Nomothetic and Idiographic Methodology in Psychiatry — A historical-philosophical analysis

The purpose of this article is to demonstrate the epistemic position of psychiatry between the science of general laws in relation to frequently encountered generality and the science of specific events which is directed towards the particular. In this respect the development of the dichotomy of nomothetic and idiographic methodology from its generally forgotten neo-Kantian origins (Windelband, Rickert, Natorp, Bauch, Münch, Hessen, Münsterberg) is delineated within the context of a historical-philosophical analysis and then its incorporation into psychology and psychopathology (Stern, Binswanger, Kronfeld, Jaspers) is reconstructed. In the course of this analysis and also in the discussion of the currently accepted theories of analytical philosophy (Stegmüller) and critical rationalism (Popper) it becomes clear that, in spite of widespread current opinions to the contrary, individualizing concept formation is an indispensable element in the methodological inventory of psychiatric science. This revised version was published online in July 2006 with corrections to the Cover Date.     

Underreporting of Meningococcal Disease Incidence in the Netherlands: Results from a Capture–Recapture Analysis Based on Three Registration Sources with Correction for False Positive Diagnoses

In order to come to a reliable evaluation of the effectiveness of the chosen vaccination policy regarding meningococcal disease, the completeness of registrations on meningococcal disease in the Netherlands was estimated with the capture–recapture method. Data over 1993–1998 were collected from (A) mandatory notifications (n = 2926); (B) hospital registration (n = 3968); (C) laboratory surveillance (n = 3484). As the standard capture–recapture method does not take into account false positive diagnoses, we developed a model to adjust for the lack of specificity of our sources. We estimated that 1363 cases were not registered in any of the three sources in the period of study. The completeness of the three sources was therefore estimated at 49% for source A, 67% for source B and 58% for source C. After adjustment for false positive diagnoses, the completeness of source A, B, and C was estimated as 52%, 70% and 62%, respectively. The capture–recapture methods offer an attractive approach to estimate the completeness of surveillance sources and hence contribute to a more accurate estimate of the disease burden under study. However, the method does not account for higher-order interactions or presence of false positive diagnoses. Being aware of these limitations, the capture–recapture method still elucidates the (in)completeness of sources and gives a rough estimate of this (in)completeness. This makes a more accurate monitoring of disease incidence possible and hence attributes to a more reliable foundation for the design and evaluation of health interventions such as vaccination programs.     

Source Identification of Atmospheric Polycyclic Aromatic Hydrocarbons in Industrial Complex Using Diagnostic Ratios and Multivariate Factor Analysis

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous pollutants worldwide; currently, they are being described as potential persistent organic pollutants (POPs). This study is aimed to identify sources of PAHs in the atmosphere around the Sihwa and Banwol industrial area by using diagnostic ratios and multivariate factor analysis such as principal component analysis/absolute principal component score (PCA/APCS) and positive matrix factorization (PMF). The atmospheric PAHs level was 8.07–177 ng/m³ (gaseous phase: 5.93–68.4 ng/m³; particulate phase: 1.85–128 ng/m³) and PAHs concentration in the warm period was lower than the cold period. As a result of the examination of relative BaP concentration, photodecomposition was found not to be an important factor in the seasonal difference of PAHs concentration in this study. Source identification was first carried out through a double ratio plot. As a result of double ratio plots, atmospheric PAHs in this study were found to stem from the combination of vehicular emission, combustion (coal or biomass–wood or grass), and petroleum. Moreover, PCA/APCS and PMF showed that the main sources were vehicular emission and coal combustion and and incineration-related source with a summed contribution of about 72.6–86.7%. Finally, the fitness of the two models was very good; the estimated values were highly correlated with the measured values (R ² = 0.991–0.999, p < 0.05).     

Occurrence of perfluorinated substances in an adult German population in southern Bavaria

Objectives Perfluorinated compounds (PFCs) are a large group of chemicals produced for several decades and widely used for many industrial and consumer applications. Because of their global occurrence in different environmental media, their persistence, and their potential to bioaccumulate in organisms they are of toxicological and public concern. Methods In the present study, the internal exposure to perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) in 356 human plasma samples collected from an adult population in Germany in 2005 is quantified. Results We were able to detect the target analytes in all plasma samples and observed a significant correlation between the PFOS and PFOA concentrations. In female participants, the levels of PFOS and PFOA ranged between 2.5–30.7 (median: 10.9 μg/l) and 1.5–16.2 μg/l (median: 4.8 μg/l), respectively. In males we observed concentrations from 2.1 to 55.0 μg/l (median: 13.7 μg/l) for PFOS and from 0.5 to 19.1 μg/l (median: 5.7 μg/l) for PFOA. A significant correlation between both PFOS and PFOA concentrations and gender was observed. We also found increased levels of the PFCs with increasing age of the participants, but this association reached statistical significance among females only. Conclusions Our data agree well with results of other recent studies in Europe and suggest that the current exposure of the adult German population is lower than the exposure of the US and Canadian population. The sources of human exposure are currently not well understood. Toxicological implications are restricted to animal studies and occupational investigations not adequate for quantitative risk assessment in humans. Overall, more scientific research is necessary to characterize the body burden of PFCs (especially for relevant subsets of the population) and the main sources and routes, which are responsible for human exposure and possible health implications of these compounds.     

