Clinical research: where does it come from? Where is it going?

In this editorial the author examines briefly the past, present and future of clinical investigation in general and particularly in Switzerland, where the same problems are encountered as in other European countries and North America. The main problems reside in the fragmentation of internal medicine into subspecialities with their own separate meetings and journals, at the expense of multidisciplinary sources of information on medical progress, thus widening the gap between the practitioners and the scientific community. Through examples, it is pointed out that the progression of medical knowledge follows the path from basic research in biochemistry, cellular biology, animal experiments, clinical investigation and finally clinical medicine not unidirectionally but bidirectionally. Thanks to the Swiss National Science Foundation, the Medical Schools of the five Universities and many private foundations, a considerable effort has been made in past decades to foster basic and clinical research, resulting in a most favorable position for our country on the international scene. There is a fear that political and administrative decision could jeopardize the present situation and imperil the future. Finally, citing Osler from his work "Aequanimitas", the author stresses that "the true test of a nation's life... is to be found in its intellectual and moral standards", and that "the measure of the value of a nation to the world is neither the bushel nor the barrel, but mind".     

Convention publicity: should it grow?

"The question of what sort of public information program the APA should have generally starts a lively discussion." A principal obstacle "… that impedes the flow of a tremendous amount of psychology to the public… calls for the professional skills and intuitions of a public information specialist… ." The "… APA can get constructive publicity, in quantity, in all the mass media, not only at convention time, but throughout the year… " and the author believes "… that the APA should want it." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The association between computer use and cognition across adulthood: Use it so you won't lose it?

Understanding the association between computer use and adult cognition has been limited until now by self-selected samples with restricted ranges of age and education. Here we studied effects of computer use in a large national sample (N = 2,671) of adults aged 32–84, assessing cognition with the Brief Test of Adult Cognition by Telephone (Tun & Lachman, 2005) and executive function with the Stop and Go Switch Task (Tun & Lachman, 2008). Frequency of computer activity was associated with cognitive performance after controlling for age, sex, education, and health status: That is, individuals who used the computer frequently scored significantly higher than those who seldom used the computer. Greater computer use was also associated with better executive function on a task-switching test, even after controlling for basic cognitive ability as well as demographic variables. These findings suggest that frequent computer activity is associated with good cognitive function, particularly executive control, across adulthood into old age, especially for those with lower intellectual ability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Religion and health: is there an association, is it valid, and is it causal?

This paper reviews evidence for a relationship between religion and health. Hundreds of epidemiologic studies have reported statistically significant, salutary effects of religious indicators on morbidity and mortality. However, this does not necessarily imply that religion influences health; three questions must first be answered: "Is there an association?", "Is it valid?", and, "Is it causal?" Evidence presented in this paper suggests that the answers to these respective questions are "yes," "probably," and "maybe." In answering these questions, several issues are addressed. First, key reviews and studies are discussed. Second, the problems of chance, bias, and confounding are examined. Third, alternative explanations for observed associations between religion and health are described. Fourth, these issues are carefully explored in the context of Hill's well-known features of a causal relationship. Despite the inconclusiveness of empirical evidence and the controversial and epistemologically complex nature of religion as an epidemiologic construct, this area is worthy of additional investigation. Further research can help to clarify these provocative findings.     

Psychobabble: Why do we do it?

Many expressions originating in contemporary, "instant" therapies have become incorporated into everyday speech. These expressions, otherwise know as "psychobabble," convey connotative meanings rather than precise, denotative ones. It is concluded here that they also function as indexes, thereby serving as markers for identifying group members, and as security operations, thereby enhancing self-esteem. Consequently, psychobabble has personal significance for the speaker/therapist but not for the listener/client. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Will it benefit from the WTO entry?.

On November 15,1999,after 13 years ofnegotiations between China and the UnitedStates,the two countries finally signedthe bilateral agreement on the issue ofChina's joining in the World Trade Organi-zation(WTO).This event marks an impor-tant step forward for China in its sus-tained efforts to become a member of theWTO,and with ongoing talks with the re-maining countries,China expects to fulfillthe joining procedures required by the     

When is it safe for babies to swim?

