Selective serotonin reuptake inhibitors’ wide use, combined with the blurry limit between health and psychological illness, have led neuroscientists, clinicians and ethicists to envision the possibility of these medications’ use in non-clinical populations. This prospect has evoked ethical debates, which have often ignored the findings of the empirical literature. In this context, an evaluation of the empirical evidence for SSRIs’ personality enhancing effects is needed. The present paper examines SSRIs’ effects on healthy personality, including the Five Factor Model traits (...) Neuroticism and Extraversion, as well as some of their facets: Angry Hostility, Impulsiveness, Vulnerability, Warmth, Gregariousness and Assertiveness. The review encompasses investigations in healthy humans, human clinical populations, as well as relevant animal studies. Emerging data raise the possibility that SSRIs, when used by people without a currently diagnosable mental disorder, may reduce some facets of Neuroticism, especially Angry Hostility. On the other hand, very limited support exists for an SSRI-driven change in other Neuroticism facets, such as Impulsiveness, in healthy humans. An increase in Extraversion is possible, but currently available evidence is only indirect. Future research is needed, both to clarify methodological ambiguities in existing studies, and to answer unaddressed questions, such as ones of the stability, predictors, moderators, dose- and context-dependency of the effects. (shrink)

Micah 7:1-6 represents the prophet's lamentation of the deficiency of moral value in a beloved nation. The oracle is a watershed in the Book of Micah that is aptly characterised by certain degrees of socio-economic and religious unfaithfulness, especially in privileged circumstances. The oracle unit forms the darkest descriptions of degrees about the apparent moral wasteland of ancient Judah. The prophet's metaphors are used to describe the miserable moral morass of society form a kind of compendium with a progression of (...) thoughts and coherence of moral depravity. This article underscores that when people and society live in dishonesty and corruption, the essentially integrated spiritual-ethical-community of health and prosperity that is expected to unfold in time of covenant fidelity will eventually be reduced to poverty and despair, where people hunt each other for survival. This article explores aspects of dishonesty and corruption in the Book of Micah that are pointers to the tragic situation, analyses the various descriptions of corruption in the oracle unit and consequently examines its ethical imperatives for community living. CONTRIBUTION: As a biblical, literary and theological interpretation of Micah's oracle concerning ancient Judah's moral morass, this article brings together moral insights that are potentially viable for making major contributions to the life of people and just social order in an economics of affluence, politics of oppression and corruption in societies. (shrink)

Advance directives are propagated as instruments to maintain patients’ autonomy in case they can no longer decide for themselves. It has been never been examined whether patients’ and healthy persons themselves are inclined to adhere to these documents. Patients’ and healthy persons’ views on whether instructions laid down in advance directives should be followed because that is (or is not) “the right thing to do”, not because one is legally obliged to do so, were studied and (...) compared with that of medical staff. Method: Vignette study presenting five cases. Cancer patients, healthy persons, nursing staff and physicians (n = 100 in each group) were interviewed. An adherence score was calculated (maximum value 5). The adherence score is found to be low in all groups, yet lowest in patients (1.55; standard deviation 1.13) and healthy controls (1.60; 1.37). The scores are significantly different between nursing staff on the one hand and patients and healthy controls on the other (p < 0.005 and p < 0.05, respectively), and between doctors and patients (p < 0.05). Interviewees who want these documents to be followed tend to live alone and to have already written an advance directive. Conclusions: Cancer patients and healthy persons widely disregard instructions laid down in advance directives and consider them less binding than physicians and nursing staff do. Only a minority tends to adhere more to advance directives. To improve decision-making at the end of life when patients are no longer able to decide for themselves alternative concepts, such as advanced care planning, should be considered. (shrink)

How should governments balance saving people from very large individual disease burdens (such as an early death) against saving them from middling burdens (such as erectile dysfunction) and minor burdens (such as nail fungus)? This chapter considers this question through an analysis of a priority-setting proposal in the Netherlands, on which avoiding a multitude of middling burdens takes priority over saving one person from early death, but no number of very small burdens can take priority over avoiding one death. It (...) argues that there is some, albeit imperfect, evidence of substantial public support for such a policy. Furthermore, it provides a principled rationale for it in terms of respect for the person who faces the largest burden. (shrink)

Lifestyle-induced diseases are becoming a burden on healthcare, actualizing the discussion on health responsibilities. Using data from the National Association for Heart and Lung Diseases ’s 2015 Health Survey, this study examined the public’s attitudes towards personal and social health responsibility in a Norwegian population. The questionnaires covered self-reported health and lifestyle, attitudes towards personal responsibility and the authorities’ responsibility for promoting health, resource-prioritisation and socio-demographic characteristics. Block-wise multiple linear regression assessed the association between attitudes towards health responsibilities and individual (...) lifestyle, political orientation and health condition. We found a moderate support for social responsibility across political views. Respondents reporting unhealthier eating habits, smokers and physically inactive were less supportive of health promotion policies. The idea that individuals are responsible for taking care of their health was widely accepted as an abstract ideal. Yet, only a third of the respondents agreed with introducing higher co-payments for treatment of ‘self-inflicted’ conditions and levels of support were patterned by health-related behaviour and left-right political orientation. Our study suggests that a significant support for social responsibility does not exclude a strong support for personal health responsibility. However, conditional access to healthcare based on personal lifestyle is still controversial. (shrink)