Interference by Carbohydrate Substrates, Flavonoids, and Monosaccharide Derivatives on Bacterial β-D-Glucuronidase Assays

Most commercially available test kits for water and foodstuffs use β-galactosidase activity for coliforms and β-glucuronidase activity for Escherichia coli. We tested the effects on the β-glucuronidase activity of E. coli W3110 of substances usually present in foods and several synthetic pharmaceutical compounds. Thirteen substances were tested: three carbohydrates, four flavonoids, five monosaccharide derivatives, and dimethyl sulphoxide. In a minimum medium without any other carbon source, glucose (0.1 mM), quercetin (0.1 mM), silymarin (10 mg/L), D-gluconic acid (0.01 mM), D-gluconic acid lactone (0.01 mM), isopropyl-β-D-thiogalacto pyranoside (1 mM), p-nitrophenyl β-D-glucuronide (1 mM), and DMSO (1 M) completely inhibited E. coli glucuronidase activity at the above concentrations. However, the following compounds stimulated E. coli glucuronidase activity within the ranges of concentrations shown: glucose (0.0001–0.01 mM), lactose and sucrose (>0.1 mM), D-saccharic acid 1,4 lactone (0.0001–0.1 mM), p-nitrophenyl β-D-glucuronide (0.001–0.01 mM) and DMSO (2–500 mM). In a rich culture medium that contained other carbon sources (lauryl tryptose broth) E. coli glucuronidase activity in the presence of the extra nutrients was unaffected by the test substances and therefore, under normal conditions in water or foods, they should not interfere with E. coli assays based on measurements of β-glucuronidase activity. Received: 17 February 1998/Accepted: 1 July 1998     

Effects of black and green tea consumption on blood glucose levels in non-obese elderly men and women from Mediterranean Islands (MEDIS epidemiological study)

Background Obesity and diabetes are metabolic disorders that affect a large amount of the elderly population and are related to increased cardiovascular risk. Tea intake has been associated with lower risk of mortality and morbidity in some, but not all studies. We evaluated the association between tea intake, blood glucose levels, in a sample of elderly adults. Methods During 2005–2006, 300 men and women from Cyprus, 142 from Mitilini and 100 from Samothraki islands (aged 65–100 years) were enrolled. Dietary habits (including tea consumption) were assessed through a food frequency questionnaire. Among various factors, fasting blood glucose and body mass index (BMI) were measured. Results Fifty-four percent of the participants reported that they consume tea at least once a week (mean intake 1.6 ± 1.1 cup/day). A significant interaction was observed between tea intake, obesity status on glucose levels (P < 0.001). After adjusting for various confounders, tea intake was associated with lower blood glucose levels in non-obese (P for trend <0.001), but not in obese people (P = 0.24). Multiple logistic regression analysis revealed that moderate tea consumption (1–2 cups/day) was associated with 88% (95% CI 76–98%) lower odds of having diabetes among non-obese participants, irrespective of age, sex, smoking, physical activity status, dietary habits and other clinical characteristics. Conclusion Tea consumption is associated with reduced levels of fasting blood glucose only among non-obese elderly people.     

Functional Capacity Evaluation in Subjects with Early Osteoarthritis of Hip and/or Knee; is Two-Day Testing Needed?

