Decomposing Cross-Country Gaps in Obesity and Overweight: Does the Social Environment Matter?

[cat] Una qüestió clau sobre la producció de salut relativament poc explorada es refereix a la influència dels factors socioeconòmics i mediambientals sobre el pes i l’obesitat. Aquesta problemàtica adquireix particular rellevància quan es comparen dos països Mediterranis com Itàlia i Espanya. És interessant adonar-se que l’obesitat a Espanya és 5 punts percentual més elevada al 2003 mentre que a l’any 1990 era aproximadament la mateixa en ambdós països. Aquesta article presenta una descomposició no lineal dels gaps o diferencials en taxes de sobrepès (índex de massa corporal – IMC- entre 25 i 29.9 9 kg/m2), obesitat classe 1 (IMC≥30 kg/m2) i classe 2 (IMC≥35 kg/m2) entre Espanya i Itàlia per gènere i grups d’edat. En explicar aquests gaps entre països aïllem les influències dels estils de vida, els efectes socioeconòmics i els mediambientals. Els nostres resultats indiquen que quan no es controla pels efectes mediambientals (efectes de grup o ‘peer effects’) els hàbits alimentaris i el nivell educatiu són els principals predictors del gaps totals entre països (36-52%), si bé aquests dos factors exerceixen un impacte diferenciat segons gènere i edat. Un tant paradoxalment, quan controlem pels efectes de grup aquests predictors perden la seva capacitat explicativa i els efectes de grup passen a explicar entre el 46-76% dels gaps en sobrepès i obesitat i mostren un patró creixent amb l’edat.

Psychometric properties of the Marlowe-Crowne Social Desirability Scale in eight African countries and Switzerland

The purpose of this study was to assess the cross-cultural validity of the Marlowe-Crowne Social Desirability scale short form C, in a large sample of French-speaking participants from eight African countries and Switzerland. Exploratory and confirmatory analyses suggested retaining a two-factor structure. Item bias detection according to country was conducted for all 13 items and effect was calculated with R2. For the two-factor solution, 9 items were associated with a negligible effect size, 3 items with a moderate one, and 1 item with a large one. A series of analyses of covariance considering the acquiescence variable as a covariate showed that the acquiescence tendency does not contribute to the bias at item level. This research indicates that the psychometric properties of this instrument do not reach a scalar equivalence but that a culturally reliable measurement of social desirability could be developed.

La perception subjective de l'effet des neuroleptiques chez des patients schizophrènes ambulatoires: une étude transversale [Subjective perception of the effect of neuroleptics by outpatient schizophrenic patients: a cross-sectional study].

Subjective response to neuroleptics is essential to long term observance of treatment and quality of life of patients. Numerous factors (pharmacological, relational and psychopathological) are responsible of this subjective response. Objectives of this study are: (a) to examine psychometric features of the french version of the Drug Attitude Inventory (DAI-30) [13] and (b) to explore pharmacological, relational and psychopathological factors related to this subjective response. Subjects and methods: 78 subjects were rated (self rated response rate 61% (n = 48)) for (a) subjective response to neuroleptics, (b) compliance, (c) therapeutic alliance, (d) symptoms (e) severity of disorder. RESULTS: Factor analysis yielded 2 main clinically relevant factors, similar to the original version: (I) global subjective response and (II) specific subjective response. Internal consistency is high. Correspondance analysis showed two important dimensions in the treatment of schizophrenic patients: (I) Recovery--aggravation, (II) Therapeutic ambition--positive or negative symptoms. CONCLUSION: French version of DAI-30 seems to have a similar structure and psychometric features as the original version. It shows concordance with the degree of compliance. Pharmacological factors are not the only factors implicated in subjective response, but are still to be identified. Limitations of our study are: (a) nonhomogenous indication for treatment, (b) small rate and degree of non compliance in our sample. Relationships between therapeutic ambition, type of symptoms and treatment outcome should be further studied.

Social inequalities of functioning and perceived health in Switzerland: a representative cross-sectional analysis.

