Biomedical risk assessment as an aid for smoking cessation.

BACKGROUND: A possible strategy for increasing smoking cessation rates could be to provide smokers who have contact with healthcare systems with feedback on the biomedical or potential future effects of smoking, e.g. measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer. We reviewed systematically data on smoking cessation rates from controlled trials that used biomedical risk assessment and feedback. OBJECTIVES: To determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. SEARCH STRATEGY: We systematically searched he Cochrane Collaboration Tobacco Addiction Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 2004), and EMBASE (1980 to 2004). We combined methodological terms with terms related to smoking cessation counselling and biomedical measurements. SELECTION CRITERIA: Inclusion criteria were: a randomized controlled trial design; subjects participating in smoking cessation interventions; interventions based on a biomedical test to increase motivation to quit; control groups receiving all other components of intervention; an outcome of smoking cessation rate at least six months after the start of the intervention. DATA COLLECTION AND ANALYSIS: Two assessors independently conducted data extraction on each paper, with disagreements resolved by consensus. MAIN RESULTS: From 4049 retrieved references, we selected 170 for full text assessment. We retained eight trials for data extraction and analysis. One of the eight used CO alone and CO + Genetic Susceptibility as two different intervention groups, giving rise to three possible comparisons. Three of the trials isolated the effect of exhaled CO on smoking cessation rates resulting in the following odds ratios (ORs) and 95% confidence intervals (95% CI): 0.73 (0.38 to 1.39), 0.93 (0.62 to 1.41), and 1.18 (0.84 to 1.64). Combining CO measurement with genetic susceptibility gave an OR of 0.58 (0.29 to 1.19). Exhaled CO measurement and spirometry were used together in three trials, resulting in the following ORs (95% CI): 0.6 (0.25 to 1.46), 2.45 (0.73 to 8.25), and 3.50 (0.88 to 13.92). Spirometry results alone were used in one other trial with an OR of 1.21 (0.60 to 2.42).Two trials used other motivational feedback measures, with an OR of 0.80 (0.39 to 1.65) for genetic susceptibility to lung cancer alone, and 3.15 (1.06 to 9.31) for ultrasonography of carotid and femoral arteries performed in light smokers (average 10 to 12 cigarettes a day). AUTHORS' CONCLUSIONS: Due to the scarcity of evidence of sufficient quality, we can make no definitive statements about the effectiveness of biomedical risk assessment as an aid for smoking cessation. Current evidence of lower quality does not however support the hypothesis that biomedical risk assessment increases smoking cessation in comparison with standard treatment. Only two studies were similar enough in term of recruitment, setting, and intervention to allow pooling of data and meta-analysis.

Self-deception as affective coping. An empirical perspective on philosophical issues.

In the philosophical literature, self-deception is mainly approached through the analysis of paradoxes. Yet, it is agreed that self-deception is motivated by protection from distress. In this paper, we argue, with the help of findings from cognitive neuroscience and psychology, that self-deception is a type of affective coping. First, we criticize the main solutions to the paradoxes of self-deception. We then present a new approach to self-deception. Self-deception, we argue, involves three appraisals of the distressing evidence: (a) appraisal of the strength of evidence as uncertain, (b) low coping potential and (c) negative anticipation along the lines of Damasio's somatic marker hypothesis. At the same time, desire impacts the treatment of flattering evidence via dopamine. Our main proposal is that self-deception involves emotional mechanisms provoking a preference for immediate reward despite possible long-term negative repercussions. In the last part, we use this emotional model to revisit the philosophical paradoxes.

