Understanding behavior makes it more normal.
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Meehl (1973) has informally observed that clinicians will perceive a patient as being more normal if they can understand the patient's behaviors. In Experiment 1, undergraduate participants received descriptions of 10 people, each with three characteristics (e.g., frequently suffers from insomnia) taken from the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994). When the characteristics formed a plausible causal chain, adding a causal explanation increased perceived normality; but when a causal chain was implausible, perceived normality decreased. In Experiments 2 and 3, a negative life event (e.g., is very stressed out due to her workload) was added as an explanation for the first characteristic in a three-characteristic causal chain. Undergraduates, graduate students in clinical psychology, and expert clinicians all reliably perceived the patients as being more normal with these explanations than without them, confirming Meehl's prediction. (+info)
Psychological contribution to the understanding of adverse events in health care.
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In the past it has sometimes been assumed in health care that all adverse events involve individual incompetence and therefore blameworthiness, an assumption that is likely to hinder the development of comprehensive and honest incident reporting systems. At the same time, a full understanding of adverse events in healthcare systems requires that distinctions are drawn between a variety of error types, each of which has different origins and demands different strategies for remediation. In this paper a range of cognitive biases identified by psychologists is described. Examples are given of these biases, which are naturally employed in trying to understand our own behaviour and that of others, and therefore affect our understanding of adverse events. It is suggested that awareness of these biases, which form part of our normal thinking, should help to avoid a narrow focus on individual culpability and facilitate a more sophisticated approach to the investigation of adverse events. (+info)
Personal risk perception, HIV knowledge and risk avoidance behavior, and their relationships to actual HIV serostatus in an urban African obstetric population.
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One quarter of pregnant women in Zambia are infected with HIV. Understanding how knowledge of HIV relates to personal risk perception and avoidance of risky behaviors is critical to devising effective HIV prevention strategies. In conjunction with a large clinical trial in Lusaka, Zambia, we surveyed postpartum women who had been tested for HIV but did not know their status before undergoing the questionnaire. Of 858 women for whom complete data were available, 248 (29%) were HIV infected. Women 22 years of age or older (adjusted odds ratio [AOR], 1.7; 95% confidence interval [CI], 1.1-2.5), women reporting > or =2 sexual partners in their lifetime (AOR, 1.8; 95% CI, 1.3-2.5), and women reporting a history of a sexually transmitted infection (AOR, 2.7; 95% CI, 1.7-4.3) were more likely to be HIV infected. Having had > or =2 lifetime sexual partners was a marker for perception of high personnel risk for HIV infection (AOR, 1.5; 95% CI, 1.1-2.1). However, there was no relationship between perceived risk of HIV infection and actual HIV status. In fact, 127 (52%) of 245 women who stated that they were at no or low risk for HIV infection were HIV infected. Living in an area of high HIV seroprevalence like Zambia seems to be the greatest risk factor for infection in unselected pregnant women. Before significant inroads can be made in decreasing the incidence of HIV infection among pregnant women, population-based strategies that involve men must be implemented. (+info)
Asymmetrical involvement of frontal lobes in social reasoning.
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The frontal lobes are widely implicated in logical reasoning. Recent neuroimaging studies suggest that frontal lobe involvement in reasoning is asymmetric (L>R) and increases with the presence of familiar, meaningful content in the reasoning situation. However, neuroimaging data can only provide sufficiency criteria. To determine the necessity of prefrontal involvement in logical reasoning, we tested 19 patients with focal frontal lobe lesions and 19 age- and education-matched normal controls on the Wason Card Selection Task, while manipulating social knowledge. Patients and controls performed equivalently on the arbitrary rule condition. Normal controls showed the expected improvement in the social knowledge conditions, but frontal lobe patients failed to show this facilitation in performance. Furthermore, left hemisphere patients were more affected than right hemisphere patients, suggesting that frontal lobe involvement in reasoning is asymmetric (L>R) and necessary for reasoning about social situations. (+info)
Reading others emotions: The role of intuitive judgments in predicting marital satisfaction, quality, and stability.
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This study examined links between emotion expression in couple interactions and marital quality and stability. Core aspects of emotion expression in marital interactions were identified with the use of naive observational coding by multiple raters. Judges rated 47 marital discussions with 15 emotion descriptors. Coders' pooled ratings yielded good reliability on 4 types of emotion expression: hostility, distress, empathy, and affection. These 4 types were linked with concurrent marital satisfaction and interviewer ratings of marital adjustment as well as with marital stability at a 5-year follow-up. The study also examined the extent to which naive judges' ratings of emotion expression correspond to "expert" ratings using the Specific Affect Coding System (SPAFF). The unique advantages of naive coding of emotion expression in marital interaction are discussed. (+info)
Racial and ethnic differences in patient perceptions of bias and cultural competence in health care.