What factors are important when health professionals are asked "At what age is it safe to take my baby swimming in a public pool?". In a survey of primary health care doctors, no unified approach was identified but many considered immunisation essential before swimming. There is no evidence to support this view. Careful attention to the infant's body temperature is more important.     

Adverse impact: Is it a viable concept?

It appears that those federal agencies responsible for enforcement persist in the belief that a given test score can mean one thing in one subgroup and something else in another and/or that inferences from a set of test scores can be valid for one subgroup but not for another. First surfacing in early agency regulations in connection with the now discontinued "differential validity" requirement, the belief still manifests itself in the concepts of "unfairness" and "adverse impact." Furthermore, the determination of the presence or absence of adverse impact on the basis of the impact ratio involves numerous statistical and measurement issues. Use of the impact ratio to establish the prosecutorial posture of an enforcement agency is clearly flawed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term caregiving: What happens when it ends?

Data from a longitudinal study were used to examine what happens to caregivers in the years after their cognitively impaired spouse dies. Comparisons of 42 current caregivers, 49 former caregivers, and 52 noncaregivers over a 4-year period showed that former caregivers did not improve on several measures of psychological well-being. Although former caregivers experienced decreases in stress and negative affect, their scores on depression, loneliness, and positive affect did not rebound to levels comparable to noncaregivers and, in fact, remained similar to those of current caregivers up to 3 years after caregiving had ceased. The most consistent predictors of postcaregiving outcomes were social support and intrusive–avoidant thinking about caregiving. The data suggest that some consequences of long-term caregiving may be long-term as well. The needs of former spousal caregivers warrant greater attention both in research and in practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk stratification in cardiac surgery: is it worthwhile?

Outcome analysis of many surgical procedures has become increasingly important to surgeons, institutions, and the public. Because there may be wide differences in case mix, outcomes must be evaluated in light of the patient's preoperative status. All relevant preoperative conditions must be identified and weighted, so that when risk factor scores are combined in some fashion, they will provide a single preoperative risk estimate for the individual patient, representing the likelihood of dying as a consequence of the operation. Comparing the mean risk adjusted score of a group of patients undergoing the same procedure with the observed mortality rate for the same group yields an index of the quality of care, provided all preoperative risk scores are calculated with reference to the same benchmark. We question the logic and wisdom of surgical outcome analysis because of the infinitely complex nature of biological and pathological processes, as well as the practical problems of reliable data collection. The assumption of true scientific accuracy may be illusory. Even though risk adjusted outcome analysis has merit in studying trends in therapy, it should be regarded with caution when used as a tool for evaluating quality of care. If publicized at all, the results should not be represented as "hard" scientific fact.     

Human engineering research—who should do it and why.

"The in-service laboratory groups, the universities, and private consultants and consulting organizations most certainly should be conducting the major research programs, but the human engineering staff that is part of an engineering manufacturing organization cannot and should not undertake a major human engineering research program for every need of the design engineer." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brain microdialysis of GABA and glutamate: what does it signify?

