the post-treatment measurements, a variety of instruments showed a change in the AB pattern and an improvement in craving and anxiety responses. As a result of the systematic desensitization, virtual exposure gradually reduced the responses to significant alcohol-related cues and contexts. The implications for AB, anxiety and craving are discussed. (shrink)

For nearly five years, bioethicists and neurologists debated whether Jahi McMath, an African American teenager, was alive or dead. While Jahi's condition provides a compelling study for analyzing brain death, circumscribing her life status to a question of brain death fails to acknowledge and respond to a chronic, if uncomfortable, bioethics problem in American health care—namely, racial bias and unequal treatment, both real and perceived. Bioethicists should examine the underlying, arguably broader social implications of what Jahi's medical (...) class='Hi'>treatment and experience represented. On any given day, disparities in the quality of health care and health outcomes for people of color in comparison to whites are evidenced in American hospitals and clinics. These disparities are not entirely explained by differences in patient education, insurance status, employment, income, expressed preference for treatments, and severity of disease. Instead, research indicates that, even for African Americans able to gain access to health care services and navigate institutional nuances, disparities persist across a broad range of services, including diagnostic screening and general medical care, mental health diagnosis and treatment, pain management, HIV‐related care, and treatments for cancer, heart disease, diabetes, and kidney disease. (shrink)

Patients with advanced dementia are less likely than those with other terminal illnesses to receive palliative care. Due to the nature and course of dementia, there may be a failure to recognize the terminal stage of the disease. A possible and under-investigated explanation for this healthcare disparity is the healthcare practitioner who plays a primary role in end-of-life decision-making. Two potential areas that might impact provider decision-making are cognitive biases and moral considerations. In this analysis, we demonstrate how the cognitive (...) biases and moral considerations of practitioners related to clinical decision-making are inherent in clinical practice and may impact on providers’ accuracy related to diagnostic and treatment related decision-making associated with patients with advanced dementia. Anchoring, default, availability, representativeness and framing biases are cognitive biases based on the "Two System Model" that relate to decision-making in end-of-life care. In patients with advanced dementia, those biases may result in a tendency to adhere to traditional mandatory care, involving an aggressive approach to care, which values saving lives at all costs, without taking into account the possible suffering and long-term consequences. Aspects such as moral sensitivity and moral courage play an important role in ethical decision-making related to advanced dementia. Investigations of clinical decision-making that include the cognitive biases and ethical considerations of practitioners might advance the comprehensive understanding of the clinical decision-making process related to care of patients with advanced dementia and promote the quality of care given to this population. (shrink)

Our paper contributes to the rapidly expanding body of experimental research on transformative decision making, and in the process, marks out a novel empirical interpretation for assessments of subjective value in transformative contexts. We start with a discussion of the role of subjective value in transformative decisions, and then critique extant experimental work that explores this role, with special attention to Reuter and Messerli (2018). We argue that current empirical treatments miss a crucial feature of practical deliberation manifesting across a (...) variety of everyday decisions: often, people attach more weight to decision criteria that they can know—a phenomenon known as the “evaluability bias.” In transformative contexts, if people cannot know the subjective value of an option, they are unlikely to attach it much weight. Despite this, people may care very much about such value. We then use this point to develop and present new empirical results that, in addition to supporting our concerns about evaluability bias, support the hypothesis that people care about subjective value. Our work enriches the current philosophical understanding of transformative decisions and helps to frame the emerging experimental paradigm for the empirical dimensions of the debate. (shrink)

