Do mindfulness-based programmes improve the cognitive skills, behaviour and mental health of children and adolescents? An updated meta-analysis of randomised controlled trials

QUESTION

Mindfulness-based programmes (MBPs) are an increasingly popular approach to improving mental health in young people. Our previous meta-analysis suggested that MBPs show promising effectiveness, but highlighted a lack of high-quality, adequately powered randomised controlled trials (RCTs). This updated meta-analysis assesses the-state-of the-art of MBPs for young people in light of new studies. It explores MBP's effectiveness in active vs passive controls; selective versus universal interventions; and studies that included follow-up.

STUDY SELECTION AND ANALYSIS

We searched for published and unpublished RCTs of MBPs with young people (<19 years) in PubMed Central, PsycINFO, Web of Science, EMBASE, ICTRP, ClinicalTrials.gov, EThOS, EBSCO and Google Scholar. Random-effects meta-analyses were conducted, and standardised mean differences (Cohen's d) were calculated.

FINDINGS

Sixty-six RCTs, involving 20 138 participants (9552 receiving an MBP and 10 586 controls), were identified. Compared with passive controls, MBPs were effective in improving anxiety/stress, attention, executive functioning, and negative and social behaviour (d from 0.12 to 0.35). Compared against active controls, MBPs were more effective in reducing anxiety/stress and improving mindfulness (d=0.11 and 0.24, respectively). In studies with a follow-up, there were no significant positive effects of MBPs. No consistent pattern favoured MBPs as a universal versus selective intervention.

CONCLUSIONS

The enthusiasm for MBPs in youth has arguably run ahead of the evidence. While MBPs show promising results for some outcomes, in general, the evidence is of low quality and inconclusive. We discuss a conceptual model and the theory-driven innovation required to realise the potential of MBPs in supporting youth mental health.

Effectiveness of universal school-based mindfulness training compared with normal school provision on teacher mental health and school climate: results of the MYRIAD cluster randomised controlled trial

BACKGROUND

Education is broader than academic teaching. It includes teaching students social-emotional skills both directly and indirectly through a positive school climate.

OBJECTIVE

To evaluate if a universal school-based mindfulness training (SBMT) enhances teacher mental health and school climate.

METHODS

The My Resilience in Adolescence parallel group, cluster randomised controlled trial (registration: ISRCTN86619085; funding: Wellcome Trust (WT104908/Z/14/Z, WT107496/Z/15/Z)) recruited 85 schools (679 teachers) delivering social and emotional teaching across the UK. Schools (clusters) were randomised 1:1 to either continue this provision (teaching as usual (TAU)) or include universal SBMT. Data on teacher mental health and school climate were collected at prerandomisation, postpersonal mindfulness and SBMT teacher training, after delivering SBMT to students, and at 1-year follow-up.

FINDING

Schools were recruited in academic years 2016/2017 and 2017/2018. Primary analysis (SBMT: 43 schools/362 teachers; TAU: 41 schools/310 teachers) showed that after delivering SBMT to students, SBMT versus TAU enhanced teachers' mental health (burnout) and school climate. Adjusted standardised mean differences (SBMT minus TAU) were: exhaustion (-0.22; 95% CI -0.38 to -0.05); personal accomplishment (-0.21; -0.41, -0.02); school leadership (0.24; 0.04, 0.44); and respectful climate (0.26; 0.06, 0.47). Effects on burnout were not significant at 1-year follow-up. Effects on school climate were maintained only for respectful climate. No SBMT-related serious adverse events were reported.

CONCLUSIONS

SBMT supports short-term changes in teacher burnout and school climate. Further work is required to explore how best to sustain improvements.

CLINICAL IMPLICATIONS

SBMT has limited effects on teachers' mental and school climate. Innovative approaches to support and preserve teachers' mental health and school climate are needed.

The impact of mindfulness training in early adolescence on affective executive control, and on later mental health during the COVID-19 pandemic: a randomised controlled trial

BACKGROUND

Previous research suggests that mindfulness training (MT) appears effective at improving mental health in young people. MT is proposed to work through improving executive control in affectively laden contexts. However, it is unclear whether MT improves such control in young people. MT appears to mitigate mental health difficulties during periods of stress, but any mitigating effects against COVID-related difficulties remain unexamined.

OBJECTIVE

To evaluate whether MT (intervention) versus psychoeducation (Psy-Ed; control), implemented in after-school classes: (1) Improves affective executive control; and/or (2) Mitigates negative mental health impacts from the COVID-19 pandemic.

METHODS

A parallel randomised controlled trial (RCT) was conducted (Registration: https://osf.io/d6y9q/; Funding: Wellcome (WT104908/Z/14/Z, WT107496/Z/15/Z)). 460 students aged 11-16 years were recruited and randomised 1:1 to either MT (N=235) or Psy-Ed (N=225) and assessed preintervention and postintervention on experimental tasks and self-report inventories of affective executive control. The RCT was then extended to evaluate protective functions of MT on mental health assessed after the first UK COVID-19 lockdown.

FINDINGS

Results provided no evidence that the version of MT used here improved affective executive control after training or mitigated negative consequences on mental health of the COVID-19 pandemic relative to Psy-Ed. No adverse events were reported.