Introduction The Work Well Functional Capacity Evaluation (WW FCE) is a two-day performance based test consisting of several work-related activities. Three lifting and carrying test items may be performed on both days. The objective of this study was to assess the need for repeated testing of these items in subjects with early osteoarthritis of the hip and/or the knee and to analyze sources of variation between the 2 days of measurement. Methods A standardized WW FCE protocol was applied, including repeated testing of lifting low, lifting overhead and carrying. Differences and associations between the 2 days were calculated using paired samples t-tests, intraclass correlation coefficients (ICC) and limits of agreement (LoA). Possible sources of individual variation between the 2 days were identified by Wilcoxon signed ranks tests. Pearson correlation coefficients were calculated for differences in performances between days and differences in possible sources of variation between days. Results Seventy-nine subjects participated in this study, their mean (SD) age was 56.6 (4.8) years, median (min–max) WOMAC (Western Ontario and McMaster Universities) index scores for pain, stiffness and physical function were 5 (0–17), 3 (0–7) and 14 (0–49), respectively. Median (min–max) SF36 physical function was 75 (5–95), and SF36 pain score was 67 (12–76). Mean performance differences ranged from −0.2 to −0.8 kg (P > 0.05). ICC’s ranged from 0.75 (lifting overhead) to 0.88 (lifting low). LoA were: lifting low 8.0 kg; lifting overhead 6.5 kg; carrying 9.0 kg. Pearson’s correlations were low and non-significant. Conclusions All three tests show acceptable two-day consistency. WW FCE testing on two consecutive days is not necessary for groups of subjects with early osteoarthritis. Individual sources of variation could not be identified.     

Consumption of cocoa-containing foods and risk of hypertension in French women

Multiple randomised controlled trials have shown high doses of cocoa to reduce blood pressure and improve endothelial function. However, evidence regarding long-term consumption of cocoa and its potential effect on hypertension is lacking. We aimed to prospectively evaluate if cocoa intake from various food sources was associated with incident hypertension. Among 45,653 women of the E3N cohort, chocolate consumption was estimated from a 208 item dietary questionnaire and 24-h recall. Quantities of cocoa for certain foods including chocolate drinks, Danish pastries, chocolate biscuits, chocolate cakes, chocolate candy-bars, plain chocolate bars, and chocolate desserts, were estimated using a detailed food composition table. Using Cox models with time-update exposures, we assessed associations between specific sources of cocoa, and hypertension risk. Self-reported cases were validated using a drug reimbursement database. 12,793 cases of hypertension were identified. Median cocoa consumption in the entire cohort was 2.3 g/day at baseline. Moderate but not high cocoa consumption from all sources was inversely associated with the risk of hypertension (hazard ratios HRQ1–Q3 0.93 [0.88:0.98], HRQ1–Q4 0.98 [0.93:1.03], p for trend < 0.01). Consumption of cocoa from plain chocolate was associated with reduced risk (HRT1–T2 0.89 [0.85:0.94] and HRT1–T3: 0.93 [0.89:0.97], p for trend < 0.01). Cocoa from dessert sources was associated with an increased risk of hypertension (HRT1–T3 1.09 [1.04:1.14], p for trend < 0.01). Moderate consumption of cocoa from plain chocolate could potentially reduce hypertension risk. Cocoa from sweet sources was associated with increased risk of hypertension.     

Hypothetical approval in prudence and medicine

We often assume that hypothetical approval – either in the form of preferences or consent – under ideal conditions adds to the legitimacy of an arrangement or act. I want to show that this assumption, reasonable as it may seem, will also give rise to ethical problems. I focus on three problem areas: prudence, euthanasia and coercive psychiatric treatment. If we are to count as prudentially or morally␣relevant those preferences you would have if you were informed and rational, we will run into difficulties in all these areas if your actual and rational preferences are at variance with each other. In the prudential sphere we may question the personal value of satisfying preferences that a person does not actually have. In this case our problem concerns the point of satisfying a rational preference in conflict with an actual one. In the cases of euthanasia and coercive care it concerns instead whether it would be morally right to do such a thing. I doubt there is a simple solution to our problem. In this paper at most I prepare the way for a solution or for wiser decisions in the hard cases, by pointing out what they will have to deal with.     

How Readable are Spanish-Language Medicaid Applications?

Nationally, Hispanics comprise nearly one-quarter of all non-elderly Medicaid recipients. We evaluated readability, layout characteristics, and document complexity of state-issued Spanish-language Medicaid enrollment applications. We located and analyzed Internet-based Spanish enrollment applications from 37 states and the District of Columbia. We calculated the readability of each Medicaid enrollment application “Signature” page using the Spanish Lexile Analyzer. We assessed application layout characteristics utilizing the User-Friendliness Tool, and we evaluated document complexity using the PMOSE/IKIRSCH scale. The average Lexile score estimated an 11th–12th grade reading level (M = 1184, SD = 192) for “Signature” pages of enrollment applications. Most applications used small font size and lacked adequate white space. Document complexity ranged from level 3 (moderate) to level 5 (very high); the majority of applications ranked at level 4 (high). Spanish-language Medicaid enrollment applications should be revised to adhere to low-literacy guidelines, which may improve the accessibility of Medicaid coverage for eligible Spanish-speaking families.