ObjectiveThe objective of this paper is to evaluate the cognitive benefit of exercise after stroke, so as to provide more accurate and reliable guidance for targeted exercise intervention. Methods. Randomized controlled trials of the relationship between exercise and cognition after stroke were identified in Cochrane Library and PubMed. Methodological quality was assessed using the Cochrane tool of bias. SMD and 95% confidence intervals were calculated, and Chi-squared test was adopted to estimate the heterogeneity. Results. Twenty-three studies met inclusion criteria, (...) including 1528 participants. Heterogeneity was from low to high such as attention, executive function, cognition, and working memory. The overall effect on cognition was small but significant and there is a difference between cognitive domains in attention, executive function, and working memory. Exercise training was less effective before the 18th month after stroke. Higher benefits on cognition were found after combined therapy compared with other exercise programs, and the older the stroke survivors, the less the cognitive benefit of exercise. Conclusion. Small-to-moderate effect of exercise on cognitive benefit after stroke was found, and the effect was moderated by treatment protocols and sample characteristics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:My Lost SurvivorVirginia HammondI can’t remember the exact words as I brought my 7–year–8–month–old daughter Ann to the university medical center late spring for a review of her brain surgery from March 1990, but the words were something like it was a remarkable 98% resection, then the team went on to say 75% was considered successful and they were surprised since the surgery was not done at a major (...) medical facility. I explained to the team we had three neurosurgeons in our town from major facilities out of state who were very well regarded so I opted to stay in town for her surgery, but valued the university medical center’s recommendation for radiation treatment. The next decision I had to make was where. I not only had to consider my daughter, but my toddler that I had to drag everywhere through all this as I had no family nearby to help me. I opted for a 75–mile drive.The radiation protocol was for eight weeks of hyperfractionated radiation. I would leave the house with the both kids by 7:30 a.m. and stay until 3:30 p.m. because there were two treatments a day around six hours apart. I had thoughts that I would be able to take the kids to the zoo or children’s museum in between treatments, but Ann was much too sick for that. We spent most of our day at the playroom in the cancer patient house next to the radiation facility. We eventually got a room at the cancer home.Even before the radiation therapy, Ann became sick and would wake up every morning vomiting very much like she would before the tumor resection. This vomiting went on for almost two years after her surgery and radiation. We were bounced around between doctors and specialist then finally a pediatric neurologist was concerned about how thin and frail she was and prescribed a medication that goes by the generic name Cyproheptadine hoping it would help her appetite. Within a couple of days, much to my surprise, the medicine stopped the morning vomiting and she began to eat and regain some strength as she approached the age of ten.Now that Ann was no longer showing the outward physical signs of being ill, her school didn’t think it was necessary to make accommodations for Special Education, or follow the recommendations made by a neuropsychologist’s report. I was told her educational performance was average for her age and grade level. The school did discover she could not hear in her left ear and sent home a note that demanded I seek medical attention. I explained to [End Page E4] them her doctors were well aware of her perforation in her ear and decided they wanted more time to pass from the brain surgery before performing ear surgery.There was one bright spot during her elementary school years. She had a teacher who went out of his way to make sure Ann was responding to what was being taught. Aware of her hearing deficit in her left ear and some of her cognitive deficits, he sat her in the classroom where she could hear at her best and placed her next to classmates who would not distract her. When she would forget to bring her homework home, he would stop by the house with it rather than write a disciplinary action against her. She responded so well to this teacher, she was one of a couple of students in her class that was sent to the countywide science competition. She thrived that year, but never again was she to have a professional teacher that made sure she got it!When Ann was 11, the ear doctor decided it was time for her left ear perforation to be repaired and that would restore her hearing in that ear. She had the surgery, but the hearing was never restored.Ann’s ability to learn was becoming more difficult. I pulled her out of traditional public school to home school her through public charter school. I wish I had another option as she didn’t always appreciate my... (shrink)

This paper discusses two conservative ways of treating evidence. (I) Closing inquiry involves discounting evidence bearing on one's belief unless it is particularly strong evidence; (II) biased assimilation involves dedicating more investigative resources to scrutinizing disconfirming evidence (than confirming evidence), thereby increasing the chances of finding reasons to dismiss it. It is natural to worry that these practices lead to irrational biases in favor of one's existing beliefs, and that they make one's epistemic condition significantly path-sensitive by giving a bigger (...) role to batches of evidence obtained earlier in the course of inquiry compared with those subsequently acquired. However, I argue that both practices are demanded by considerations of practical rationality. I also argue that, contrary to initial appearances, there is little reason to worry about the effects of these practices on the dynamics of one's beliefs. (shrink)

ABSTRACTPrior research on attention bias in anxious youth, often utilising a visual dot probe task, has yielded inconsistent findings, which may be due to how bias is assessed and/or variability in the phenomenon. The present study utilises eye gaze tracking to assess attention bias in socially anxious adolescents, and explores several methodological and within-subject factors that may contribute to variability in attention bias. Attention bias to threat was measured in forty-two treatment-seeking adolescents diagnosed with (...) Social Anxiety Disorder. Bias scores toward emotional stimuli and bias scores away from emotional stimuli were explored. Bias scores changed between vigilance and avoidance within individuals and over the course of stimulus presentation. These differences were not associated with participant characteristics nor with self-reported social anxiety symptoms. However, clinician rated severity of social anxiety, explained a signific... (shrink)