Many people worldwide live with a disability, i.e. limitations in functioning. The prevalence is expected to increase due to demographic change and the growing importance of non-communicable disease and injury. To date, many epidemiological studies have used simple dichotomous measures of disability, even though the WHO's International Classification of Functioning, Disability, and Health (ICF) provides a multi-dimensional framework of functioning. We aimed to examine associations of socio-economic status (SES) and social integration in 3 core domains of functioning (impairment, pain, limitations in activity and participation) and perceived health. We conducted a secondary analysis of representative cross-sectional data of the Swiss Health Survey 2007 including 10,336 female and 8,424 male Swiss residents aged 15 or more. Guided by a theoretical ICF-based model, 4 mixed effects Poisson regressions were fitted in order to explain functioning and perceived health by indicators of SES and social integration. Analyses were stratified by age groups (15-30, 31-54, ≥55 years). In all age groups, SES and social integration were significantly associated with functional and perceived health. Among the functional domains, impairment and pain were closely related, and both were associated with limitations in activity and participation. SES, social integration and functioning were related to perceived health. We found pronounced social inequalities in functioning and perceived health, supporting our theoretical model. Social factors play a significant role in the experience of health, even in a wealthy country such as Switzerland. These findings await confirmation in other, particularly lower resourced settings.

The double-edged sword of social capital: Three essays on entrepreneurship in developing nations

ABSTRACT My study seeks to answer the main question: "how does entrepreneurs' social capital positively and negatively affect their resource mobilization efforts, and exploitation of entrepreneurial opportunity?" To answer this question, I develop a model for examining positive and negative effects of social capital on resource accumulation by entrepreneurs, and the subsequent effect of resource accumulation on the exploitation of entrepreneurial opportunity, and utilize data from Africa to ëmpirically test the relationships in this model. Developing nations are a suitable context because: a) They require entrepreneurship for economic development, b) They have received less attention in management and entrepreneurship research, c) Because of inadequately-developed institutions, entrepreneurs from developing nations face major resource mobilization challenges hence they often turn to their social ties for resources, and d) The communalistic and collectivistic nature of most developing nations -encouraging support and sharing of resources- may help us better understand how society's values and structures may contribute and also deduct firm resources. My study reveals that social capital contributes resources to entrepreneurs in developing nations at a cost that takes away resources, and that more resources but lower costs facilitate entrepreneurial opportunity exploitation. For entrepreneurs in developing nations, large networks, greater shared identity, and more trust are beneficial. To increase chances of raising more resources, entrepreneurs from communalistic societies should include network members from outside their communities. Besides providing financial support, policy-makers should develop training programs and advisory services on configuration of entrepreneurs' networks so as to achieve more resources at a low cost. My study insights can help improve entrepreneurs' resource accumulation efforts and the subsequent growth of their firms, leading to the overall economic growth of developing nations.

Cross-scale analysis of the region effect on vascular plant species diversity in southern and northern European mountain ranges.

Background: The divergent glacial histories of southern and northern Europe affect present-day species diversity at coarse-grained scales in these two regions, but do these effects also penetrate to the more fine-grained scales of local communities?Methodology/Principal Findings: We carried out a cross-scale analysis to address this question for vascular plants in two mountain regions, the Alps in southern Europe and the Scandes in northern Europe, using environmentally paired vegetation plots in the two regions (n = 403 in each region) to quantify four diversity components: (i) total number of species occurring in a region (total gamma-diversity), (ii) number of species that could occur in a target plot after environmental filtering (habitat-specific gamma-diversity), (iii) pair-wise species compositional turnover between plots (plot-to-plot beta-diversity) and (iv) number of species present per plot (plot gamma-diversity). We found strong region effects on total gamma-diversity, habitat-specific gamma-diversity and plot-to-plot beta-diversity, with a greater diversity in the Alps even towards distances smaller than 50 m between plots. In contrast, there was a slightly greater plot alpha-diversity in the Scandes, but with a tendency towards contrasting region effects on high and low soil-acidity plots.Conclusions/Significance: We conclude that there are strong regional differences between coarse-grained (landscape- to regional-scale) diversity components of the flora in the Alps and the Scandes mountain ranges,but that these differences do not necessarily penetrate to the finest-grained (plot-scale) diversity component, at least not on acidic soils. Because different processes can lead to a similar pattern, we discuss the consistency of our results with Quaternary history and other divergent features between the two regions such as habitat connectivity, selection for vagility and environmental differences not accounted for in our analyses

Developmental critical period in genetic redox dysregulation: animal and human studies in schizophrenia