CONCLUSIONS

There is no evidence that MT improves affective control or downstream mental health of young people during stressful periods.

CLINICAL IMPLICATIONS

We need to identify interventions that can enhance affective control and thereby young people's mental health.

Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial

BACKGROUND

Systematic reviews suggest school-based mindfulness training (SBMT) shows promise in promoting student mental health.

OBJECTIVE

The My Resilience in Adolescence (MYRIAD) Trial evaluated the effectiveness and cost-effectiveness of SBMT compared with teaching-as-usual (TAU).

METHODS

MYRIAD was a parallel group, cluster-randomised controlled trial. Eighty-five eligible schools consented and were randomised 1:1 to TAU (43 schools, 4232 students) or SBMT (42 schools, 4144 students), stratified by school size, quality, type, deprivation and region. Schools and students (mean (SD); age range=12.2 (0.6); 11-14 years) were broadly UK population-representative. Forty-three schools (n=3678 pupils; 86.9%) delivering SBMT, and 41 schools (n=3572; 86.2%) delivering TAU, provided primary end-point data. SBMT comprised 10 lessons of psychoeducation and mindfulness practices. TAU comprised standard social-emotional teaching. Participant-level risk for depression, social-emotional-behavioural functioning and well-being at 1 year follow-up were the co-primary outcomes. Secondary and economic outcomes were included.

FINDINGS

Analysis of 84 schools (n=8376 participants) found no evidence that SBMT was superior to TAU at 1 year. Standardised mean differences (intervention minus control) were: 0.005 (95% CI -0.05 to 0.06) for risk for depression; 0.02 (-0.02 to 0.07) for social-emotional-behavioural functioning; and 0.02 (-0.03 to 0.07) for well-being. SBMT had a high probability of cost-effectiveness (83%) at a willingness-to-pay threshold of £20 000 per quality-adjusted life year. No intervention-related adverse events were observed.

CONCLUSIONS

Findings do not support the superiority of SBMT over TAU in promoting mental health in adolescence.

CLINICAL IMPLICATIONS

There is need to ask what works, for whom and how, as well as considering key contextual and implementation factors.

TRIAL REGISTRATION

Current controlled trials ISRCTN86619085. This research was funded by the Wellcome Trust (WT104908/Z/14/Z and WT107496/Z/15/Z).

Protocol for a randomised controlled trial investigating an intervention to boost decentering in response to distressing mental experiences during adolescence: the decentering in adolescence study (DECADES)

INTRODUCTION

Decentering describes the ability to voluntarily adopt an objective self-perspective from which to notice internal, typically distressing, stressors (eg, difficult thoughts, memories and feelings). The reinforcement of this skill may be an active ingredient through which different psychological interventions accrue reductions in anxiety and/or depression. However, it is unclear if decentering can be selectively trained at a young age and if this might reduce psychological distress. The aim of the current trial is to address this research gap.

METHODS AND ANALYSIS

Adolescents, recruited from schools in the UK and Ireland (n=57 per group, age range=16-19 years), will be randomised to complete 5 weeks of decentering training, or an active control group that will take part in a combination of light physical exercise and cognitive training. The coprimary training outcomes include a self-reported decentering inventory (ie, the Experiences Questionnaire) and the momentary use of decentering in response to psychological stressors, using experience sampling. The secondary mental health outcomes will include self-reported inventories of depression and anxiety symptoms, as well as psychological well-being. Initial statistical analysis will use between-group analysis of covariance to estimate the effect of training condition on self-rated inventories, adjusted for baseline scores. Additionally, experience sampling data will be examined using hierarchical linear models.

ETHICS AND DISSEMINATION

This study was approved by the Cambridge Psychology Research Ethics Committee, University of Cambridge (PRE.2019.109). Findings will be disseminated through typical academic routes including poster/paper presentations at (inter)national conferences, academic institutes and through publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ISRCTN14329613.

The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds

BACKGROUND

The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6-year-old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD-YC), including the adult-led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive-focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD-YC.

METHOD

Study 1 (N = 105) assessed ASD and PTSD-YC diagnosis in 3- to 8-year-old children within one month and at around three months following attendance at an emergency room. Study 2 (N = 37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early-phase trial comparing CBT-3M, a cognitive-focused intervention, to treatment-as-usual (TAU) delivered within the UK NHS to 3- to 8-year-olds diagnosed with PTSD-YC.

RESULTS

In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD-YC (minus the duration requirement) was 8.6% in the first month post-trauma and 10.1% at 3 months. Length of hospital stay, but no other demographic or trauma-related characteristics, predicted development of later PTSD-YC. Early (within one month) diagnosis of acute PTSD-YC had a positive predictive value of 50% for later PTSD-YC. In Study 2, most children lost their PTSD-YC diagnosis following completion of CBT-3M (84.6%) relative to TAU (6.7%) and CBT-3M was acceptable to recipient families. Effect sizes were also in favor of CBT-3M for secondary outcome measures.

CONCLUSIONS

The ASD diagnosis is not fit for purpose in this age-group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive-focused treatment for PTSD, and a larger trial of CBT-3M is now warranted.

Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report

Decentering is a ubiquitous therapeutic concept featuring in multiple schools of psychological intervention and science. It describes an ability to notice to day-to-day psychological stressors (negative thoughts, feelings, and memories) from an objective self-perspective and without perseverating on the themes they represent. Thus, decentering dampens the impact and distress associated with psychological stressors that can otherwise increase mental ill health in vulnerable individuals. Importantly, the strengthening of decentering-related abilities has been flagged as a core component of psychological interventions that treat and prevent anxiety and depression. We provide an in-depth review evidence of the salutary effects of decentering with a special focus on youth mental health. This is because adolescence is a critical window for the development of psychopathology but is often under-represented in this research line. A narrative synthesis is presented that integrates and summarizes findings on a range of decentering-related abilities. Section 1 reviews extant conceptualizations of decentering and data-driven approaches to characterize its characteristic. A novel definition is then offered to guide future empirical research. Section 2 overviews laboratory-based research into the development of decentering as well as its relationship with anxiety and depression. Section 3 examines the role decentering-related skills play in psychological interventions for anxiety and depression. Critically, we review evidence that treatment-related increases in decentering predict latter reductions in anxiety and depression severity. Each section highlights important areas for future research. The report concludes by addressing the vital questions of whether, how, why and when decentering alleviates youth anxiety and depression.

The effect of axial and abaxial release on meniscal displacement in the dog

The meniscal release (MR) is used to minimize meniscal pathology after Tibial Plateau Leveling Osteotomy (TPLO) surgery. The purposes of this study were: i) to describe meniscal orientation in a unaltered cadaveric canine stifle, a cruciate deficient stifle, TPLO repaired stifle with and without the MR using magnetic resonance imaging; ii) to determine if the abaxial release is equivalent to the axial release in its ability to affect caudal pole displacement in a TPLO repaired stifle and iii) to evaluate with MRI the effect of MR on the femorotibial articular cartilage contact area in a TPLO repaired stifle. Briefly, cadaver limbs were placed into a jig designed to mimic a weight-bearing stance at 140° and 90° at the stifle. The limbs were sequentially evaluated from the unaltered state; after cranial cruciate ligament transection; after TPLO stabilization; and finally after a meniscal release. No significant difference was found between the intrameniscal area (IMA) of the abaxial and axial meniscal releases although there was an increase in the IMA after the meniscal release compared to the IMA in the normal, cranial cruciate ligament deficient stifle, and TPLO stabilized stifle. In the abaxial release, a meniscal remnant remained in situ and provided a space effect between the femur and the tibial plateau. This is in contrast to the axial meniscal release, where the entire caudal pole of the medial meniscus relocated caudolaterally and consequently permitted more direct femorotibial contact. Overall, however, there was evidence of caudal pole compression of the medial meniscus throughout the MRI series which was ameliorated by either of the MR procedures.

The effect of leg length discrepancy on pelvis and spine kinematics during gait

There are assumptions that leg length discrepancy (LLD) may cause low back pain by creating pelvis obliquity and lumbar scoliosis. Although individuals with LLD develop compensatory movements in the lower limbs and pelvis during walking, few investigations have attempted to identify kinematic variables of the upper body. This study aims to gain an understanding of how simulated LLD influences three-dimensional motion of the pelvis and spine. Seven male participants were required to walk barefoot at a preferred speed. Three LLD conditions (1, 2, and 3cm) were simulated using modified pieces of high density EVA attached to the right foot. An optoelectronic motion analysis system was used to record kinematic data of the pelvis and spine (lumbar, lower and upper thoracic segments) for each condition. Differences in range of motion and patterns of movement for the pelvis and lumbar spine were minimal between barefoot and LLD conditions. These observations could be attributed to various kinematic compensatory strategies within the lower limbs which require further in-depth investigation.

The effect of axial and abaxial release on meniscal displacement in the dog

The meniscal release (MR) is used to minimize meniscal pathology after Tibial Plateau Leveling Osteotomy (TPLO) surgery. The purposes of this study were: (i) to describe meniscal orientation in a unaltered cadaveric canine stifle, a cruciate deficient stifle, TPLO repaired stifle with and without the MR using magnetic resonance imaging; (ii) to determine if the abaxial release is equivalent to the axial release in its ability to affect caudal pole displacement in a TPLO repaired stifle and (iii) to evaluate with MRI the effect of MR on the femorotibiol articular cartilage contact area in a TPLO repaired stifle. Briefly, cadaver limbs were placed into a jig designed to mimic a weight-bearing stance at 140 degrees and 90 degrees at the stifle. The limbs were sequentially evaluated from the unaltered state; after cranial cruciate ligament transection; after TPLO stabilization; and finally after a meniscal release. No significant difference was found between the intrameniscal area (IMA) of the abaxial and axial meniscal releases although there was an increase in the IMA after the meniscal release compared to the IMA in the normal, cranial cruciate ligament deficient stifle, and TPLO stabilized stifle. In the abaxial release, a meniscal remnant remained in situ and provided a space effect between the femur and the tibial plateau. This is in contrast to the axial meniscal release, where the entire caudal pole of the medial meniscus relocated caudolaterally and consequently permitted more direct femorotibial contact. Overall, however, there was evidence of caudal pole compression of the medial meniscus throughout the MRI series which was ameliorated by either of the MR procedures.