Intimate partner violence is an important problem that has significant detrimental effects on the wellbeing of female victims. The chronic physical and psychological effects of intimate partner violence are complex, long-lasting, chronic, and require treatments focusing on improving mental health issues, safety, and support. Various psycho-social intervention programs are being implemented to improve survivor wellbeing. However, little is known about the effectiveness of different treatments on IPV survivors' wellbeing. For this purpose, we conducted a systematic review and meta-analysis to (...) assess the effectiveness of interventions on improving outcomes that describe the wellbeing of adult female survivors of IPV. We searched PubMed, PsycINFO, and Cochrane Library. We explored the effectiveness of available interventions on multiple outcomes that are critical for the wellbeing of adult female victims of IPV. To provide a broad and comprehensive view of survivors' wellbeing, we considered outcomes including mental health, physical health, diminishing further violence, social support, safety, self-efficacy, and quality of life. We reviewed 2,770 citations. Among these 25 randomized-controlled-study with a total of 4,683 participants met inclusion criteria. Findings of meta-analyses on interventions indicated promising results in improving anxiety [standardized mean difference −7.15, 95% confidence interval −8.39 to −5.92], depression, safety, violence prevention, health, self-esteem, social support, and stress management at the post-test. We found that empowerment plays a vital role, especially when treating depression and Post-Traumatic Stress Disorder, which are difficult to improve across interventions. We found mixed findings on self-efficacy and quality of life. The effects of IPV are long-lasting and require treatments targeting co-morbid issues including improving safety and mental health issues. (shrink)

Many babies with trisomy 13 and 18 die in the first year of life. Survivors all have severe cognitive impairment. There has been a debate among both professionals and parents about whether it is appropriate to provide life-sustaining interventions to babies with these serious conditions. On one side of the debate are those who argue that there is no point in providing invasive, painful, and expensive procedures when the only outcomes are either early death or survival with severe cognitive impairment. (...) Others suggest that, although mortality is high and cognitive impairment universal, babies with these conditions have an acceptable quality of life. In this paper, we will discuss both points of view. We will review the ways in which these conditions are portrayed in pediatrics textbooks and on social media sites that offer support to parents. We will then suggest an appropriate way to deal with clinical decisions for babies with these trisomies. (shrink)

ObjectiveCancer and its treatments affect patients’ fertility potential. This study examined the prevalence of reproductive concerns and their relationship with metacognitions among Chinese young adult female cancer survivors.MethodsA total of 318 YAFCS completed an online survey from March to December 2021. Participants reported sociodemographic characteristics, reproductive concerns and metacognitions. Reproductive concerns were measured using the Reproductive Concerns after Cancer scale, and metacognitions were measured by the Short Form of Metacognitions Questionnaire. We used Pearson correlation analysis to examine associations between metacognitions (...) and reproductive concerns across multiple domains and multivariable linear regression to determine the influencing factors of reproductive concerns.ResultsThe mean score of reproductive concern among YAFCS was 49.97 ± 12.52. A total of 57.9% of participants reported a high level of concern regarding at least one dimension of reproductive concerns, and they were most concerned about their child’s health and least concerned about partner disclosure of fertility status. We also found a moderate association between RCAC and MCQ-30 scores. In multivariate analyses, metacognitions, especially negative metacognitive beliefs had an impact on reproductive concerns among YAFCS.ConclusionHigher reproductive concerns were associated with higher metacognitions among YAFCS, especially with negative metacognitive beliefs. Oncology professionals should pay attention to assessing reproductive concerns in patients who want to have children or who have no children. Moreover, metacognitive beliefs may be an intervention target for alleviating reproductive concerns among YAFCS. (shrink)

Depression is a highly recurrent disorder with limited treatment alternatives for reducing risk of subsequent episodes. Acceptance and commitment therapy (ACT) and attention bias modification (ABM) separately have shown some promise in reducing depressive symptoms. This study investigates (a) if group-based ACT had a greater impact in reducing residual symptoms of depression over a 12-month follow-up than a control condition, and (b) if preceding ACT with ABM produced added benefits. This multisite study consisted of two phases. In phase (...) 1, participants with a history of depression, currently in remission (N= 244), were randomized to either receive 14 days of ABM or a control condition. In phase 2, a quasi- experimental design was adopted, and only phase-1 participants from the Sørlandet site (N= 124) next received an 8-week group-based ACT intervention. Self-reported and clinician-rated depression symptoms were assessed at baseline, immediately after phase 1 and at 1, 2, 6, and 12 months after the conclusion of phase 1. At 12-month follow-up, participants who received ACT exhibited fewer self-reported and clinician-rated depressive symptoms. There were no significant differences between ACT groups preceded by ABM or a control condition. There were no significant differences between ACT groups preceded by ABM or a control condition. Group-based ACT successfully decreased residual symptoms in depression over 12 months, suggesting some promise in preventing relapse. (shrink)