Converging evidence favors an abnormal susceptibility to oxidative stress in schizophrenia. Decreased levels of glutathione (GSH), the major cellular antioxidant and redox regulator, was observed in cerebrospinal-fluid and prefrontal cortex of patients. Importantly, abnormal GSH synthesis of genetic origin was observed: Two case-control studies showed an association with a GAG trinucleotide repeat (TNR) polymorphism in the GSH key synthesizing enzyme glutamate-cysteine-ligase (GCL) catalytic subunit (GCLC) gene. The most common TNR genotype 7/7 was more frequent in controls, whereas the rarest TNR genotype 8/8 was three times more frequent in patients. The disease associated genotypes (35% of patients) correlated with decreased GCLC protein, GCL activity and GSH content. Similar GSH system anomalies were observed in early psychosis patients. Such redox dysregulation combined with environmental stressors at specific developmental stages could underlie structural and functional connectivity anomalies. In pharmacological and knock-out (KO) models, GSH deficit induces anomalies analogous to those reported in patients. (a) morphology: spine density and GABA-parvalbumine immunoreactivity (PV-I) were decreased in anterior cingulate cortex. KO mice showed delayed cortical PV-I at PD10. This effect is exacerbated in mice with increased DA from PD5-10. KO mice exhibit cortical impairment in myelin and perineuronal net known to modulate PV connectivity. (b) physiology: In cultured neurons, NMDA response are depressed by D2 activation. In hippocampus, NMDA-dependent synaptic plasticity is impaired and kainate induced g-oscillations are reduced in parallel to PV-I. (c) cognition: low GSH models show increased sensitivity to stress, hyperactivity, abnormal object recognition, olfactory integration and social behavior. In a clinical study, GSH precursor N-acetyl cysteine (NAC) as add on therapy, improves the negative symptoms and decreases the side effects of antipsychotics. In an auditory oddball paradigm, NAC improves the mismatched negativity, an evoked potential related to pre-attention and to NMDA receptors function. In summary, clinical and experimental evidence converge to demonstrate that a genetically induced dysregulation of GSH synthesis combined with environmental insults in early development represent a major risk factor contributing to the development of schizophrenia

Absorptive capacity and the effect of social integration mechanisms in knowledge utilization

Tiedosta on tullut määräävä tekijä yrityksensuorituskyvylle. Yritykset hankkivat aktiivisesti uutta tietoa ulkoisesta ympäristöstään ja tallentavat sitä tietokantoihinsa. Uusi tieto on innovaatioiden ja uusien ideoiden peruselementti. Uudet ideat pitää myös kaupallistaa, jotta niiden avulla voidaan hankkia kilpailuetua. Absorptiivisen kapasiteetin malli yhdistää tiedon prosessointiin liittyvät kyvykkyydet, jotka vaikuttavat yrityksen kykyyn hyödyntää tietoa tehokkaasti. Ennen kuin tietoa voidaan käyttää uusien tuotteiden ja palveluiden luomiseen, täytyy sitä jakaa yrityksessä ja muuttaa se yrityksen toimintaa palvelevaksi. Aiemmissa tutkimuksissa innovaatiot ovat vahvasti liitetty yrityksen kykyyn uudistua. Tämä pro gradu -tutkielma tutkii sosiaalisten integraatiomekanismien vaikutusta potentiaalisen absorptiivisen kapasiteetin muuttamiseen toteutuneeksi absorptiiviseksi kapasiteetiksi. Yksilöiden ja osastojen välisen yhteistyön sekä luottamuksen vaikutus tiedon sisäistämiseen tutkittiin. Tutkielma pohjautuu monikansallisessa yrityksessä keväällä 2006 suoritettuun uudistumiskyky-tutkimukseen. Tutkielma keskittyy yrityksen kykyyn uudistua uuden tiedon ja innovaatioiden avulla. Tutkielma on kvantitatiivinen tapaustutkimus. Tutkielmassa tehtyjen havaintojen mukaan sosiaaliset integraatiomekanismit ovat tärkeitä uuden tiedon hyödyntämisessä. Tiedon eksplisiittyyden havaitaan vaikuttavan tiedon muuttamiseen yritykselle hyödylliseksi resurssiksi.