Recent research on the relations of personality to well-being shows that the people who are most healthy, happy and fulfilled are those who are high in all three of the character traits of self-directedness, cooperativeness, and self-transcendence as measured by the Temperament and Character Inventory. In the past, the healthy personality has often been considered to require only high self-directedness and high cooperativeness. However, now the self-centred behaviour of people who are low in self-transcendence is degrading the conditions (...) needed for sustainable life by all human beings. Consequently, human beings need to and can develop their capacity for self-transcendence in order to maintain their individual and collective well-being. (shrink)

This paper examines what, if anything, is morally problematic about the desire for healthy limb amputation. The paper begins with a brief survey of the empirical data concerning the desire to amputate a healthy limb, focusing on questions of characterisation and treatment. Subsequent to this, the paper focuses on two normative questions: is the amputation of a healthy limb in and of itself morally questionable if those persons requesting it are autonomous? And, are patients who desire (...) the amputation of a healthy limb autonomous? With respect to the first question, I reject two possible objections to healthy limb amputation, namely the claim that it is repugnant, and that it might cause harm to others, thus showing there is nothing inherently objectionable to healthy limb amputation. With respect to the second question, I critique two opposing views of patient autonomy from the healthy limb amputation literature, in order to show that the nature of the desire itself may inhibit a person‟s autonomy. (shrink)

Ambient Assisted Living (AAL) refers to technologies that track daily activities of persons in need of care to enhance their autonomy and minimise their need for assistance. New technological developments show an increasing effort to integrate automated emotion recognition and regulation (ERR) into AAL systems. These technologies aim to recognise emotions via different sensors and, eventually, to regulate emotions defined as “negative” via different forms of intervention. Although these technologies are already implemented in other areas, AAL stands out by (...) its tendency to enable an inconspicuous 24-hour surveillance in the private living space of users who rely on the technology to maintain a certain degree of independence in their daily activities. The combination of both technologies represents a new dimension of emotion recognition in a potentially vulnerable group of users. Our paper aims to provide an ethical contextualisation of the novel combination of both technologies. We discuss different concepts of emotions, namely Basic Emotion Theory (BET) and the Circumplex Model of Affect (CMA), that form the basis of ERR and provide an overview over the current technological developments in AAL. We highlight four ethical issues that specifically arise in the context of ERR in AAL systems, namely concerns regarding (1) the reductionist view of emotions, (2) solutionism as an underlying assumption of these technologies, (3) the privacy and autonomy of users and their emotions, (4) the tendency of machine learning techniques to normalise and generalise human behaviour and emotional reactions. (shrink)

Proponents of the emerging field of P4 medicine argue that computational integration and analysis of patient-specific “big data” will revolutionize our health care systems, in particular primary care-based disease prevention. While many ambitions remain visionary, steps to personalize medicine are already taken via personalized genomics, mobile health technologies and pilot projects. An important aim of P4 medicine is to enable disease prevention among healthy persons through detection of risk factors. In this paper, we examine the current status of (...) P4 medicine in light of historical and current challenges to predictive and preventive medicine, including overdiagnosis and overtreatment. Moreover, we ask whether it is likely that in silico integration of patient-specific data will be able to better deal such challenges and to turn risk predictions into disease-preventive actions in a wider social context. Given the lack of evidence that P4 medicine can tip the balance between benefits and harms in preventive medicine, we raise concerns about the current promotion of P4 medicine as a solution to the current challenges in public health. (shrink)

Wherever I Go the Ministry Follows is an answer to a vision given to Matthew Webster at the young age of fifteen. The book took six years to complete and is a testimony of how God can use the most ordinary people to accomplish extraordinary things through Jesus Christ. It is Matt's prayer that you will be inspired, convicted, and prompted by the Holy Spirit to answer the calling from God to be and act as a chosen generation, a royal (...) priesthood, an holy nation, a peculiar people; that ye should shew forth the praises of Him who hath called you out of darkness into His marvelous light 1 Peter 2:9. The goal of Wherever I Go the Ministry Follows is for you the reader to meditate individually on each chapter and how it relates to surrendering yourself totally to God. This book is short because it is intended to be read slowly and read over and over again. It is an ideal book for a ten or eleven week Bible study. As you read each chapter you are faced with the question, am I taking the gospel everywhere I go? You are challenged to move towards a holy and a righteous lifestyle, to effectively reflect the image of Christ. The amazing thing about Wherever I Go the Ministry Follows is that as you read it you can see how each chapter is intricately woven together to give us the whole picture of what God expects from His people and what God is trying to mold each one of us into. Wherever I Go the Ministry Follows does not shy away from answering the tough questions we face in life like; What is God's will for my life? Is healing for everyone and if so then why am I not healed? Instead of dancing around the issues this book tackles the issues head on. This book is a great book for non-believers, new Christians, and mature Christians alike, because it has something unique to offer each person and it has challenges for all walks with the Lord or for those who currently are not in a personal relationship with Jesus Christ. (shrink)

Aging populations have become a major concern in the developed world and are expected to require novel care strategies. Public policies, health-care regimes and technology developers alike stress the need for a more individualized care to meet the increased demand for care services in response to demographic change. Increasingly, care services are offered to individuals with diseases and or disabilities in their homes by means of Personalized Health-Monitoring (PHM) technologies. PHM-based home care is typically portrayed as the key to a (...) cost-effective future care that better can accommodate the needs of an aging population and promote care recipients’ independence. In light of the emerging technology-based home care, this article sets forth to investigate the significance and implications of a strong emphasis on independence in relation to this novel care form. Notions of independence as used by care planners, care providers and technology developers are examined in relation to ICT-based home care and the reasonableness of independence as an aim for future health-care is critically discussed. In conclusion, the need for a shift from a strong emphasis on independence to a right to healthy dependence is advocated. (shrink)