The influence of four wound dressings on the kinetics of human walking

OBJECTIVES

This in vivo study (the second phase of a research project first described in the February issue of Journal of Wound Care) reports on the influence of various wound dressings on the dynamics of human walking. Allevyn (Smith and Nephew), Biatain (Coloplast), Lyofoam (Seton Scholl) and Tielle (Johnson and Johnson) were used in this study. The investigation aimed to assess the ground reaction forces in the foot while the dressings were applied to the plantar surface of the foot.

METHOD

A strain gauge force plate system was used. Six subjects with 'normal' gait patterns and no foot pathology were recruited into the study. Eight trials were recorded for each subject. The peak push-off force, in the vertical component of the ground reaction force, and the maximum braking and propulsive forces in the medial-lateral component of the ground reaction force were estimated and reported.

RESULTS

Among the various dressings tested, Allevyn performed closest to barefoot in the peak push-off force and demonstrated an increased braking force at the deceleration point in the gait cycle.

CONCLUSION

These findings may have implications for clinicians selecting wound dressings for the treatment of certain foot ulcerations. However, further clinical research is warranted in this area.

Improving the oral hygiene of institutionalized mentally retarded clients

PURPOSE

The quality of oral health care of persons with mental retardation has been reported in the literature to be less than that of their normal peers. The purpose of this study, set in a Midwest institution for persons with developmental retardation, was to determine if a change in policy followed by staff training and monitored by an interested third party would improve the oral hygiene of clients living on wards.

METHODS

Methods used to train staff in proper toothbrushing were developed. Three living units were randomly selected for study: control, training plus accountability (experimental group I), and training without accountability (experimental group II). The direct care staff of both experimental groups were trained in proper toothbrushing techniques. Staff of the control group received no training. A dental hygienist visited the living unit periodically to evaluate and provide feedback on the plaque index scores taken by the caregivers in both experimental groups.

RESULTS

The plaque indexes of group I showed significant improvement over the control group and group II.

CONCLUSION

The results of this pilot study support the other findings of higher plaque indexes for residents with mental retardation and that modifying toothbrushing policies and staff training are not as critical to the improvement of the clients' oral hygiene as is the presence of an involved, interested third party.

The use of distraction osteogenesis to induce new suprabony periodontal attachment in the beagle dog

Using a technique called distraction osteogenesis (DO), orthopedic surgeons are capable of reconstructing 4 to 5 cm of bone and soft tissue without bone grafts or pedicle flap procedures. DO has been used recently to generate maxillofacial bone as an alternative to maxillary and mandibular osteotomies. Using DO methodology, this study attempted to regenerate supraalveolar buccal periodontium on the mandibular second, third, and fourth premolars of beagle dogs. A small but statistically significantly greater amount of new cementum was generated in experimental teeth, with no difference found between experimental and control groups with respect to regenerating alveolar bone. Further studies using modifications of this technique are warranted to explore the potential of DO as an alternative to conventional regenerative approaches.

Feeling "holier than thou": are self-serving assessments produced by errors in self- or social prediction?

People typically believe they are more likely to engage in selfless, kind, and generous behaviors than their peers, a result that is both logically and statistically suspect. However, this oft-documented tendency presents an important ambiguity. Do people feel "holier than thou" because they harbor overly cynical views of their peers (but accurate impressions of themselves) or overly charitable views of themselves (and accurate impressions of their peers)? Four studies suggested it was the latter. Participants consistently overestimated the likelihood that they would act in generous or selfless ways, whereas their predictions of others were considerably more accurate. Two final studies suggest this divergence in accuracy arises, in part, because people are unwilling to consult population base rates when predicting their own behavior but use this diagnostic information more readily when predicting others'.

Egocentric empathy gaps between owners and buyers: misperceptions of the endowment effect

In 5 studies, the authors examined people's perceptions of the endowment effect, or the tendency to value an object more once one owns it. In the 1st 2 studies, the authors documented egocentric empathy gaps between owners and buyers regarding the endowment effect: Both owners and buyers overestimated the similarity between their own valuation of a commodity and the valuation of people in the other role. The next 2 studies showed that these empathy gaps may lead to reduced earnings in a market setting. The final study showed that egocentric empathy gaps stem partly from people's misprediction of what their own valuation would be if they were in the other role.

Egocentric empathy gaps between owners and buyers: misperceptions of the endowment effect

In 5 studies, the authors examined people's perceptions of the endowment effect, or the tendency to value an object more once one owns it. In the 1st 2 studies, the authors documented egocentric empathy gaps between owners and buyers regarding the endowment effect: Both owners and buyers overestimated the similarity between their own valuation of a commodity and the valuation of people in the other role. The next 2 studies showed that these empathy gaps may lead to reduced earnings in a market setting. The final study showed that egocentric empathy gaps stem partly from people's misprediction of what their own valuation would be if they were in the other role.