In pediatric emergency rooms (ERs), social workers must navigate diverse responsibilities including acting as advocates and liaisons between families and multidisciplinary treatment teams, providing compassionate support to families in crisis, and assessing for and reporting any suspicions of child abuse or neglect. These potentially contrasting roles can place social workers at the center of dealing with ethical dilemmas and advocating against ethical violations, such as bias and discrimination toward families. This qualitative study seeks to gain insight into ethical (...) issues commonly encountered in pediatric ERs by exploring the perspectives of 23 social workers at Level 1 trauma centers in the United States. Thematic analysis was used to develop major themes and subthemes related to ethical violations, dilemmas, and best practices in pediatric ERs. Major themes emerged related to unfair treatment of families (with subthemes of bias, discrimination, and compassion fatigue), ethical dilemmas (with subthemes of cultural issues, safety and system issues), and promoting ethical practices (with subthemes of self-awareness, advocacy, and efforts to change the system). This study provides important insights into ethical issues in pediatric ERs as experienced by social workers and can inform efforts to improve the quality and equity of care for all families in pediatric ERs. (shrink)

The majority of the studies underlined how adolescent and young adult Cancer Survivors had no significant differences in their well-being and quality of life compared with a control group of healthy counterparts, although French et al. found less years of education among cancer survivors. The present study aimed at comparing AYA cancer survivors and a control group of peers who had no history of serious illness, in terms of well-being, cognitive functioning, and perceptions of life. Participants in this study were (...) 205 AYA cancer survivors, 126 males, off therapy from a mean of 10.87 years, with a mean age of 18.96, recruited during follow-up visits and healthy counterparts, matched for age and gender. They all completed self-report questionnaires: Ladder of Life, BSI-18 and Cognitive problems. Paired t test evidenced significant differences between survivors and controls in perceptions of quality of life regarding 5 years before the current time [t = −3.39; p = 0.001], with a lower level for childhood cancer survivors. Specifically, Hierarchical regression identified a shorter time since the completion of treatment and a trend of stem cell transplantation experience as factors associated with negative perception of precedent quality of life. The AYA cancer survivors reported lower cognitive difficulties than controls [t = −3.41; p = 0.001]: in memory [t = −4.52; p = 0.001], in concentration [t = −4.66; p = 0.001] and in mental organization skills [t = −2.56; p = 0.01], even if they had a lower educational attainment [X2 = 131.28; p = 0.001]. They showed similar satisfaction with their psychological well-being and their lives as healthy counterparts, except for past life perceptions associated with the cancer period. Important recommendations for future research and clinical suggestions could be given. (shrink)

Cognitive reappraisal is one of the core treatment components of cognitive behavioral therapy and is the gold standard treatment for major depressive disorders. Accumulating evidence indicates that cognitive reappraisal could function as a protective factor of cognitive vulnerability to depression. However, the neural mechanism by which CR training reduces cognitive vulnerability to depression is unclear. There is ample evidence that the prefrontal–amygdala circuit is involved in CR. This study proposes a novel cognitive bias model of CR training (...) which hypothesizes that CR training may improve the generation ability of CR with altered prefrontal–amygdala functional activation/connectivity, thus reducing negative cognitive bias and alleviating depressive symptoms. This study aims to explore whether there is abnormal CR strategy generation ability in individuals who are cognitively vulnerable to depression; test the hypothesis that CR training alleviates depressive symptoms through the mediators of cognitive bias ; explore the neural mechanism by which CR training may enhance the ability of CR strategy generation; and examine the short- and long-term effects of CR training on the reduction in depressive symptoms in individuals who are cognitively vulnerable to depression following intervention and 6 months later. The study is promising, providing theoretical and practical evidence for the early intervention of depression-vulnerable individuals. (shrink)