This article explored health determinants on successful, healthy ageing in sub-Saharan Africa, using the case of Ramotswa in Botswana. The study used contextual, descriptive and qualitative approaches. It also explored the integrative nature of determinants to healthy and successful ageing by examining the biopsychological and physiological challenges. The article made use of the pastoral theological approach in understanding the complexity of ageing and revealing solutions for mitigating the health challenges encountered by older persons. While the article was (...) theological in its approach, it acknowledged the interconnectedness with other disciplines, such as sociology and psychology, as fundamental in dealing with this topic. The findings revealed the elderly caregivers’ need for emotional support. This study maintained that emotional support could minimise the burden on elderly caregivers, because reports during the study indicated that elderly caregivers experienced a mixture of emotions such as loneliness, frustration, anger, depression, guilt, anxiety, love, acceptance and warmth, which could have negative consequences on them. Contribution: In conclusion, the article suggested that given the complexity of the understanding of successful and healthy ageing, as well as the integrative nature of determinants of successful ageing, it is crucial for caregivers and policymakers to avoid a blanket approach in dealing with elderly persons in a context of care. (shrink)

Everyone wants to be healthy, but many of us decline to act in healthy ways. Should these choices have any bearing on the ethics of clinical practice and health policy? How may personal responsibility for health be manipulated in health policy debates.

Combatting chronic, lifestyle-related disease has become a healthcare priority in the developed world. The role personal responsibility should play in healthcare provision has growing pertinence given the growing significance of individual lifestyle choices for health. Media reporting focussing on the ‘bad behaviour’ of individuals suffering lifestyle-related disease, and policies aimed at encouraging ‘responsibilisation’ in healthcare highlight the importance of understanding the scope of responsibility ascriptions in this context. Research into the social determinants of health and psychological mechanisms of health behaviour (...) could undermine some commonly held and tacit assumptions about the moral responsibility of agents for the sorts of lifestyles they adopt. I use Philip Petit's conception of freedom as ‘fitness to be held responsible’ to consider the significance of some of this evidence for assessing the moral responsibility of agents. I propose that, in some cases, factors outside the agent's control may influence behaviour in such a way as to undermine her freedom along the three dimensions described by Pettit: freedom of action; a sense of identification with one's actions; and whether one's social position renders one vulnerable to pressure from more powerful others. (shrink)

Proponents of the emerging field of P4 medicine argue that computational integration and analysis of patient-specific “big data” will revolutionize our health care systems, in particular primary care-based disease prevention. While many ambitions remain visionary, steps to personalize medicine are already taken via personalized genomics, mobile health technologies and pilot projects. An important aim of P4 medicine is to enable disease prevention among healthy persons through detection of risk factors. In this paper, we examine the current status of (...) P4 medicine in light of historical and current challenges to predictive and preventive medicine, including overdiagnosis and overtreatment. Moreover, we ask whether it is likely that in silico integration of patient-specific data will be able to better deal such challenges and to turn risk predictions into disease-preventive actions in a wider social context. Given the lack of evidence that P4 medicine can tip the balance between benefits and harms in preventive medicine, we raise concerns about the current promotion of P4 medicine as a solution to the current challenges in public health. (shrink)

This paper argues against incorporating assessments of individual responsibility into healthcare policies by expanding an existing argument and offering a rebuttal to an argument in favour of such policies. First, it is argued that what primarily underlies discussions surrounding personal responsibility and healthcare is not causal responsibility, moral responsibility or culpability, as one might expect, but biases towards particular highly stigmatised behaviours. A challenge is posed for proponents of taking personal responsibility into account within health policy to either expand the (...) debate to also include socially accepted behaviours or to provide an alternative explanation of the narrowly focused discussion. Second, a critical response is offered to arguments that claim that policies based on personal responsibility would lead to several positive outcomes including healthy behaviour change, better health outcomes and decreases in healthcare spending. It is argued that using individual responsibility as a basis for resource allocation in healthcare is unlikely to motivate positive behaviour changes, and is likely to increase inequality which may lead to worse health outcomes overall. Finally, the case of West Virginia's Medicaid reform is examined, which raises a worry that policies focused on personal responsibility have the potential to lead to increases in medical spending overall. (shrink)

Little is known about how ethical organizational contexts influence employees’ perceived stress levels and well-being. This study used two theoretical lenses, ethical impact theory (Promislo et al. in Handbook of Unethical Work Behavior, M.E. Sharpe, Armonk, 2013) and ethical decision-making theory (Schwartz in J Bus Ethics 139(4): 755–776, 2016), to investigate the relationships among perceived organizational ethics (comprised of ethical climate, leader/manager ethics, and corporate social responsibility), work-related stress, and employee well-being (comprised of vitality, life satisfaction, personal growth initiative, flourishing, (...) positive mental health, and self-actualization). Findings across two studies indicated that organizational ethics was negatively related to work-related stress, and that work-related stress was negatively related to employee well-being. Perceived organizational ethics is positively related to employee well-being, with post hoc mediation tests indicating that work-related stress partially mediates this relationship. Our findings suggest that organizations should be proactive in improving their ethical climate, such as choosing ethical leaders, developing a robust and well-communicated code of ethics, and actively practicing CSR. These measures should reduce excessive work-related stress and improve employee well-being. (shrink)