Unskilled and unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments

People tend to hold overly favorable views of their abilities in many social and intellectual domains. The authors suggest that this overestimation occurs, in part, because people who are unskilled in these domains suffer a dual burden: Not only do these people reach erroneous conclusions and make unfortunate choices, but their incompetence robs them of the metacognitive ability to realize it. Across 4 studies, the authors found that participants scoring in the bottom quartile on tests of humor, grammar, and logic grossly overestimated their test performance and ability. Although their test scores put them in the 12th percentile, they estimated themselves to be in the 62nd. Several analyses linked this miscalibration to deficits in metacognitive skill, or the capacity to distinguish accuracy from error. Paradoxically, improving the skills of participants, and thus increasing their metacognitive competence, helped them recognize the limitations of their abilities.

Unskilled and unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments

People tend to hold overly favorable views of their abilities in many social and intellectual domains. The authors suggest that this overestimation occurs, in part, because people who are unskilled in these domains suffer a dual burden: Not only do these people reach erroneous conclusions and make unfortunate choices, but their incompetence robs them of the metacognitive ability to realize it. Across 4 studies, the authors found that participants scoring in the bottom quartile on tests of humor, grammar, and logic grossly overestimated their test performance and ability. Although their test scores put them in the 12th percentile, they estimated themselves to be in the 62nd. Several analyses linked this miscalibration to deficits in metacognitive skill, or the capacity to distinguish accuracy from error. Paradoxically, improving the skills of participants, and thus increasing their metacognitive competence, helped them recognize the limitations of their abilities.

Information source preferences for selecting dental services among elderly consumers

This manuscript presents the results of a primary research study conducted among the elderly to determine the sources of information they prefer for the selection of dental services. The results of the study are presented in terms of source preferences by dental need (generalist or specialist), source preferences by gender (male or female), source preferences by level of education (low or high), and source preferences by income level (low or high). Conclusions are drawn from the results of the research, and suggestions are made regarding the use of information source preferences for the marketing of dental services to the elderly.

Gingival fluid IL-1beta in postmenopausal females on supportive periodontal therapy. A longitudinal 2-year study

Posterior interproximal alveolar bone in 59 women, within 5 years after menopause, was assessed at baseline and after 2 years of supportive periodontal therapy (history of moderate/advanced periodontitis) using digitized image analysis. Baseline lumbar spine bone mineral density, smoking status, and yearly serum estradiol (E2) levels also were obtained to group subjects. An additional 16 non-periodontitis postmenopausal women were followed 2 years for clinical and estrogen status. 2-min GCF IL-1beta levels averaged from 2 baseline periodontal pockets (in periodontitis subjects) and 2 non-periodontitis sites (in non-periodontitis and periodontitis subjects) were determined with an enzyme immunoassay. A progressive and stable site were also monitored every 6 months for GCF IL-1beta in 15 patients. Results after 2 years indicated that 17 subjects had no posterior interproximal sites losing > or =0.4 mm of alveolar crest bone height, while 13 subjects had > or =3 such sites. Using analysis of variance, none of the above clinical groupings resulted in a significant difference in mean baseline or longitudinal GCF IL-1beta levels. However, when subjects who lost alveolar crest bone height were considered, E2-sufficient subjects had significantly depressed baseline GCF IL-1beta (in past-periodontitis sites) compared to E2-deficient patients (9.1+/-2.1 versus 31.7+/-10.2 pg/2-min sample, p<0.05), suggesting E2 influences gingival IL-1beta production in progressive periodontitis patients.

Prevalence of temporomandibular disorders (TMD) in children based on physical signs

Temporomandibular disorders (TMD) are related to the function and integrity of the masticatory system with restricted jaw movement and/or joint clicking or crepitus, for example, dominating the clinical signs of these disorders. The prevalence of TMD signs was examined in non-patient children ages six to twelve (1994 n = 185, 1995 n = 237) by four examiners using standardized techniques. Of significance was the finding that 7.3 percent of the 1994 children had audible joint sounds, while the 1995 examination reported 3 percent. Statistically significant relationships (p < 0.05) between the ages of the subjects and measurements of overbite (p < 0.0001), overjet (p < 0.01), and clicking (p < 0.005) were calculated from the 1994 data, while significant correlations for overbite (p < 0.001) and overjet (p < 0.01), but not clicking were found in the 1995 examination. One study of four- to six-year-old nonpatients reported a higher occurrence of joint sounds (48 percent). This disparity indicates a possible need for standardization of examination techniques specifically targeting joint sounds and their role in TM disorders.

Analysis of prognostic indicators for dogs with pericardial effusion: 46 cases (1985-1996)

OBJECTIVE

To determine factors associated with disease-free interval and survival time for dogs with pericardial effusion.

DESIGN

Retrospective study.

ANIMALS

46 dogs.

PROCEDURE

Signalment, history, results of physical examination, electrocardiography, echocardiography, and thoracic radiography; disease-free interval; and survival time were obtained from medical records or telephone conversations with owners and referring veterinarians.

RESULTS

Dogs that had ascites at the time of the initial physical examination were significantly less likely, and dogs that had evidence of pulmonary metastases on thoracic radiographs or that had echocardiographic evidence of a right atrial mass were significantly more likely, to have died of pericardial effusion or the underlying cause of effusion than were dogs that did not. Median survival time was 15.3 months for dogs with idiopathic pericardial effusion, 16 days for dogs with hemangiosarcoma, and 13.6 months for dogs with mesothelioma. Dogs that had a nonspecific extracardiac mass and underwent pericardiectomy were significantly less likely to have had recurrence of signs than were dogs that did not. However, dogs with mesothelioma or hemangiosarcoma that underwent pericardiectomy did not have a significantly different risk of recurrence of signs or survival time, compared with dogs that did not.