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OBJECTIVES: To determine: 1) whether racial and ethnic differences exist in patients' perceptions of primary care provider (PCP) and general health care system-related bias and cultural competence; and 2) whether these differences are explained by patient demographics, source of care, or patient-provider communication variables. DESIGN: Cross-sectional telephone survey. SETTING: The Commonwealth Fund 2001 Health Care Quality Survey. SUBJECTS: A total of 6,299 white, African-American, Hispanic, and Asian adults. MEASUREMENTS AND MAIN RESULTS: Interviews were conducted using random-digit dialing; oversampling respondents from communities with high racial/ethnic minority concentrations; and yielding a 54.3% response rate. Main outcomes address respondents' perceptions of their PCPs' and health care system-related bias and cultural competence; adjusted probabilities (Pr) are reported for each ethnic group. Most racial/ethnic differences in perceptions of PCP bias and cultural competence were explained by demographics, source of care, and patient-physician communication variables. In contrast, racial/ethnic differences in patient perceptions of health care system-wide bias and cultural competence persisted even after controlling for confounders: African Americans, Hispanics, and Asians remained more likely than whites (P <.001) to perceive that: 1) they would have received better medical care if they belonged to a different race/ethnic group (Pr 0.13, Pr 0.08, Pr 0.08, and Pr 0.01, respectively); and 2) medical staff judged them unfairly or treated them with disrespect based on race/ethnicity (Pr 0.06, Pr 0.04, Pr 0.06, and Pr 0.01, respectively) and how well they speak English (Pr 0.09, Pr 0.06, Pr 0.06, and Pr 0.03, respectively). CONCLUSION: While demographics, source of care, and patient-physician communication explain most racial and ethnic differences in patient perceptions of PCP cultural competence, differences in perceptions of health care system-wide bias and cultural competence are not fully explained by such factors. Future research should include closer examination of the sources of cultural bias in the US medical system. (+info)
Social processing deficits in agenesis of the corpus callosum: narratives from the Thematic Appreciation Test.
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Clinical observations suggest that individuals with agenesis of the corpus callosum (ACC) and normal IQ may have deficits in social intelligence. This study analyzed responses by normally intelligent individuals with ACC to pictures from the Thematic Apperception Test. A rating system was developed to assess three elements of story-generation: story logic, social understanding, and common content. Six individuals with ACC (five complete and one partial; IQs > 85) were compared to eight controls matched for sex, age, and IQ. Based on independent rankings of story protocols by two raters, the five individuals with complete ACC were found to be significantly impaired on all three criteria. The one individual with partial ACC performed better than the majority of controls in all three domains. Results demonstrated that individuals with complete ACC are impaired in understanding socially complex scenes and generating appropriate narratives. Absence of the anterior corpus callosum appears to be important for this deficit. (+info)
Teenagers and their family practitioner: matching between their reasons for encounter.
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OBJECTIVES: The aim of this study was to analyse the reasons for encounter of teenagers in family practice and to compare them with the reasons recorded by their family practitioner (FP). METHODS: This cross-sectional study involved 91 FPs from the Paris area and from the French-speaking part of Belgium. The teenagers (12-17 years old) filled in an auto-administered questionnaire in the waiting room of their FP during a 1-week period. The doctor independently filled in a similar form after the consultation. Both questionnaires were matched afterwards to assess the concordance between the reasons for encounter recorded by the young patient and by his/her FP. RESULTS: More than 100 reasons for encounter were given by 457 teenagers. The majority of the complaints were respiratory (26%), general health (18.5%), osteoarticular (15%), digestive (11%) and neurological problems (9.5%). Gender did not influence the nature of the complaints, but age played a role. The older teenagers had more respiratory complaints, general and pregnancy/contraception problems. In 80% of the cases, the ailments listed by the teenagers were picked up by the practitioner. In 18% of the consultations, the FP recorded problems that had not been noted by the patient. CONCLUSION: Many common and a few serious although frequent youth problems were found among the reasons for encounter. Most of them were recorded by the practitioner. Time and communication skills are important to give the opportunity to the teenager to share sensitive topics with his/her FP. (+info)