The physical activity-related health competence model assumes that individuals require movement competence, control competence, and self-regulation competence to lead a healthy, physically active lifestyle. Although previous research has already established some measurement factors of the three dimensions, no attempts have so far been made to statistically aggregate them on the sub-competence level. Therefore, the goal of the present study was to test two additional factors for PAHCO and subsequently model the second-order structure with two samples from the fields of (...) rehabilitation and prevention. We conducted two questionnaire surveys with persons with multiple sclerosis and teaching students undergoing a basic qualification course in physical education. After performing exploratory items analysis, we used second-order confirmatory factor analysis and multidimensional scaling to investigate whether the scales could be bundled in accordance with the PAHCO model. The CFAs with 10 factors demonstrated a good model fit. In contrast, the second-order analysis with a simple loading structure on the three sub-competencies revealed an unacceptable model fit. Instead, a second-order model variant was preferred [comparative fit index = 0.926, root mean square error of approximation = 0.048, standardized root mean square residual = 0.065] in which body awareness and self-efficacy had theory-conform cross-loadings. The results of multidimensional scaling were in line with the extracted second-order structure. The present results suggested that the extension of the measurement instrument to 10 first-order factors was psychometrically justified for the two populations. The results from the second-order analyses provided the basis for the creation of sum scores, representing manifest indicators of movement competence, control competence, and self-regulation competence. Future studies are needed that cross-validate the extended measurement model with other populations and that relate the sub-competencies of PAHCO to indicators of health-enhancing physical activity. (shrink)

In dementia research evidence is mounting that therapeutic strategies that target moderate and even mild Alzheimer's disease may be missing the ‘therapeutic window’. Given that the neuropathology that leads to Alzheimer's disease probably begins somewhere between 10 and 15 years before symptoms manifest, many believe that the optimal therapeutic strategy would target persons in the earliest phases of disease development or even earlier. This would include, for example, persons with prodromal Alzheimer's and even persons who are deemed (...) at risk. Given the nature of research involving the central nervous system, it is conceivable that some therapeutic investigations may involve an increase over minimal risk. This paper examines how, in dementia research, at-risk persons, although healthy, bring multiple and intersecting vulnerabilities to the prospect of research participation even though they are clinically healthy. Current guidelines for research ethics may not provide adequately for the nuances of ‘healthy individuals’ and their possible vulnerabilities. In the context of neurodegenerative disease, the fact of being ‘at risk’ alters the vulnerability profile in significant ways. While healthy persons who are at risk of developing dementia may not appear to warrant placement in the research category of vulnerable participants (alongside prisoners, pregnant women and children) careful regard for the vulnerabilities that arise as a result of the intersecting circumstances of being healthy and at risk of an incurable disease are worthy of increased attention and consideration, particularly as the research effort for the increasingly prevalent disease of Alzheimer's moves forward. (shrink)

Does a human right to healthcare imply individual obligations to healthy behavior? Or put another way: Is a self-induced condition a relevant criterion for some sort of restriction of this right—like withholding or modifying treatment in circumstances where choices have to be made? For instance, should a drunk driver bear the costs of medical care that he needs after a car accident he has caused? Should there be a difference in healthcare entitlements between the smoker with a heart attack (...) who is seriously overweight and the 60-year old man who has always taken excellent care of himself and is suddenly stricken by leukemia? And how should we think about the risk-taking behavior of all the persons going on a skiing holiday or an exotic hiking trip? a. (shrink)

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the (...) desire for amputation in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image. (shrink)

Obesity is a widespread and broadly consequential health condition associated with numerous medical complications that could increase mortality rates. As personality concerned individual’s patterns of feeling, behavior, and thinking, it may help in understanding how people with obesity differ from people with normal-weight status in their typical weight-relevant behavior. So far, studies about personality and BMI associations have mainly focused on broad personality traits. The main purpose of this study was to explore the personality and health associations among a clinical (...) group composed of 46 outpatients with overweight/obesity in comparison to a healthy control group that included 46 subjects. Both the clinical and control groups were composed of 14 males and 32 females. Several personality and psychopathological aspects were assessed with the Personality Assessment Inventory. The results of the analysis of variance of aligned rank transformed showed that patients with overweight/obesity reported higher scores for Somatic Complaints, Depression, and Borderline Features than the control group. Logistic regression highlighted specifically that the subscales of the Borderline Features assessing the Negative Relationship contributed to the increased risk of belonging to the clinical group. For the purpose of this study, the role of gender was considered. The present findings highlight the importance of focusing on assessing personality functioning in the health context and on specific characteristics of interpersonal relationships to promote more tailored treatments. (shrink)

Most of the literature on phase one trials has focused on ethical and safety issues in research on patients with advanced cancer, but this article focuses on healthy, adult subjects. The article makes six specific recommendations for protecting the rights and welfare of healthy subjects in phase one trials: 1) because phase one trials are short in duaration (usually 1 to 3 months), researchers should gather more data on the short-term and long-term risks of participation in phase one (...) studies by healthy subjects; 2) researchers should develop strict inclusion/exclusion criteria that exclude unhealthy or vulnerable subjects, such as decisionally impaired people, in phase one studies; 3) subjects should not participate in more than one phase one study at the same time and should wait at least 30 days between participating in different studies; 4) researchers should develop a database to keep track of phase one participants; 5) subjects should be guaranteed a minimum wage equivalent to the equivalent type of unskilled labor, but there should be no upper limits on wages; and 6) subjects should be allowed to engage in collective bargaining with research sponsors. *Disclaimer: The ideas and opinions expressed in this article are the authors' personal views and do not represent the views of the National Institute of Environmental Health Sciences, the National Institutes of Health, or the United States government. (shrink)