CLINICAL IMPLICATIONS

Results suggest that pericardiectomy will not affect risk of recurrence or survival time in dogs with pericardial effusion secondary to hemangiosarcoma or mesothelioma. However, pericardiectomy is still needed to differentiate dogs with neoplastic pericardial effusion from dogs with idiopathic pericardial effusion.

Turning up the contrast: self-enhancement motives prompt egocentric contrast effects in social judgments

Contrast effects occur when people judge the behavior and attitudes of others relative to their own. We tested a motivational account suggesting that these effects arise because people tailor their judgments of others to affirm their own self-worth. Consistent with that interpretation, participants displayed more egocentric contrast in their judgments of another person's intelligence (i.e., their evaluation of his score on the Scholastic Aptitude Test was more negatively related to their own score) after their self-esteem was threatened than after it was bolstered (Studies 1 and 2). High-self-esteem individuals displayed more judgmental contrast overall than did their low-esteem counterparts (Study 2). Strongly pro-choice participants whose esteem was threatened also displayed more contrast in their judgments of another person's attitude on abortion, relative to esteem-bolstered participants (Study 3). Discussion centers on the implications of these findings for theory on social comparison, self-affirmation, and social judgment.

Stereotypes and tacit inference

To judge another person's behavior, one often has to come to an understanding of what that behavior was in its detail. Five studies demonstrated that stereotypes influence the tacit inferences people make about the unspecified details and ambiguities of social behavior (e.g., what the behavior specifically was, what stimulus the individual reacted to, what caused the individual to act) and that these inferences occur when people encode the relevant information. One study found that participants who scored low on a measure of modern sexism were just as likely to make tacit inferences based on gender stereotypes as were those who scored high. Discussion centers on the implications of these findings for identification processes in social judgment, as well as whether stereotypes influence tacit inferences at an implicit level.

Stereotypes and tacit inference

To judge another person's behavior, one often has to come to an understanding of what that behavior was in its detail. Five studies demonstrated that stereotypes influence the tacit inferences people make about the unspecified details and ambiguities of social behavior (e.g., what the behavior specifically was, what stimulus the individual reacted to, what caused the individual to act) and that these inferences occur when people encode the relevant information. One study found that participants who scored low on a measure of modern sexism were just as likely to make tacit inferences based on gender stereotypes as were those who scored high. Discussion centers on the implications of these findings for identification processes in social judgment, as well as whether stereotypes influence tacit inferences at an implicit level.

Construal processes and trait ambiguity: implications for self-peer agreement in personality judgment

The relationship between trait ambiguity and self-peer agreement in personality judgment was examined. In Study 1, self-peer agreement was lower on ambiguous traits (those with many behavioral referents) than on unambiguous ones (those with few behavioral referents). This finding was partially moderated by the level of friendship between peers. These results suggest that people disagree in their judgments because they use idiosyncratic trait definitions when making judgments on ambiguous traits. Study 2 tested this explanation by exploring self-peer agreement when participant pairs were forced to use the same trait definition versus different ones when judging themselves and each other. Forcing participants to use the same trait definition increased the degree to which their judgments covaried with one another. Discussion centers on the cognitive and motivational forces that can influence the degree to which personality judgments differ.

Idiosyncratic trait definitions: implications for self-description and social judgment

Descriptions of self (e.g., "I am dominant") may reflect not only a person's behavioral tendencies but also idiosyncratic definitions of the social concepts and categories being considered. Five studies revealed that participants who differed in their self-ratings along trait dimensions also tended to associate different behaviors and performances with those traits. For example, participants who described themselves as dominant tended to emphasize desirable over undesirable behaviors and characteristics in their definitions of the trait, whereas self-described nondominants highlighted the opposite. Participants' self-ratings on dominance were also influenced by making positive or negative examples of dominant behavior salient to them. Moreover, when participants were induced to shift self-descriptions in self-serving ways, they tended to do so by revising their prototype of the trait in question. Discussion centers on the implications of these findings for the prediction of behavior and the interpretation of some social science results.

Idiosyncratic trait definitions: implications for self-description and social judgment

Descriptions of self (e.g., "I am dominant") may reflect not only a person's behavioral tendencies but also idiosyncratic definitions of the social concepts and categories being considered. Five studies revealed that participants who differed in their self-ratings along trait dimensions also tended to associate different behaviors and performances with those traits. For example, participants who described themselves as dominant tended to emphasize desirable over undesirable behaviors and characteristics in their definitions of the trait, whereas self-described nondominants highlighted the opposite. Participants' self-ratings on dominance were also influenced by making positive or negative examples of dominant behavior salient to them. Moreover, when participants were induced to shift self-descriptions in self-serving ways, they tended to do so by revising their prototype of the trait in question. Discussion centers on the implications of these findings for the prediction of behavior and the interpretation of some social science results.