Survivors of childhood brain tumors face many obstacles to living independently as adults. Causes for lack of independence are multifactorial and generally are investigated in terms of physical, cognitive, and psychosocial treatment–related sequelae. Little is known, however, about the role of expectation for survivors’ function. From a mixed–methods study including qualitative interviews and quantitative measures from 40 caregiver–survivor dyads, we compared the data within and across dyads, identifying four distinct narrative profiles: (A) convergent expectations about an optimistic future, (...) (B) convergent expectations about a less optimistic future, (C) non–convergent expectations about a less optimistic future, and (D) non–convergent expectations about an unclear future. Dyads both do well and/or struggle in systematically different manners in each profile. These profiles may inform the design of interventions to be tested in future research and help clinicians to assist families in defining, (re–)negotiating, and reaching their expectations of function and independence. (shrink)

Biological and epidemiological phenomena are often measured with error or imperfectly captured in data. When the true state of this imperfect measure is a confounder of an outcome exposure relationship of interest, it was previously widely believed that adjustment for the mismeasured observed variables provides a less biased estimate of the true average causal effect than not adjusting. However, this is not always the case and depends on both the nature of the measurement and confounding. We describe two sets of (...) conditions under which adjusting for a non-deferentially mismeasured proxy comes closer to the unidentifiable true average causal effect than the unadjusted or crude estimate. The first set of conditions apply when the exposure is discrete or continuous and the confounder is ordinal, and the expectation of the outcome is monotonic in the confounder for both treatment levels contrasted. The second set of conditions apply when the exposure and the confounder are categorical. In all settings, the mismeasurement must be non-differential, as differential mismeasurement, particularly an unknown pattern, can cause unpredictable results. (shrink)

BackgroundBreast cancer patients are at elevated risk of depression during treatment, thus provoking the chance of poor clinical outcomes. This retrospective cohort study aimed to investigate whether integrating Chinese herbal medicines citation into conventional cancer therapy could decrease the risk of depression in the long-term breast cancer survivors.MethodsA cohort of patients aged 20–70 years and with newly diagnosed breast cancer during 2000–2008 was identified from a nationwide claims database. In this study, we focused solely on survivors of breast cancer (...) at least1 year after diagnosis. After one-to-one matching for age, sex, and baseline comorbidities, breast cancer patients who received and did not receive CHM treatment were enrolled. The incidence rate and hazard ratio citation for depression between the two groups was estimated at the end of 2012. A Cox proportional hazard model was constructed to examine the impact of the CHM use on the risk of depression.ResultsDuring the study period, the incidence rate of depression was significantly lower in the treated cohort than in the untreated cohort [8.57 compared with 11.01 per 1,000 person-years citation], and the adjusted HR remained significant at 0.74 in a Cox proportional hazards regression model. The corresponding risk further decreasing to 43% among those using CHM for more than 1 year.ConclusionFinding from this investigation indicated that the lower risk of depression observed in breast cancer patients treated with CHM, suggesting that CHM treatment should be considered for disease management toward breast cancer. Yet, the optimal administered dose should be determined in further clinical trials. (shrink)

Antipsychotic medications are sometimes imposed on psychiatric patients deemed dangerous to themselves and others. This is based on the assumption that treatment is safe and effective, and that recovery depends on biological adjustment. Under new laws, patients can be required to remain on these medications after leaving hospitals. However, survivors attest that forced treatment used as a restraint can feel like torture, while the consequences of withdrawal can also be severe.

IntroductionHead and neck cancer diagnosis and treatment can be a significant life trauma. Some HNC survivors experience post-traumatic growth, which has been linked with better health-related quality-of-life. Empirical research on PTG, and theoretical models, point to the importance of being able to purposely make sense of the traumatic experience. Intrusive rumination, by contrast, is linked to poorer outcomes. This study explored HNC survivors’ experiences of rumination.MethodsTwenty HNC survivors between 9 months and 5 years post-diagnosis were recruited. They had a (...) range of HNC sub-types and cancer treatments. Participants underwent a semi-structured interview about their cancer diagnosis and treatment. Reflexive thematic analysis identified themes and sub-themes around rumination.ResultsFour themes with linked subthemes on the content and process of rumination were identified. Theme 1 was rumination and worry related to diagnosis. Here, survivors discussed how the HNC diagnosis and plans for treatment had dominated their initial thoughts. Theme 2 was processing the trauma of HNC. This theme reflected rumination on the traumatic experience of diagnosis and treatment and how the participant was reacting to it. Theme 3 was considering the impact. This theme encompassed retrospective thinking and comparisons between the participant now versus the early days after diagnosis. Theme 4 was continued rumination. This theme included ongoing intrusive and distressing rumination about the trauma and impact of cancer. Those who expressed ongoing rumination revisited fears or returned to negative experiences.ConclusionThis study uniquely describes the nature and content of rumination following HNC. Early intrusive rumination is common and may reflect perceptions of cancer as an existential threat. Over time, rumination can become more reflective and move towards deliberate meaning-making. Some HNC survivors may benefit from interventions to reduce barriers to this transition. The content of distressing and difficult to control rumination helps to identify those who may benefit from more directed psychological support. (shrink)