Cognition et psychopathologie chez les nonagénaires et centenaires vivant en établisement médico-social gériatrique en Suisse : focalisation sur l'anosognosie = [Cognition and psychopathology in nonagenarians and centenarians living in geriatric nursing homes in Switzerland : a focus on anosognosia]

Les nonagénaires et centenaires voient actuellement leur nombre augmenter considérablement, beaucoup d'entre eux vivant en maison de retraite. Pour cette population, on dispose de très peu de données au sujet de la Symptomatologie psychiatrique et des capacités cognitives autres que mnésiques. Cette étude exploratoire se concentre sur l'anosognosie et ses liens avec les symptômes psychiatriques et cognitifs courants. Cinquante-huit sujets âgés de 90 ans ou plus ont été recrutés dans des établissements médico-sociaux gériatriques et divisés en 5 groupes selon le Mini Mental State Examination (MMSE). Les évaluations incluent le test des 5 mots, le CLOX, les fluences lexicales et catégorielles, le questionnaire d'anosognosie- démence (AQ-D), l'inventaire neuropsychiatrique (NPI) et l'index de comorbidité de Charlson. Les sujets étudiés présentent une atteinte cognitive modérée, le MMSE moyen (±DS) étant à 15.41 ± 7.04. L'anosognosie augmente avec l'atteinte cognitive, étant associée avec tous les domaines cognitifs, mais aussi avec les symptômes psychopathologiques d'apathie et d'agitation. Les sujets ayant une atteinte cognitive légère semblent moins anosognosiques que ceux avec l'atteinte cognitive la plus faible ou ceux ne présentant aucune atteinte. Ni l'anosognosie ni les symptômes psychopathologiques ne sont liés aux comorbidités somatiques. Chez les résidents très âgés étudiés vivant en maison de retraite, l'anosognosie est principalement légère. Elle est associée à des changements cognitifs, mais aussi psychopathologiques. Des investigations supplémentaires sont toutefois nécessaires pour déterminer s'il existe un lien causal entre l'anosognosie et les atteintes psychopathologiques.

Is the Front Line Prepared for the Changing Faces of Patients? Predictors of Cross-Cultural Preparedness Among Clinical Nurses and Resident Physicians in Lausanne, Switzerland.

UNLABELLED: Phenomenon: Assuring quality medical care for all persons requires that healthcare providers understand how sociocultural factors affect a patient's health beliefs/behaviors. Switzerland's changing demographics highlight the importance of provider cross-cultural preparedness for all patients-especially those at risk for social/health precarity. We evaluated healthcare provider cross-cultural preparedness for commonly encountered vulnerable patient profiles. APPROACH: A survey on cross-cultural care was mailed to Lausanne University hospital's "front-line healthcare providers": clinical nurses and resident physicians at our institution. Preparedness items asked "How prepared do you feel to care for ... ?" (referring to example patient profiles) on an ascending 5-point Likert scale. We examined proportions of "4 - well/5 - very well prepared" and the mean composite score for preparedness. We used linear regression to examine the adjusted effect of demographics, work context, cultural-competence training, and cross-cultural care problem awareness, on preparedness. FINDINGS: Of 885 questionnaires, 368 (41.2%) were returned: 124 (33.6%) physicians and 244 (66.4%) nurses. Mean preparedness composite was 3.30 (SD = 0.70), with the lowest proportion of healthcare providers feeling prepared for patients "whose religious beliefs affect treatment" (22%). After adjustment, working in a sensitized department (β = 0.21, p = .01), training on the history/culture of a specific group (β = 0.25, p = .03), and awareness regarding (a) a lack of practical experience caring for diverse populations (β = 0.25, p = .004) and (b) inadequate cross-cultural training (β = 0.18, p = .04) were associated with higher preparedness. Speaking French as a dominant language and physician role (vs. nurse) were negatively associated with preparedness (β = -0.26, p = .01; β = -0.22, p = .01). Insights: The state of cross-cultural care preparedness among Lausanne's front-line healthcare providers leaves room for improvement. Our study points toward institutional strategies to improve preparedness: notably, making sure departments are sensitized to cross-cultural care resources and increasing provider diversity to reflect the changing Swiss demographic.

L'articulation des rapports sociaux de sexe, de classe et de race dans la migration et le travail des femmes haïtiennes