Self, mémoire épisodique et narration chez l'enfant de 6 à 9 ans

Le self est une notion polysémique qui fait l'objet d'un consensus relatif dans plusieurs domaines, dont la psychologie du développement. Elle rend compte de la faculté de s'éprouver le même au fil du temps et de distinguer le « je » qui regarde du « moi » regardé. C'est le garant d'un sens de soi plus ou moins cohérent au fil du temps, en dépit des changements qui surviennent au cours de la vie. Le self combine des processus de réflexivité et d'intersubjectivité. Nous en avons analysé trois composantes fonctionnelles : la mémoire de travail, la mémoire épisodique et la narration, à partir d'un protocole expérimental témoignant de son ontogenèse chez des enfants de 6 à 9 ans (n=24 répartis en deux groupes de 6‐7 et 8-9 ans). Nous avons créé le « jeu informatique du lutin » qui propose un parcours semiorienté dans un monde imaginaire. C'est une narration de soi, opérant la mise en sens des temporalités et des espaces auxquels les événements se réfèrent. Deux semaines après cette « aventure », on recueille la narration des souvenirs épisodiques de cette histoire. Nous avons également utilisé un test de mémoire de travail visuospatiale non verbale. Des différences développementales affectent les dimensions narratives de la mémoire de l'épisode du jeu, comme l'efficacité de la mémoire de travail visuospatiale. Ces développements témoignent d'une augmentation de « l'épaisseur temporelle de la conscience» entre 6 et 9 ans. L'épaisseur de la conscience renvoie fondamentalement à la faculté du self de vivre le temps dans une cyclicité incluant le passé, le présent et le futur anticipé. Le développment observé élargit les possibilités de mettre en lien des mémoires et des scénarios futurs, tout comme les mises en sens des relations aux autres et à soi-­même. Self is a polysemic concept of common use in various scientific fields, among which developmental psychology. It accounts for the capacity to maintain the conviction to be « oneself », always the same through circumstances and throughout my life. This important function contributes in maintaining coherence and some sorte of Ariadne's thread in memory. To analyse the ontogeny of the self, we have focused upon three components : working memory, episodic memory and narration in children aged between 6 and 9 years. We used a non verbal working memory task. It was completed by a video game specially designed for our purpose, in which children were engaged in moving an elf in a landscape changing through seasons, in order to deliver a princess from a mischievous wizard. Two weeks after the game, the children had to tell what happened while they moved the elf. It is a self-narrative that creates a link‐up of temporality and spaces to which the events refer. The narrated episode was assessed for its coherence and continuity dimensions. Developmental differences affect the narrative dimensions of the memory of the episode of the game, as the effectiveness of visuospatial working memory. These developments show an increase in "temporal thickness of consciousness" between 6 and 9 years. The thickness of consciousness basically refers to the ability of the self to live in a cyclical time including past, present and anticipated future. The observed development broadens the possibilities to link memories and future scenarios, like setting sense of relations with others and with oneself.

Perceived modifiability of self-blame attributions for negative life events : implications for well-being /

Research suggests that self-blame attributions are important in the process of adjustment to negative life events. Much of the research originates from JanofTBulman's (1979) theory regarding behavioural and characterological self-blame. She argued that attributing negative events to one's behaviour is adaptive because behavioural self-blame involves attributions to a modifiable source, which implies that a similar event can be avoided in the future. In contrast, attributing negative events to one's character is believed to be maladaptive because character is seen as relatively stable and unmodifiable. Unfortunately, the empirical literature does not show consistent relations between these two types of self-blame attributions and well-being as predicted by Janoff-Bulman. For this thesis, I proposed that one reason for this inconsistency is that Janoff-Bulman's assumption about the perceived modifiability of behavioural versus characterological causes is incorrect — people often dlo perceive character (as well as behaviour) to be modifiable. Sixty-two participants completed a questionnaire regarding a recent negative life event and its impact on their well-being. Consistent with my argument, I found that both behavioural and characterological self-blame attributions following a negative life event were seen as modifiable. As hypothesized, perceived modifiability of causes v^as related to well-being. For example, overall modifiability was related to greater coping efficacy, less social dysfunction, less severe depression, and greater positive affect; however. contrary to predictions, the relation between perceived modifiability of causes and wellbeing was not mediated by the perception that similar events could be avoided in the future. Individual differences in attributional style were also assessed in this study. An attributional style that tended to be more internal, stable, and specific was related to wellbeing as expected; however, neither the perceived modifiability of blame attributions nor the perceived avoidability of similar future events mediated this relation. Implications for professionals dealing with trauma victims and potential directions for future research are discussed.

Factors affecting a woman's decision to leave an abusive relationship : the theory of planned behaviour /

The present study tested the appHcabiUty of Ajzen's (1985) theory of planned behaviour (TPB), an extension of Fishbein and Ajzen's (1975) theory of reasoned action (TRA), for the first time, in the context of abused women's decision to leave their abusive relationships. The TPB, as a means of predicting women's decision to leave their abusive partners' was drawn from Strube's (1988, 1991) proposed decision-making model based on the principle that the decision-making process is a rational, deliberative process, and regardless of outcome, was a result of a logical assessment of the available data. As a means of predicting those behaviours not under volitional control, Ajzen's (1985) TPB incorporated a measure of perceived behavioural control. Data were collected in two phases, ranging from 6 months to 1 year apart. It was hypothesized that, to the extent that an abused woman held positive attitudes, subjective norms conducive to leaving, and perceived control over leaving, she would form an intention to leave and thus, increase the likelihood of actually leaving her partner. Furthermore, it was expected that perceptions of control would predict leaving behaviour over and above attitude and subjective norm. In addition, severity and frequency of abuse were assessed, as were demographic variables. The TPB failed to account significantly for variability in either intentions or leaving behaviour. All of the variance was attributed to those variables associated with the theory of reasoned action, with social influence emerging as the strongest predictor of a woman's intentions. The poor performance of this model is attributed to measurement problems with aspects of attitude and perceived control, as well as a lack of power due to the small sample size. The insufficiency of perceived control to predict behaviour also suggests that, on the surface at least, other factors may be at work in this context. Implications of these results, and recommendations such as, the importance of obtaining representative samples, the inclusion of self-esteem and emotions as predictor variables in this model, a reevaluation of the target behaviovu" as nonvolitional, and longitudinal studies spanning a longer time period for future research within the context of decision-making are discussed.