The case outlined below is the basis for the In That Case section of the “Ethics and Epistemology of Big Data” symposium. Jordan receives reports from two separate personal genomic tests that provide intriguing data about ancestry and worrying but ambiguous data about the potential risk of developing Alzheimer’s disease. What began as a personal curiosity about genetic inheritance turns into an alarming situation of medical uncertainty. Questions about Jordan’s family tree are overshadowed by even more questions about Alzheimer’s disease (...) and healthy ageing. As a parent, Jordan is unsure whether to share these results and what it would mean for their children to learn about their genetic inheritance and potential future health. Furthermore, Jordan is unsure how to make sense of these reports in light of current knowledge of the risk factors for Alzheimer’s disease and in the absence of effective treatments or robust preventative guidelines. (shrink)

This study examines the personal values and value types of Chinese accounting practitioners and students, using the values survey questionnaire developed and validated by Schwartz (1992, Advances in Experimental Social Psychology 25, 1–65). A total of 454 accounting practitioners and 126 graduate accounting students participated in the study. The results show that Healthy, Family Security, Self-Respect, and Honoring of Parents and Elders are the top four values for both accounting practitioners and accounting students, although these values are not ranked (...) in the same order. Social Power, An Exciting Life, Devout, and Accepting My Portion in Life are the lowest rated four values for the accounting practitioners whereas Devout, An Exciting Life, Detachment, and Accepting My Portion in Life form the bottom four values for the accounting students. Both accounting practitioners and students ranked Security as the highest value type and Tradition as the lowest one, and the students rated Self-Direction as significantly more important than the practitioners. With respect to gender differences, both the male accounting practitioners and students rated the value type Achievement significantly higher than their female counterparts and there were several significant gender differences in personal values for both accounting practitioners and students. In addition, the perceived values are linked to social and cultural factors as well as to the influence of Western values. (shrink)

The HealthyFood program offers members up to 25% cash back monthly on healthy food purchases. In this randomized controlled trial, we tested the efficacy of financial incentives combined with text messages in increasing healthy food purchases among HF members. Members receiving the lowest cash back level were randomized to one of six arms: Arm 1 : 10% cash back, no weekly text, standard monthly text; Arm 2: 10% cash back, generic weekly text, standard monthly text; Arm 3: 10% (...) cash back, personalized weekly text, standard monthly text; Arm 4: 25% cash back, personalized weekly text, standard monthly text; Arm 5: 10 + 15%NET cash back, personalized weekly text, standard monthly text; and, Arm 6: 10 + 15%NET cash back, personalized weekly text, unbundled monthly text. In the 10 + 15%NET cash back, the cash back amount was the baseline 10% plus 15% of the net difference between healthy and unhealthy spending. The generic text included information on HF and healthy eating, while the personalized text had individualized feedback on purchases. The standard monthly text contained the cash back amount. The unbundled monthly text included the amount lost due to unhealthy purchases. The primary outcome was the average monthly percent healthy food spending. Secondary outcomes were the percent unhealthy food spending, and the percent healthy and unhealthy food items. Of the members contacted, 20 opted out, and 2841 met all inclusion criteria. There were no between-arm differences in the examined outcomes. The largest mean difference in percent healthy spending was between Arm 1 and Arm 2, and the largest mean difference in percent unhealthy spending was also between Arm 1 and Arm 2, but no differences were statistically significant after correction for multiple comparisons. None of the tested financial incentive structures or text strategies differentially affected food purchasing. Notably, more than doubling the cash back amount and introducing a financial disincentive for unhealthy purchases did not affect purchasing. These findings speak to the difficulty of changing shopping habits and to the need for innovative strategies to shift complex health behaviors. NCT02486588 Increasing Engagement with a Healthy Food Benefit. The trial was prospectively registered on July 1, 2015. (shrink)

Most of the literature on phase one trials has focused on ethical and safety issues in research on patients with advanced cancer, but this article focuses on healthy, adult subjects. The article makes six specific recommendations for protecting the rights and welfare of healthy subjects in phase one trials: 1) because phase one trials are short in duaration (usually 1 to 3 months), researchers should gather more data on the short-term and long-term risks of participation in phase one (...) studies by healthy subjects; 2) researchers should develop strict inclusion/exclusion criteria that exclude unhealthy or vulnerable subjects, such as decisionally impaired people, in phase one studies; 3) subjects should not participate in more than one phase one study at the same time and should wait at least 30 days between participating in different studies; 4) researchers should develop a database to keep track of phase one participants; 5) subjects should be guaranteed a minimum wage equivalent to the equivalent type of unskilled labor, but there should be no upper limits on wages; and 6) subjects should be allowed to engage in collective bargaining with research sponsors. *Disclaimer: The ideas and opinions expressed in this article are the authors' personal views and do not represent the views of the National Institute of Environmental Health Sciences, the National Institutes of Health, or the United States government. (shrink)

Many healthy volunteers choose to take part in Alzheimer’s disease prevention studies because they want to know whether they will develop dementia—and what they can do to reduce their risk—and are therefore interested in learning the results of AD biomarker tests. Proponents of AD biomarker disclosure often refer to the personal utility of AD biomarkers, claiming that research participants will be able to use AD biomarker information for personal purposes, such as planning ahead or making important life decisions. In (...) this paper, the claim that AD biomarkers have personal utility for asymptomatic individuals is critically assessed. It demonstrates that in the absence of clinical validity, AD biomarkers cannot have personal utility and do not serve research participants’ autonomy. Over the next few years, many research groups will be confronted with participants’ preferences to learn the results of AD biomarker tests. When researchers choose to make results available upon explicit request, they should ensure adequate information provision and education, notably on the uncertain clinical significance of AD biomarker information. Routine disclosure of AD biomarkers to cognitively unimpaired individuals in research settings cannot be justified with an appeal to the personal utility of AD biomarker information. (shrink)