Nombre de femmes paysannes haïtiennes migrent vers Port-au-Prince où elles deviennent travailleuses domestiques. Leur service domestique permet aux femmes qui les emploient de s'investir dans le travail non-domestique et de pouvoir accéder ainsi à la migration internationale. En France, ces migrantes deviennent à leur tour travailleuses domestiques, ce qui permet aux femmes françaises de s'investir dans le travail non-domestique. Ces phénomènes témoignent de l'existence d'une chaîne de travail et de migration où s'articulent les rapports sociaux de sexe, de classe, de race et les confrontations Nord/Sud, au coeur de la mondialisation néolibérale. Quelques-unes de ces femmes racontent leur histoire qui exprime à la fois la violence des rapports sociaux et leurs stratégies pour devenir sujet. Pour penser ces « Sujettes », je propose une approche qui croise la recherche féministe et la sociologie clinique sur les plans théorique, méthodologique et épistémologique. -- Many rural Haitian women migrate to Port-au-Prince and become domestic workers. Their domestic service allows other women to invest in the non-domestic work and access to international migration as well. In France, these Haitian migrants become domestic workers in turn, which allows French women to invest in the non-domestic work. These phenomena demonstrate the existence of a global work and migration chain where gender, class, race and the North/South confrontations are articulated, in the neoliberal globalization. Some of these women tell their life story which expresses both the violence of social problems and their strategies to become subject. To think these "subjects" I propose to cross feminist research and clinical sociology on the theoretical, methodological and epistemological point of view. Intersectionality among gender, race and class, North / South confrontations, productive and reproductive labour , domestic work, domestic service, care work , internal and international migration, neoliberal globalization, clinical sociology.

'And the best essay is...' : Extended contact and cross-group friendships at school

We conducted one experimental intervention based on extended contact principles aimed at fostering the formation of cross-group friendships within educational settings. Italian school children took part in a school competition for the best essay on personal experiences of cross-group friendships with immigrants, to be written in small groups. This manipulation was intended to favour the exchange of personal positive cross-group experiences, thus capitalizing on the benefits of extended contact. In the control condition, participants wrote an essay on friendship, without reference to cross-group relations. Results revealed that children who took part in the intervention reported a higher number of outgroup friends 3 months later. This indirect effect was sequentially mediated by pro-contact ingroup and outgroup norms and by outgroup contact behavioural intentions. This study provides experimental evidence that interventions based on extended contact can foster cross-group friendship formation. Theoretical and practical implications of the findings are discussed.

Defining the Effect of the 16p11.2 Duplication on Cognition, Behavior, and Medical Comorbidities.

IMPORTANCE: The 16p11.2 BP4-BP5 duplication is the copy number variant most frequently associated with autism spectrum disorder (ASD), schizophrenia, and comorbidities such as decreased body mass index (BMI). OBJECTIVES: To characterize the effects of the 16p11.2 duplication on cognitive, behavioral, medical, and anthropometric traits and to understand the specificity of these effects by systematically comparing results in duplication carriers and reciprocal deletion carriers, who are also at risk for ASD. DESIGN, SETTING, AND PARTICIPANTS: This international cohort study of 1006 study participants compared 270 duplication carriers with their 102 intrafamilial control individuals, 390 reciprocal deletion carriers, and 244 deletion controls from European and North American cohorts. Data were collected from August 1, 2010, to May 31, 2015 and analyzed from January 1 to August 14, 2015. Linear mixed models were used to estimate the effect of the duplication and deletion on clinical traits by comparison with noncarrier relatives. MAIN OUTCOMES AND MEASURES: Findings on the Full-Scale IQ (FSIQ), Nonverbal IQ, and Verbal IQ; the presence of ASD or other DSM-IV diagnoses; BMI; head circumference; and medical data. RESULTS: Among the 1006 study participants, the duplication was associated with a mean FSIQ score that was lower by 26.3 points between proband carriers and noncarrier relatives and a lower mean FSIQ score (16.2-11.4 points) in nonproband carriers. The mean overall effect of the deletion was similar (-22.1 points; P < .001). However, broad variation in FSIQ was found, with a 19.4- and 2.0-fold increase in the proportion of FSIQ scores that were very low (≤40) and higher than the mean (>100) compared with the deletion group (P < .001). Parental FSIQ predicted part of this variation (approximately 36.0% in hereditary probands). Although the frequency of ASD was similar in deletion and duplication proband carriers (16.0% and 20.0%, respectively), the FSIQ was significantly lower (by 26.3 points) in the duplication probands with ASD. There also were lower head circumference and BMI measurements among duplication carriers, which is consistent with the findings of previous studies. CONCLUSIONS AND RELEVANCE: The mean effect of the duplication on cognition is similar to that of the reciprocal deletion, but the variance in the duplication is significantly higher, with severe and mild subgroups not observed with the deletion. These results suggest that additional genetic and familial factors contribute to this variability. Additional studies will be necessary to characterize the predictors of cognitive deficits.