Self-serving prototypes of social categories

Why and when do people disagree on their conceptions or prototypes of social categories? In 6 studies, it was revealed that such differences tend to be self-serving. Ss tended to endorse self-descriptive attributes as central to their prototypes of desirable social concepts and emphasize features that were not self-descriptive in their conceptions of undesirable categories. Such disagreements were constrained to attributes potentially central to the domain in question and did not occur for clearly peripheral features. Self-serving differences in prototype structure were exhibited in social information processing tasks and led to disagreements in judgments of others. Potential mechanisms underlying the development of these egocentric cognitive structures and their implications for self-serving judgments of ability are discussed.

Depression, realism, and the overconfidence effect: are the sadder wiser when predicting future actions and events?

Do depressed individuals make more realistic judgments than their nondepressed peers in real world settings? Depressed and nondepressed Ss in 2 studies were asked to make predictions about future actions and outcomes that might occur in their personal academic and social worlds. Both groups of Ss displayed overconfidence, that is, they overestimated the likelihood that their predictions would prove to be accurate. Of key importance, depressed Ss were less accurate in their predictions, and thus more overconfident, than their nondepressed counterparts. These differences arose because depressed Ss (a) were more likely to predict the occurrence of low base-rate events and (b) were less likely to be correct when they made optimistic predictions (i.e., stated that positive events would occur or that aversive outcomes would not). Discussion focuses on implications of these findings for the depressive realism hypothesis.

Nebraska dental professional's procedures and opinions related to infectious diseases

Based on the findings of this study, the following specific strategic recommendations are offered: 1. Offer continuing education courses throughout the state at reasonable fees. The courses should emphasize recognition of AIDS related lesions and infectious diseases, aseptic techniques/infectious disease control, AIDS, Hepatitis B, and infections/antibiotics. In addition, continuing education courses in the area of medical history taking methods should be offered to teach methods of inquiring about sexual and drug-use histories. 2. Establish a state resource center for information regarding infectious diseases. This could, perhaps, be a cooperative venture with the Department of Health, the Nebraska Dental Association, and the College of Dentistry. There is a need to gather, interpret and disseminate periodic updates on infectious disease research. This venture should also focus on developing literature for practitioners with consistent information about infection control regulations and guidelines. 3. Either through continuing education courses or through the information resource center, provide instruction on realistic assessment of the risk of infectious disease transmission in dentistry. 4. Develop a public relations campaign to educate the public about infection control policies in dentistry, what is being done to protect the public. 5. A research effort should be undertaken to determine the discrepancy between self-reported infection control practices and observed infection control practices. This could be accomplished through patient and dentist surveys, interviews, and/or observations. 6. Establish a confidential HIV blood screening program for health care providers.

Self-serving prototypes of social categories

Why and when do people disagree on their conceptions or prototypes of social categories? In 6 studies, it was revealed that such differences tend to be self-serving. Ss tended to endorse self-descriptive attributes as central to their prototypes of desirable social concepts and emphasize features that were not self-descriptive in their conceptions of undesirable categories. Such disagreements were constrained to attributes potentially central to the domain in question and did not occur for clearly peripheral features. Self-serving differences in prototype structure were exhibited in social information processing tasks and led to disagreements in judgments of others. Potential mechanisms underlying the development of these egocentric cognitive structures and their implications for self-serving judgments of ability are discussed.

Depression, realism, and the overconfidence effect: Are the sadder wiser when predicting future actions and events?

Do depressed individuals make more realistic judgments than their nondepressed peers in real world settings? Depressed and nondepressed Ss in 2 studies were asked to make predictions about future actions and outcomes that might occur in their personal academic and social worlds. Both groups of Ss displayed overconfidence, that is, they overestimated the likelihood that their predictions would prove to be accurate. Of key importance, depressed Ss were less accurate in their predictions, and thus more overconfident, than their nondepressed counterparts. These differences arose because depressed Ss (a) were more likely to predict the occurrence of low base-rate events and (b) were less likely to be correct when they made optimistic predictions (i.e., stated that positive events would occur or that aversive outcomes would not). Discussion focuses on implications of these findings for the depressive realism hypothesis.

The overconfidence effect in social prediction

In five studies with overlapping designs and intents, subjects predicted a specific peer's responses to a variety of stimulus situations, each of which offered a pair of mutually exclusive and exhaustive response alternatives. Each prediction was accompanied by a subjective probability estimate reflecting the subjects' confidence in its accuracy--a measure validated in Study 5 by having subjects choose whether to "gamble" on the accuracy of their prediction or on the outcome of a simple aleatory event. Our primary finding was that in social prediction, as in other judgmental domains, subjects consistently proved to be highly overconfident. That is, regardless of the type of prediction item (e.g., responses to hypothetical dilemmas, responses to contrived laboratory situations, or self-reports of everyday behaviors) and regardless of the type of information available about the person whose responses they were predicting (e.g., predictions about roommates or predictions based on prior interviews), the levels of accuracy subjects achieved fell considerably below the levels required to justify their confidence levels. Further analysis revealed two specific sources of overconfidence. First, subjects generally were overconfident to the extent they were highly confident. Second, subjects were most likely to be overconfident when they knowingly or unknowingly made predictions that ran counter to the relevant response base rates and, as a consequence, achieved low accuracy rates that their confidence estimates failed to anticipate. Theoretical and normative implications are discussed and proposals for subsequent research offered.