Based on the theoretical analysis of self-consciousness concepts, we hypothesized that the spatio-temporal pattern of functional connectivity within the default-mode network (DMN) should persist unchanged across a variety of different cognitive tasks or acts, thus being task-unrelated. This supposition is in contrast with current understanding that DMN activated when the subjects are resting and deactivated during any attention-demanding cognitive tasks. To test our proposal, we used, in retrospect, the results from our two early studies ([Fingelkurts, 1998] and [Fingelkurts et al., (...) 2003]). In both studies for the majority of experimental trails we indeed found a constellation of operationally synchronized cortical areas (indexed as DMN) that was persistent across all studied experimental conditions in all subjects. Furthermore, we found three major elements comprising this DMN: two symmetrical occipito-parieto-temporal and one frontal spatio-temporal patterns. This new data directly supports the notion that DMN has a specific functional connotation – it provides neurophysiologic basis for self-processing operations, namely first-person perspective taking and an experience of agency. (shrink)

To consider whether or not we should aim to create a perfect healthy utopia on Earth, we focus on the SF novel Harmony, written by Japanese writer Project Ito, and analyze various issues in the world established in the novel from a bioethical standpoint. In the world depicted in Harmony, preserving health and life is a top priority. Super-medicine is realized through highly advanced medical technologies. Citizens in Harmony are required to strictly control themselves to achieve perfect health and (...) must always disclose their health information to the public and continuously prove their health. From a bioethical standpoint, the world in Harmony is governed by a “healthy longevity supremacy” principle, with being healthy equated to being good and right. Privacy no longer exists, as it is perceived ethical for citizens to openly communicate health-related information to establish one’s credibility. Moreover, there is no room for self-determination concerning healthcare because medical interventions and care are completely routinized, automated, centralized, and instantly provided. This is a situation where the community exhibits extremely powerful and effective paternalism. One can argue that healthy longevity is highly preferred. But is it right to aim for a perfectly healthy society at all costs? Should we sacrifice freedom, privacy, vivid feelings, and personal dignity to achieve such a world? In our view, the answer is no, as this would require the loss of many essential values. We conclude by proposing an alternative governing principle for future healthcare, and refer to it as the “do-everything-in-moderation” principle. (shrink)

Information and communication technologies (ICTs) are building a new habitat (infosphere) in which future generations, living in advanced information societies, will spend an increasing amount of time. This paper introduces a series of articles that explore what constitutes a personal identity online (PIO) and how, as well as to what extent, individuals can learn to create, manage and perceive their PIOs in order to facilitate a healthy and rewarding online experience (onlife).

Determining the relationship between the entire brain structure and individual differences is important in extending healthy life expectancy, which can be affected by brain atrophy. The entire brain structure has been gradually known to be correlated not only with age but also with individual differences, such as quality of life, general intelligence, and lifestyle. However, little attention has been paid to the relationship between the entire brain structure and personal traits. We herein focused on one personal trait, namely spiritual (...) growth, and examined its relationship with the entire brain structure using two neuroimaging-derived measures, namely the gray matter Brain Healthcare Quotient, a measure of GM volume, and the fractional anisotropy Brain Healthcare Quotient, a measure of white matter integrity, in 229 healthy participants. The results indicated no significant relationship between the GM-BHQ and spiritual growth, but there was a significant positive correlation between the FA-BHQ and spiritual growth after controlling for age, sex, and body mass index with partial correlation analysis. Furthermore, multiple regression analysis revealed a significant positive correlation between the FA-BHQ and spiritual growth after controlling for physical characteristics, such as age, sex, and BMI, as well as other variables related to lifestyle that were collected using the Health-Promoting Lifestyle Profile. These results support the idea that there is a relationship between the entire WM brain structure and spiritual growth. Further studies are required to clarify the causal relationship between the entire WM brain structure and spiritual growth with some interventions to improve spiritual growth. Such studies will help extend healthy life expectancy from a new perspective of personal trait. (shrink)

We conducted and analyzed qualitative interviews with 12 persons working on the Healthy Public Housing Initiative in Boston, Massachusetts in 2001. Our goal was to generate ideas and themes related to the ethics of the community-based participatory research in which they were engaged. Specifically, we wanted to see if we found themes that differed from conventional research that is based on an individualistic ethics. There were clearly distinct ethical issues raised with respect to projects and individuals who engage (...) in community-based collaborations. The differences that arose from the interviews were seeking equality between the partners, the need for the community partner to defend the community, dealing with unflattering data, meeting community expectations and producing tangible benefits to the community. (shrink)

Taking regular walks when living with Parkinson’s disease has beneficial effects on movement and quality of life. Yet, patients usually show reduced physical activity compared to healthy older adults. Using auditory stimulation such as music can facilitate walking but patients vary significantly in their response. An individualized approach adapting musical tempo to patients’ gait cadence, and capitalizing on these individual differences, is likely to provide a rewarding experience, increasing motivation for walk-in PD. We aim to evaluate the observance, safety, (...) tolerance, usability, and enjoyment of a new smartphone application. It was coupled with wearable sensors and delivered individualized musical stimulation for gait auto-rehabilitation at home. Forty-five patients with PD underwent a 1-month, outdoor, uncontrolled gait rehabilitation program, using the BeatWalk application. The music tempo was being aligned in real-time to patients’ gait cadence in a way that could foster an increase up to +10% of their spontaneous cadence. Open-label evaluation was based on BeatWalk use measures, questionnaires, and a six-minute walk test. Patients used the application 78.8% of the prescribed duration and enjoyed it throughout the program. The application was considered “easy to use” by 75% of the patients. Pain, fatigue, and falls did not increase. Fear of falling decreased and quality of life improved. After the program, patients improved their gait parameters in the six-minute walk test without musical stimulation. BeatWalk is an easy to use, safe, and enjoyable musical application for individualized gait rehabilitation in PD. It increases “walk for exercise” duration thanks to high observance.Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02647242. (shrink)