Flaws, biases, and ethical problems surrounding research and diagnosis may lead to inappropriate or inequitable treatments that exacerbate or fail to improve the misery that some individuals face due to their psychiatric conditions. Possible androcentric biases in the choice and definition of categories for diagnosis available in DSM-III-R may in turn influence the approaches of therapists to clients, particularly male therapists towards female clients. Androcentric bias in diagnosis, which may also be reflected in the values of the psychiatrist, may (...) lead to treatment regimens designed to make clients fit into roles, positions, and norms prescribed by a culture reflecting patriarchal values. Some acceptance of attempts by feminists to correct androcentrism are beginning to emerge in psychiatric diagnosis. Keywords: androcentrism, bias, feminist, psychiatry of biology CiteULike Connotea Del.icio.us What's this? (shrink)

Earthquakes, which can cause widespread territorial and socio-economic destruction, are life-threatening, unexpected, unpredictable and uncontrollable events caused by the shaking of the surface of the earth. The psychological consequences, such as PTSD, anxiety, depression, and suicidal ideation, are well-known to clinicians and researchers. This study was conducted with the aim of evaluating the use of the Eye Movement Desensitization and Reprocessing (EMDR) Integrative Group Treatment Protocol (IGTP) on a sample of adolescents, after the earthquake in Central Italy on 24 (...) August 2016. The objective of the EMDR intervention was to reduce PTSD symptoms. Before and after EMDR, specific assessment to find changes in PTSD symptoms was made using the IES-R (Impact of Event Scale Revised) and through the analyses of the Subjective Units of Disturbance (SUD). The EMDR treatment was given in three sessions (T1, T2, T3), each lasting 90 minutes, and the results at follow-up phase (T4) were also monitored. The results are very encouraging, showing significantly reduced PTSD symptoms in the majority of the subjects. The clinical implications and limitations will be discussed. (shrink)

In Instrumental Variables (IV) estimation, the effect of an instrument on an endogenous variable may vary across the sample. In this case, IV produces a local average treatment effect (LATE), and if monotonicity does not hold, then no effect of interest is identified. In this paper, I calculate the weighted average of treatment effects that is identified under general first-stage effect heterogeneity, which is generally not the average treatment effect among those affected by the instrument. I then (...) describe a simple set of data-driven approaches to modeling variation in the effect of the instrument. These approaches identify a Super-Local Average Treatment Effect (SLATE) that weights treatment effects by the corresponding instrument effect more heavily than LATE. Even when first-stage heterogeneity is poorly modeled, these approaches considerably reduce the impact of small-sample bias compared to standard IV and unbiased weak-instrument IV methods, and can also make results more robust to violations of monotonicity. In application to a published study with a strong instrument, the preferred approach reduces error by about 19% in small (N ≈ 1, 000) subsamples, and by about 13% in larger (N ≈ 33, 000) subsamples. (shrink)

ObjectivesQuality of life has been the focus of increasing interest in oncology. QoL assessment instruments implicitly assume that each QoL domain has the same meaning for each patient. The objective of this study was to analyze the importance of and the satisfaction with QoL domains and to analyze the relationship between the two.MethodsA sample of 308 breast cancer survivors was examined twice with a three-month time interval. The women completed the two QoL questionnaires Questions of Life Satisfaction, which measures participants' (...) satisfaction with eight QoL domains and the subjective importance of those domains to them, and the EORTC QLQ-C30. A sample of 1,143 women from the general population served as controls.ResultsCompared with the general population sample, the patients were less satisfied with their health and more satisfied with all other QoL domains. The subjective importance of health was lower in the patients' sample. Satisfaction with health and importance of health were slightly positively correlated. The effect of QoL domain importance on general QoL was small, and interaction effects between domain importance and satisfaction on the prediction of global QoL were negligible.ConclusionIn addition to satisfaction with QoL dimensions, the subjective importance of these dimensions is relevant for psychooncological research and treatment. Health is not the only relevant QoL domain in breast cancer survivors, other domains such as finances also deserve health care providers' attention. (shrink)