Dan J Stein

BackgroundCritical to conducting high quality research is the ability to attract and retain participants, especially for longitudinal studies. Understanding participant experiences and motivators or barriers to participating in clinical research is crucial. There are limited data on healthy participant experiences in longitudinal research, particularly in low- and middle-income countries. This study aims to investigate quantitatively participant experiences in a South African birth cohort study.MethodsMaternal participant experience was evaluated by a self-administered survey in the Drakenstein Child Health Study, a longitudinal birth cohort study investigating the early life determinants of child health. Pregnant mothers, enrolled during the second trimester, were followed through childbirth and the early childhood years. Satisfaction scores were derived from the participant experience survey and quantitatively analyzed; associations between satisfaction scores and sociodemographic variables were then investigated using a linear regression model.ResultsData were included from 585 pregnant mothers, who had participated in the study for a median time of 16 months. Overall participant satisfaction was high and associated with increased attendance of study visits. Reasons for participating were a belief that involvement would improve their health, their child’s health or the health of family and friends. Potential reasons for leaving the study were inconvenience, not receiving clinical or study results, and unexpected changes in study visits or procedures. Variables associated with higher overall satisfaction scores were no prior participation in research, higher socioeconomic status, less intensive follow-up schedules and having experienced stressful life events in the past year.ConclusionsSatisfaction scores were high and associated with increased visit attendance. Participants’ perceived benefits of study participation, most notably the potential for an improvement in the health of their child, were a significant motivator to enroll and remain in the study. The consistent theme of perceived health benefits as a motivator to join and remain in the study raises the question of whether participation in research results in actual improvements in health.

Natural philosophy once spanned the fields of philosophy, science, and medicine. Scientific disciplines and medical specialties have rapidly achieved independence, and the availability of the internet and open-access publishing promises a further expansion of knowledge. Nevertheless, a consideration of the grounding concepts and ethical principles that underlie health care remains paramount. It is timely, therefore, to contribute to the global conversation on health care with an open-access journal that focuses on addressing the conceptual basis of medicine and related disciplines, considering the ethical aspects of clinical practice, and exploring its intersection with the humanities (including history of medicine)

Problems of Living: Perspectives from Philosophy, Psychiatry, and Cognitive-Affective Science addresses philosophical questions related to problems of living, including questions about the nature of the brain-mind, reason and emotion, happiness and suffering, goodness and truth, and the meaning of life. It draws on critical, pragmatic, and embodied realism as well as moral naturalism, and brings arguments from metaphysics, epistemology, and ethics together with data from cognitive-affective science. This multidisciplinary integrated approach provides a novel framework for considering not only the nature of mental disorders, but also broader issues in mental health, such as finding pleasure and purpose in life. Draws on the strongest aspects of polar positions in philosophy and psychiatry to help resolve important perennial debates in these fields Explores continuities between early philosophical work and current cognitive-affective sciences, including neuroscience and psychology Employs findings from modern cognitive-affective science to rethink key long-standing debates in philosophy and psychiatry Builds on work showing how mind is embodied in the brain, and embedded in society, to provide an integrated conceptual framework Assesses both the insights and the limitations of cognitive-affective science for addressing the big questions and hard problems of living.

This study investigated the applicability of a novel instrument to assess parent–child attunement in free play interactions, in dyads with an infant with and without visual impairments. We here report the findings on the reliability and applicability of the newly developed Attune & Stimulate Mother–Infant 56-items Instrument in two separate samples: one with infants with VI and one with typically sighted infants. In addition, we assessed the contribution of parental sensitivity to attunement in dyadic interactions. The A&S M-I is an observational comprehensive instrument of behaviors that captures different body parts and their motility, and different senses. The appropriate responding of a parent to the child’s signal reflects the ability to attune in the dyad as well as parent’s ability to stimulate the child to become engaged in the contact or activity. Consistency assessments revealed good reliability for maternal and infant behaviors, acceptable internal consistency and good test–retest reliability. Furthermore, both samples scored significantly above chance level on attunement, suggesting that the instrument captures parent–infant behavioral coordination, and VI was not related to parent–infant attunement. Lastly, a relation between parental sensitivity and attunement was found only in the TS sample. Altogether, these findings provide promising initial evidence of the applicability of the A&S M-I instrument for assessing dyadic attunement across different populations and ages. Having assessed the applicability of this observational instrument, future work should corroborate these findings in larger samples.

Global Mental Health and Neuroethics explores conceptual, ethical and clinical issues that have emerged with the expansion of clinical neuroscience into middle- and low-income countries. Conceptual issues covered include avoiding scientism and skepticism in global mental health, integrating evidence-based and value-based global medicine, and developing a welfarist approach to the practice of global psychiatry. Ethical issues addressed include those raised by developments in neurogenetics, cosmetic psychopharmacology and deep brain stimulation. Perspectives drawing on global mental health and neuroethics are used to explore a number of different clinical disorders and developmental stages, ranging from childhood through to old age. Synthesizes existing work at the intersection of global mental health and neuroethics Presents the work of leading practitioners of global mental health and neuroethics who address clinical issues Looks at clinical decision-making in settings with non-Western values and customs Covers patient empowerment, human rights, cognitive enhancement, and more.

The focus of debates about conversational AIs (CAIs) has largely been on social and ethical concerns that arise when we speak to machines. What is gained and what is lost when we replace our human interlocutors—including our human therapists— with AIs? Here, we focus instead on a distinct and growing phenomenon: letting machines speak for us. What is at stake when we replace our own efforts at interpersonal engagement with CAIs? The purpose of these technologies is, in part, to remove effort. But effort also has enormous value, and in some cases even intrinsic value. This is true in many realms, but especially in interpersonal relationships. To make an effort for someone, irrespective of what that effort amounts to, often conveys value and meaning in itself. We elaborate on the meaning, worth and significance that may be lost when we relinquish effort in our interpersonal engagements, and also on the opportunities for self-understanding and growth that we may forsake.