Preventive medicine
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Preventive medicine · Mar 1998
ReviewMaternal depression effects on infants and early interventions.
Our recent research suggests that: (1) maternal depression negatively affects infants as early as the neonatal period, implicating prenatal effects of maternal depression; (2) as early as birth the infants show a profile of "dysregulation" in their behavior, physiology, and biochemistry which probably derives from prenatal exposure to a biochemical imbalance in their mothers; (3) these effects are compounded by the disorganizing influence of the mother's interaction behavior; (4) depressed mothers have two predominant interaction styles, withdrawn or intrusive, which seem to have differential, negative effects on their infants related to inadequate stimulation and arousal modulation; (5) nondepressed caregivers such as fathers may buffer these effects because they provide more optimal stimulation and arousal modulation; and (6) interventions that are mood altering for the mothers (e.g., music and massage therapy) and arousal reducing for the infants (e.g., the same therapies) make the mothers and infants more responsive to interaction coaching and improve their interactions.
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A well-designed, adequately funded clinical trial based on sound science and conducted by experienced investigators and staff can falter if participating trial clinics are not managed well. Ten commandments for successful trial clinic management address key organizational and operational issues. Commandment I: Thou shalt know and follow thy rules. ⋯ Commandment X: Thou shalt know and accept thy limitations. This report puts these commandments into context by providing concrete examples in the clinical trial setting. These commandments could serve as guidelines to the spectrum of personnel involved in the operations of a trial clinic, namely, principal investigators and co-investigators, trial coordinators, data managers, technicians, administrators, and support staff.
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A useful way to summarize the placebo-nocebo theme is to consider the tension and interaction between conviction and responsibility. With the conviction of the mainstream biomedical paradigm prevalent today, it would be tempting to say to Dr. Engel's patient: "That question is nonsense. ⋯ Engel was both true to his convictions and responsible for providing the highest standard of care by understanding the patient's convictions and needs for comfort. The biopsychosocial concept provides a blueprint to bring the old-fashioned medical art of "humanness" to modern scientific care. Identifying the interactions of the problem, the person, and the totality of resources permits a focus on therapeutic strategies to promote placebo effects and prevent the consequences of nocebo.
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Preventive medicine · Sep 1997
ReviewThe nocebo phenomenon: concept, evidence, and implications for public health.
The nocebo hypothesis proposes that expectations of sickness and the affective states associated with such expectations cause sickness in the expectant. The nocebo phenomenon is a little-recognized facet of culture that may be responsible for a substantial variety of pathology throughout the world. However, the extent of the phenomenon is not yet known, and evidence is piecemeal and ambiguous. This paper reviews the concept of nocebo and its association with the placebo phenomenon, gives examples of evidence for the nocebo phenomenon, and suggests public health implications.