The Schwartz Values Survey (SVS), developed by Shalom Schwartz, was used to explore the values and value priorities of undergraduate business students in a mid-sized Canadian university. These business students considered family security as their top individual value and ranked successful, healthy, and enjoying life among their top ten individual values. On the other hand, detachment, accepting my portion in life and social power were least valued. They regarded Benevolence and Achievement as their top two value types (cluster of (...) related values), and ranked the higher order meta-value Self-Transcendence first followed by Openness to Change. The accounting and finance majors considered Hedonism as their top priority while the other business majors valued Benevolence most highly; however, overall, there were more similarities than differences between these two groups. When compared with the males, females valued the meta-value Self-Transcendence significantly more and exhibited values and value systems that have more of a social focus and less of a personal focus. First-year and fourth-year business students ranked the meta-values in the same order; however, Self-Transcendence was rated as significantly more important to the students in their first year compared to those in their fourth year. (shrink)

The Schwartz Values Survey, developed by Shalom Schwartz, was used to explore the values and value priorities of undergraduate business students in a mid-sized Canadian university. These business students considered family security as their top individual value and ranked successful, healthy, and enjoying life among their top ten individual values. On the other hand, detachment, accepting my portion in life and social power were least valued. They regarded Benevolence and Achievement as their top two value types, and ranked the (...) higher order meta-value Self-Transcendence first followed by Openness to Change. The accounting and finance majors considered Hedonism as their top priority while the other business majors valued Benevolence most highly; however, overall, there were more similarities than differences between these two groups. When compared with the males, females valued the meta-value Self-Transcendence significantly more and exhibited values and value systems that have more of a social focus and less of a personal focus. First-year and fourth-year business students ranked the meta-values in the same order; however, Self-Transcendence was rated as significantly more important to the students in their first year compared to those in their fourth year. (shrink)

Ancient India recognized the supreme value of education in human life. The ancient thinkers felt that a healthy society was not possible without educated individuals. They framed an educational scheme carefully and wisely aiming at the harmonious development of the mind and body of students. What they framed was a very liberal, all-round education of a very high standard, calculated to prepare the students for a useful life in enjoying all aspects of life. This is essentially a universally applicable (...) educational framework highlighting the purpose of human life and interconnectedness at all levels of existence as a basis of human values. Insights from ancient Indian educational system are of great help in facilitating the production of a creative, ethical and a learning mind, which will concern itself not only with greater ‘progress’, but primarily or more importantly with the inner transformation of the human consciousness. (shrink)

Complex problem solving can be interpreted as the number of psychological mechanisms that allow us to reach our targets in difficult situations, that can be classified as complex, dynamic, non-transparent, interconnected, and multilayered, and also polytelic. The previous results demonstrated associations between the personality dimensions neuroticism, conscientiousness, and extraversion and problem-solving performance. However, there are no studies dealing with personality disorders in connection with CPS skills. Therefore, the current study examines a clinical sample consisting of people with personality and/or depressive (...) disorders. As we have data for all the potential personality disorders and also data from each patient regarding to potential depression, we meet the whole range from healthy to impaired for each personality disorder and for depression. We make use of a unique operationalization: CPS was surveyed in a simulation game, making use of the microworld approach. This study was designed to investigate the hypothesis that personality traits are related to CPS performance. Results show that schizotypal, histrionic, dependent, and depressive persons are less likely to successfully solve problems, while persons having the additional behavioral characteristics of resilience, action orientation, and motivation for creation are more likely to successfully solve complex problems. (shrink)

Excerpt from The Idea of Personality Not since the French Revolution have the masses of men had such a passionate trust in the power of ideas as they have today. Such ideas as society, state, person, are no longer the exclusive concern of the few favored experts in philosophy and political theory. Such other ideas as authority, responsibility, conscience, right, and freedom, have become more than the mere blunted foils of friendly, academic discussion. This democratization of ideas has been, on (...) the whole, a healthy stimulant. No one who recalls the riotous confusion of thought in the nineteenth century will regret a situation that seems to promise a period of redefinition. One does not have to be an obscurantist to regret the uncontrolled and, often uncritical way, in which the findings of physical science were applied in the fields of ethics, religion, politics, sociology, economics, and history. We should have been warned that speculation was moving too rapidly. The careful scientist rarely makes a sweeping and definite conclusion. More rarely still does he make a universal application of deductions, reached in his own sphere of investigation, to all branches of knowledge. If the philosophy of life, built upon the recent biological and sociological premises, has been unsatisfactory, this has been due to an apparent unwillingness to take the time required to distinguish what is of permanent value from what is simply the exaggeration of controversy, in the anxiety to establish a theory. It is conceivable that men should wish, under the impulse of fresh evidence, to re-examine their notions of God, the nature of human progress, society, and free-will; but it is not conceivable that conclusions, reached so rapidly and with so little discrimination between fact and hypothesis, should he always accurate and should really reflect life's problems and complexities. We need to be redeemed from our own overweening confidence. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works. (shrink)