Physiological reactivity and the perception of emotional stimuli as they relate to social adaptive functioning after traumatic brain injury / y Melonie Jane Hopkins.

Traumatic brain injury (TBI) often affects social adaptive functioning and these changes in social adaptability are usually associated with general damage to the frontal cortex. Recent evidence suggests that certain neurons within the orbitofrontal cortex appear to be specialized for the processing of faces and facial expressions. The orbitofrontal cortex also appears to be involved in self-initiated somatic activation to emotionally-charged stimuli. According to Somatic Marker Theory (Damasio, 1994), the reduced physiological activation fails to provide an individual with appropriate somatic cues to personally-relevant stimuli and this, in turn, may result in maladaptive behaviour. Given the susceptibility of the orbitofrontal cortex in TBI, it was hypothesized that impaired perception and reactivity to socially-relevant information might be responsible for some of the social difficulties encountered after TBL Fifteen persons who sustained a moderate to severe brain injury were compared to age and education matched Control participants. In the first study, both groups were presented with photographs of models displaying the major emotions and either asked to identify the emotions or simply view the faces passively. In a second study, participants were asked to select cards from decks that varied in terms of how much money could be won or lost. Those decks with higher losses were considered to be high-risk decks. Electrodermal activity was measured concurrently in both situations. Relative to Controls, TBI participants were found to have difficulty identifying expressions of surprise, sadness, anger, and fear. TBI persons were also found to be under-reactive, as measured by electrodermal activity, while passively viewing slides of negative expressions. No group difference,in reactivity to high-risk card decks was observed. The ability to identify emotions in the face and electrodermal reactivity to faces and to high-risk decks in the card game were examined in relationship to social monitoring and empathy as described by family members or friends on the Brock Adaptive Functioning Questionnaire (BAFQ). Difficulties identifying negative expressions (i.e., sadness, anger, fear, and disgust) predicted problems in monitoring social situations. As well, a modest relationship was observed between hypo-arousal to negative faces and problems with social monitoring. Finally, hypo-arousal in the anticipation of risk during the card game related to problems in empathy. In summary, these data are consistent with the view that alterations in the ability to perceive emotional expressions in the face and the disruption in arousal to personally-relevant information may be accounting for some of the difficulties in social adaptation often observed in persons who have sustained a TBI. Furthermore, these data provide modest support for Damasio's Somatic Marker Theory in that physiological reactivity to socially-relevant information has some value in predicting social function. Therefore, the assessment of TBI persons, particularly those with adaptive behavioural problems, should be expanded to determine whether alterations in perception and reactivity to socially-relevant stimuli have occurred. When this is the case, rehabilitative strategies aimed more specifically at these difficulties should be considered.

Self-directed learning, stress and the adult learner /

The purpose of this correlational study was to investigate the relationship between the degree of self-directed learning readiness and stress for level one nursing students and level two nursing students. One hundred female nursing students participated in the study who were attending an Ontario Community College. Data were collected from the main nursing campus and the satellite nursing campus using the random sample method. Instruments used were said to be valid and reliable for testing self-directed learning readiness and stress respectively. Data were analyzed using frequency response to each item, means and standard deviation, and the Pearson product correlation between selfdirected learning readiness and stress. The results of the study show that there is a difference in the relationship between the degree of self-directed learning readiness and stress between the level one nursing students and the level two nursing students. Such results will be of particular interest to nursing instructors and administrators when planning for delivery of programs to such students.

Implicit self-theories of shyness : predictors and correlates in preadolescence /

Implicit theories of shyness refer to a beUef that shyness is a fixed trait versus the belief that shyness is changeable and controllable. In this study, I explored the association between overall shyness and children's implicit self-theories of shyness, as well as between implicit self-theories of shyness and children's other shyness-related beliefs (perceptions of others' theories of shyness, shyness as a perceived problem, and ideas about treatment for shyness). Forty-six 10-12- year- old children (M = 10.74, SD = .88) were interviewed individually, filled out a set of questionnaires, and completed a computer-presented task. ' "^ As was expected, in ambiguous social situations, children perceived others' theories of shyness in a way that confirmed their own theories. The hypothesized curvilinear relation between shy and implicit self-theories of shyness was not found; instead, a linear positive relationship between these two variables emerged. Although implicit self-theories of shyness were not effective in predicting either the children's views of shyness as a perceived problem or children's ideas about treatment for shyness, some interesting results were found. Specifically, children's motivation to change their shyness correlated with their views of shyness as a problem for children in general and their perceptions of others' theories of shyness. Specific agents and strategies were regarded by children as having different effectiveness in their potential to change shyness. The theoretical and practical implications of these findings were discussed. Suggestions for future research were provided.