Microdialysis has become a frequently used method to study extracellular levels of GABA and glutamate in the central nervous system. However, the fact that the major part of GABA and glutamate as measured by microdialysis does not fulfill the classical criteria for exocytotic release questions the vesicular origin of the amino acids in dialysates. Glial metabolism or reversal of the (re)uptake sites has been suggested to be responsible for the pool of nonexocytotically released amino-acid transmitters that seem to predominate over the neuronal exocytotic pool. The origin of extracellular GABA and glutamate levels and, as a consequence, the implications of changes in these levels upon manipulations are therefore obscure. This review critically analyzes what microdialysis data signify, i.e., whether amino-acid neurotransmitters sampled by microdialysis represent synaptic release, carrier-mediated release, or glial metabolism. The basal levels of GABA and glutamate are virtually tetrodotoxin- and calcium-independent. Given the fact that evidence for nonexocytotic release mediated by reversal of the uptake sites as a release mechanism relevant for normal neurotransmission is so far limited to conditions of "excessive stimulation," basal levels most likely reflect a nonneuronal pool of amino acids. Extracellular GABA and glutamate concentrations can be enhanced by a wide variety of pharmacological and physiological manipulations. However, it is presently impossible to ascertain that the stimulated GABA and glutamate in dialysates are of neuronal origin. On the other hand, under certain stimulatory conditions, increases in amino-acid transmitters can be obtained in the presence of tetrodotoxin, again suggesting that aspecific factors not directly related to neurotransmission underlie these changes in extracellular levels. It is concluded that synaptic transmission of GABA and glutamate is strictly compartmentalized and as a result, these amino acids can hardly leak out of the synaptic cleft and reach the extracellular space where the dialysis probe samples.     

Is it possible to use the term "functional heart diseases"?

The strangest things precipitate the most interesting discussions. It is interesting how frequently the word "older" appears in our language. It has been there all along, we have just become sensitized to its presence. The same may be true for you as you read the commentary on the next two pages and begin to reflect on the stereotypes and limitations placed on "older" people. Are they justified in the present day, or are they simply carryovers from the past, or is there some element of harsh reality to the characterizations?     

The "where is it?" reflex: autoshaping the orienting response

The goal of this review is to compare two divergent lines of research on signal-centered behavior: the orienting reflex (OR) and autoshaping. A review of conditioning experiments in animals and humans suggests that the novelty hypothesis of the OR is no longer tenable. Only stimuli that represent biological "relevance" elicit ORs. A stimulus may be relevant a priori (i.e., unconditioned) or as a result of conditioning. Exposure to a conditioned stimulus (CS) that predicts a positive reinforcer causes the animal to orient to it throughout conditioning. Within the CS-US interval, the initial CS-directed orienting response is followed by US-directed tendencies. Experimental evidence is shown that the development and maintenance of the conditioned OR occur in a similar fashion both in response-independent (classical) and response-dependent (instrumental) paradigms. It is proposed that the conditioned OR and the signal-directed autoshaped response are identical. Signals predicting aversive events repel the subject from the source of the CS. It is suggested that the function of the CS is not only to signal the probability of US occurrence, but also to serve as a spatial cue to guide the animal in the environment.     

Managed care: is it moral?. Interview by Cheryl Slagle King

The authors analyzed human role in ecologic system, using the principle "human--environment--health", and human function in ecologic and ergonomic system, using the principle "operator--environment--occupational reliability" for aviation ergonomics. Unfavorable ecologic environment influencing the operator was considered a complex stress factor composed of objective environmental and emotional elements. The authors describe human response to physiologically adequate and inadequate stress factors. The article stresses good prospects associated with application of aviation ergonomics to targeting some problems.     

Ethical dilemmas in psychologists accessing Internet data: Is it justified?

Many psychologists search the Internet for both personal and professional information. Although various guidelines have been proposed for psychologists regarding therapeutic services provided over the Internet, few address the ethics and efficacy of gathering information about clients, students, or employees on the web. As quickly as guidelines are written, new technologies create new challenges. With the advent of social networking sites and numerous free and paid data search engines, unique dilemmas have arisen. The ready access of voluminous personal information raises perplexing questions for clinician psychologists, instructors, supervisors, and employers. An overarching consideration addressed in this article is whether in the course of one's professional activities it is ethically appropriate to conduct intentional Internet searches for information about patients, students, or employees. We discuss ethical dilemmas such as right to privacy, trust, confidentiality, informed consent, boundary violations, and best interest of the client, student, or employee. Next we provide a list of some extant electronic sources of information and offer case examples. The article concludes with recommendations that we hope will generate further dialogue and research on these perplexing issues and provide guidance on balancing situationally appropriate flexibility with the need for adopting wise parameters of professional behavior in regard to social networking activities and Internet “investigations.” (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Providing and maintaining jobs for psychiatric patients--how can it be done?