Expertise and decision making among clinicians in investigations of alleged child sexual abuse

The purpose of the present thesis was to explore different aspects of decision making and expertise in investigations of child sexual abuse (CSA) and subsequently shed some light on the reasons for shortcomings in the investigation processes. Clinicians’ subjective attitudes as well as scientifically based knowledge concerning CSA, CSA investigation and interviewing were explored. Furthermore the clinicians’ own view on their expertise and what enhances this expertise was investigated. Also, the effects of scientific knowledge, experience and attitudes on the decision making in a case of CSA were explored. Finally, the effects of different kinds of feedback as well as experience on the ability to evaluate CSA in the light of children’s behavior and base rates were investigated. Both explorative and experimental methods were used. The purpose of Study I was to investigate whether clinicians investigating child sexual abuse (CSA) rely more on scientific knowledge or on clinical experience when evaluating their own expertise. Another goal was to check what kind of beliefs the clinicians held. The connections between these different factors were investigated. A questionnaire covering items concerning demographic data, experience, knowledge about CSA, selfevaluated expertise and beliefs about CSA was given to social workers, child psychiatrists and psychologists working with children. The results showed that the clinicians relied more on their clinical experience than on scientific knowledge when evaluating their expertise as investigators of CSA. Furthermore, social workers possessed stronger attitudes in favor of children than the other groups, while child psychiatrists had more negative attitudes towards the criminal justice system. Male participants held less strong beliefs than female participants. The findings indicate that the education of CSA investigators should focus more on theoretical knowledge and decision making processes as well as the role of beliefs In Study II school and family counseling psychologists completed a Child Sexual Abuse Attitude and Belief Scale. Four CSA related attitude and belief subscales were identified: 1. The Disclosure subscale reflecting favoring a disclosure at any cost, 2. The Pro-Child subscale reflecting unconditional belief in children's reports, 3. The Intuition subscale reflecting favoring an intuitive approach to CSA investigations, and 4. The Anti Criminal Justice System subscale reflecting negative attitudes towards the legal system. Beliefs that were erroneous according to empirical research were analyzed separately. The results suggest that some psychologists hold extreme attitudes and many erroneous beliefs related to CSA. Some misconceptions are common. Female participants tended to hold stronger attitudes than male participants. The more training in interviewing children the participants have, the more erroneous beliefs and stronger attitudes they hold. Experience did not affect attitudes and beliefs. In Study III mental health professionals’ sensitivity to suggestive interviewing in CSA cases was explored. Furthermore, the effects of attitudes and beliefs related to CSA and experience with CSA investigations on the sensitivity to suggestive influences in the interview were investigated. Also, the effect of base rate estimates of CSA on decisions was examined. A questionnaire covering items concerning demographic data, different aspects of clinical experience, self-evaluated expertise, beliefs and knowledge about CSA and a set of ambiguous material based on real trial documents concerning an alleged CSA case was given to child mental health professionals. The experiment was based on a 2 x 2 x 2 x 2 (leading questions: yes vs no) x (stereotype induction: yes vs no) x (emotional tone: pressure to respond vs no pressure to respond) x (threats and rewards: yes vs no) between-subjects factorial design, in which the suggestiveness of the methods with which the responses of the child were obtained were varied. There was an additional condition in which the material did not contain any interview transcripts. The results showed that clinicians are sensitive only to the presence of leading questions but not to the presence of other suggestive techniques. Furthermore, the clinicians were not sensitive to the possibility that suggestive techniques could have been used when no interview transcripts had been included in the trial material. Experience had an effect on the sensitivity of the clinicians only regarding leading questions. Strong beliefs related to CSA lessened the sensitivity to leading questions. Those showing strong beliefs on the belief scales used in this study were even more prone to prosecute than other participants when other suggestive influences than leading questions were present. Controversy exists regarding effects of experience and feedback on clinical decision making. In Study IV the impact of the number of handled cases and of feedback on the decisions in cases of alleged CSA was investigated. One-hundred vignettes describing cases of suspected CSA were given to students with no experience with investigating CSA. The vignettes were based on statistical data about symptoms and prevalence of CSA. According to the theoretical likelihood of CSA the children described were categorized as abused or not abused. The participants were asked to decide whether abuse had occurred. They were divided into 4 groups: one received feedback on whether their decision was right or wrong, one received information about cognitive processes involved in decision making, one received both, and one did not receive feedback at all. The results showed that participants who received feedback on their performance made more correct positive decisions and participants who got information about decision making processes made more correct negative decisions. Feedback and information combined decreased the number of correct positive decisions but increased the number of correct negative decisions. The number of read cases had in itself a positive effect on correct positive decision.