The overconfidence effect in social prediction

In five studies with overlapping designs and intents, subjects predicted a specific peer's responses to a variety of stimulus situations, each of which offered a pair of mutually exclusive and exhaustive response alternatives. Each prediction was accompanied by a subjective probability estimate reflecting the subjects' confidence in its accuracy--a measure validated in Study 5 by having subjects choose whether to "gamble" on the accuracy of their prediction or on the outcome of a simple aleatory event. Our primary finding was that in social prediction, as in other judgmental domains, subjects consistently proved to be highly overconfident. That is, regardless of the type of prediction item (e.g., responses to hypothetical dilemmas, responses to contrived laboratory situations, or self-reports of everyday behaviors) and regardless of the type of information available about the person whose responses they were predicting (e.g., predictions about roommates or predictions based on prior interviews), the levels of accuracy subjects achieved fell considerably below the levels required to justify their confidence levels. Further analysis revealed two specific sources of overconfidence. First, subjects generally were overconfident to the extent they were highly confident. Second, subjects were most likely to be overconfident when they knowingly or unknowingly made predictions that ran counter to the relevant response base rates and, as a consequence, achieved low accuracy rates that their confidence estimates failed to anticipate. Theoretical and normative implications are discussed and proposals for subsequent research offered.

The role of construal processes in overconfident predictions about the self and others

Overconfident behavioral predictions and trait inferences may occur because people make inadequate allowance for the uncertainties of situational construal. In Studies 1-3, Ss estimated how much time or money they would spend in various hypothetical, incompletely specified situations. Ss then offered associated "confidence limits" under different "construal conditions". In Study 4, Ss made trait inferences about someone they believed had responded "deviantly"--again with situational details unspecified and construal conditions manipulated. In all 4 studies, Ss who made predictions or trait inferences without being able to assume the accuracy of their situational construals offered confidence limits no broader than those of Ss who made their responses contingent on such accuracy. Only in conditions where Ss were obliged to offer alternative construals did they appropriately broaden their confidence limits or weaken their trait inferences.

Mental addition versus subtraction in counterfactual reasoning: on assessing the impact of personal actions and life events

Assessing the consequences of actions and events often requires comparing a mental stimulation of the world in which the action is present to one in which the action is absent. We propose that people perceive more impact when asked to assess whether an action would increase the likelihood or degree of a potential outcome (mental addition) than when asked whether it would reduce the probability or extent of a potential consequence (mental subtraction). This judgmental asymmetry occurs because people (a) give more weight to features of the particular mental stimulation (the action or its absence) serving as the subject of comparison and (b) give more weight to factors that produce as opposed to inhibit the relevant outcome. In 4 studies, Ss assessed the impact of personal actions (e.g., studying for an exam). Ss perceived more impact when the assessment was placed in an additive frame (e.g., "how many more questions will you get right if you study?") as opposed to a subtractive one (e.g., "how many fewer will you get right if you do not study?"). This effect was not influenced by the hedonic value of the event or by whether the S had actually experienced it. Discussion centers on the relevance of these results for the undoing of scenarios and causal attribution.

Mental addition versus subtraction in counterfactual reasoning: On assessing the impact of personal actions and life events

Assessing the consequences of actions and events often requires comparing a mental stimulation of the world in which the action is present to one in which the action is absent. We propose that people perceive more impact when asked to assess whether an action would increase the likelihood or degree of a potential outcome (mental addition) than when asked whether it would reduce the probability or extent of a potential consequence (mental subtraction). This judgmental asymmetry occurs because people (a) give more weight to features of the particular mental stimulation (the action or its absence) serving as the subject of comparison and (b) give more weight to factors that produce as opposed to inhibit the relevant outcome. In 4 studies, Ss assessed the impact of personal actions (e.g., studying for an exam). Ss perceived more impact when the assessment was placed in an additive frame (e.g., "how many more questions will you get right if you study?") as opposed to a subtractive one (e.g., "how many fewer will you get right if you do not study?"). This effect was not influenced by the hedonic value of the event or by whether the S had actually experienced it. Discussion centers on the relevance of these results for the undoing of scenarios and causal attribution.

Erythrocyte glutathione S-transferase deficiency and hemolytic anemia

A patient with unexplained erythrocyte glutathione-S-transferase (GST) deficiency has been detected among 513 unrelated persons with hemolytic anemia. An otherwise healthy adult male, the deficient individual had a mild hemolytic anemia with splenomegaly, indirect hyperbilirubinemia, and cholelithiasis. Because he was adopted and childless, the hereditary nature of the defect could not be established. The residual enzyme activity was only about 15% of mean normal. Depletion of glutathione (GSH) from the cells by 1-chloro-2,4-dinitrobenzene (CDNB), a substrate for GST, was somewhat decreased in the red cells from the patient, suggesting that a functional defect existed. The kinetic properties of the residual enzyme and the ratio of activity to antigenicity were normal. Modest decreases in leukocyte and platelet GST activities were documented. Although a cause-and-effect relationship between the GST deficiency and hemolysis may exist, this cannot be proven in the absence of affected family members.