Based mainly on research conducted as part of a doctoral thesis (Guimond-Plourde, 2004), this paper introduces an epistemological and methodological framework based on the foundations and characteristics of a qualitative/interpretative approach rooted in hermeneutic phenomenology as conducive to disclosing the meaning that healthy adolescents, aged 15 to 17, attribute to the stress they experience in school and to their coping behaviour. Moving from the empirical to the phenomenal makes it possible to evoke a return to dimensions of meaning which (...) have been set aside or forgotten in the lived experience of stress-coping. By thus bringing stress-coping into focus in a new way, it enables us to glimpse the phenomenon anew, with the prospect of revealing what we haven't yet appreciated. A dual philosophical approach is outlined: a phenomenological perspective apprehends stress-coping as an existential phenomenon, while the hermeneutic focus is on interpreting the links between lived experience and meaning. The kind of knowledge generated by means of this approach offers a new way of understanding that focuses on the unique and personal nature of healthy adolescents' daily life at school and, as such, provides educators with a sensitive account of adolescents' experiences of stress in the school context. (shrink)

The aim of this paper is to explore a new framework for personality assessment that may function as sanity nosology of personality traits: the Positive Personality Model. The recent publication of DSM-5 created the opportunity to assess personality traits as dimensional constructs (American Psychiatric Association, 2013). In Section III, five maladaptive personality traits are proposed as the maladaptive versions of Five Factor Model (FFM) traits (Costa and McCrae, 1985). This approach draws on the existing idea of conceptualizing pathological and typical (...) personality traits as part of a continuum. It places DSM-5’s maladaptive traits in a sickness pole and FFM’s traits in a “typical” pole. This spectrum, however, does not include a positive perspective that represents healthy behavior: a sanity nosology. The Positive Traits Inventory-5 (PTI-5; de la Iglesia and Castro Solano, 2018) is a measure designed to assess the positive reverse of the Personality Inventory for DSM-5-Adult (PID-5; Krueger, Derringer, Markon, Watson and Skodol, 2013). The 220 positive personality criteria were studied psychometrically using a sample of 1902 Argentinean adults from the general population (Mage = 39.10, SD = 13.81, Min = 18, Max = 83; 50.1% females, 49.9% males). Exploratory and confirmatory factor analyses resulted in a five-factor solution. The dimensions were labeled Sprightliness, Integrity, Serenity, Moderation, and Humanity and subsumed under the denomination of Positive Personality Model (PPM). Analyses of convergent validity provided some grounds for interpreting the five positive traits as positive versions of the pathological traits and the typical traits. When tested for its predictive capability on mental health, the PPM outperformed the variance explained by the FFM. It is concluded that the PPM may constitute a positive pole in the continuum of personality traits –possibly functioning as a sanity nosology– and that it is somewhat more related to optimal functioning than to typical trait models. The PPM should be confirmed in other populations, its predictive capability ought to be tested with other relevant variables, and longitudinal studies should be done to analyze the stability of the traits over time. (shrink)

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the (...) desire for amputation in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image. (shrink)

Many individuals with disabling conditions have difficulty with gait and balance control that may result in a fall. Exoskeletons are becoming an increasingly popular technology to aid in walking. Despite being a significant aid in increasing mobility, little attention has been paid to exoskeleton features to mitigate falls. To develop improved exoskeleton stability, quantitative information regarding how a user reacts to postural challenges while wearing the exoskeleton is needed. Assessing the unique responses of individuals to postural perturbations while wearing an (...) exoskeleton provides critical information necessary to effectively accommodate a variety of individual response patterns. This report provides kinematic and neuromuscular data obtained from seven healthy, college-aged individuals during posterior support surface translations with and without wearing a lower limb exoskeleton. A 2-min, static baseline standing trial was also obtained. Outcome measures included a variety of 0 dimensional measures such as center of pressure RMS, peak amplitude, velocities, pathlength, and electromyographic RMS, and peak amplitudes. These measures were obtained during epochs associated with the response to the perturbations: baseline, response, and recovery. T-tests were used to explore potential statistical differences between the exoskeleton and no exoskeleton conditions. Time series waveforms of the COP and EMG data were also analyzed. Statistical parametric mapping was used to evaluate the 1D COP and EMG waveforms obtained during the epochs with and without wearing the exoskeleton. The results indicated that during quiet stance, COP velocity was increased while wearing the exoskeleton, but the magnitude of sway was unchanged. The OD COP measures revealed that wearing the exoskeleton significantly reduced the sway magnitude and velocity in response to the perturbations. There were no systematic effects of wearing the exoskeleton on EMG. SPM analysis revealed that there was a range of individual responses; both behaviorally and among neuromuscular activation patterns. Using both the OD and 1D measures provided a more comprehensive representation of how wearing the exoskeleton impacts the responses to posterior perturbations. This study supports a growing body of evidence that exoskeletons must be personalized to meet the specific capabilities and needs of each individual end-user. (shrink)

In postmodern society, many of the perceptions that people had about them, their lives, the values ​​that define them and the strategies that they can use to achieve their ideals have changed. Specifically, today we can talk about new paradigms, such as health, lifestyle focused on personal well-being, obtained through fitness and wellness, respectively wellbeing that adds the spiritual component, in an holistic interdependence. An important role in the changes we are talking about has been played by the media, which (...) promote living standards built on hedonistic principles, specific to the consumer society. The consequence is that more and more teenagers and young people want to look good and feel good, but only a small part of them reach the specialists, who are best able to provide individualized guidance, support, and programs to prevent any negative consequences of uninspired choices or poorly dosed enthusiasm The stakes of choice are high, because a healthy lifestyle, which should not be limited to body aesthetics, but also aims to develop the spiritual side, can support a more effective adaptation to the dynamics of changes in society. The last year, marked by a new challenge, the pandemic, has fully demonstrated the need to assume on a personal level a balanced and responsible lifestyle, which offers new values ​​of quality of life, as well as complementing proactive management with that managed by specialists. (shrink)