An innovative project has produced some good results in the placement of psychically disabled people in the general labour market. The "foster colleague model" provides support for the client directly at her or his place of work by a specially trained member of company staff (the "foster colleague"). This method has so far managed to provide 18 formerly psychically ill people with employment and helped to keep them in work.     

Testing children for genetic predispositions: is it in their best interest?

Serotonin (5-hydroxytryptamine; 5-HT), an endogenous and ubiquitous monoamine, has become a subject of "explosive" research. Though its vasoconstrictor properties were first noticed in defibrinated or clotted blood, 5-HT was discovered 75 years later going through several denominations such as "enteramine, serotonin or 5-HT". Once confirmed that serotonin, enteramine and 5-HT were the same substance, the compound was synthesized and efforts with a view to analyze 5-HT receptors were performed. On the basis of the actions of 5-HT and other drugs on several smooth muscle experimental preparations, it was originally suggested that 5-HT could act via different receptors. Thus, Gaddum and Picarelli proposed the "D" and "M" classification based on the differential sensitivity of guinea pig ileum 5-HT-induced contraction to some drugs. Later on, this classification was confronted with the new Peroutka's 5-HT, and 5-HT2 classification derived from radioligand binding studies. Since these 5-HT receptors were being referred to by many names, an international committee formulated some criteria for the characterization and a framework for the nomenclature of 5-HT receptors into 5-HT1, 5-HT2 and 5-HT3 categories. More recently, functional evidence unrelated to activation of the above 5-HT receptor types was given and a new 5-HT (5-HT4) receptor was proposed to exist. From this stage, molecular biologists have been cloning several 5-HT receptors which are different from the various receptors (sub)types characterized thus far. This review is focused on the discovery of 5-HT and the evolution of the classification of 5-HT receptors, from historical remarks to the modern concepts about receptor characterization; furthermore, the relevance of this development to medical research is considered.     

When is it safe to use an oversimplified substitution model in tree-making?

The choice of an "optimal" mathematical model for computing evolutionary distances from real sequences is not currently supported by easy-to-use software applicable to large data sets, and an investigator frequently selects one of the simplest models available. Here we study properties of the observed proportion of differences (p-distance) between sequences as an estimator of evolutionary distance for tree-making. We show that p-distances allow for consistent tree-making with any of the popular methods working with evolutionary distances if evolution of sequences obeys a "molecular clock" (more precisely, if it follows a stationary time-reversible Markov model of nucleotide substitution). Next, we show that p-distances seem to be efficient in recovering the correct tree topology under a "molecular clock," but produce "statistically supported" wrong trees when substitutions rates vary among evolutionary lineages. Finally, we outline a practical approach for selecting an "optimal" model of nucleotide substitution in a real data analysis, and obtain a crude estimate of a "prior" distribution of the expected tree branch lengths under the Jukes-Cantor model. We conclude that the use of a model that is obviously oversimplified is inadvisable unless it is justified by a preliminary analysis of the real sequences.     

Whose fault is it? People's own conceptions of the reasons for health inequalities

How do people themselves think about inequalities in health? The topic has rarely been investigated, and oblique evidence has to be drawn from research on general lay ideas about health and the causes of illness. Data from a large British survey are combined with a review of the extensive body of, more usually, qualitative research on attitudes to health in Western industrialised societies. One tentative conclusion is that social inequality in health is not a topic which is very prominent in lay presentations, and paradoxically this is especially true among those who are most likely to be exposed to disadvantaging environments. Possible explanations are offered in terms of the effects of widespread "health promotion" activities, and the way in which lay theorising incorporates relationships between the group and the individual. The methods used in asking people to talk about health are also relevant: accounts of health and illness are accounts of social identity, and it is unreasonable to expect people to devalue that identity by labelling their own "inequality".