Antisocial behaviour in children with and without callous-unemotional traits

More than 15 years of research have documented behavioural differences between callous-unemotional and non-callous subtypes of children with antisocial behaviour. Recent studies also suggest that children with callous-unemotional traits may be genetically vulnerable to antisocial behaviour, while those without callous-unemotional traits appear to have primarily environmental aetiology to their antisocial behaviour. Furthermore neurocognitive profiles differ between antisocial children with and without callous-unemotional traits. While the former group appears emotionally under-reactive, particularly to others' distress, the latter group may be emotionally over-reactive, particularly to perceived threat. In this review we provide an overview of the current evidence base with regard to callous-unemotional and non-callous subgroups of children with antisocial behaviour and discuss the implications of the current evidence base for prevention and intervention. This overview selectively focuses on recent advances in this area of research, as well as earlier studies where these help set the research context.     

The association between alcohol misuse and suicidal behaviour

AIMS: Despite recent small reductions in overall suicide rates, rates among those aged 25-44 have remained high. The aim of this paper was to examine the evidence for a link between alcohol misuse/consumption and suicidal behaviour, explore the reasons for this association, and consider the implications for reducing rates of suicidal behaviour. METHODS: A medline search was performed to find relevant research evidence. RESULTS: There is evidence to suggest alcohol misuse predisposes to suicidal behaviour through its depressogenic effects and promotion of adverse life events, and both behaviours may share a common genetic predisposition. Acute alcohol use can also precipitate suicidal behaviours through induction of negative affect and impairment of problem-solving skills, as well as aggravation of impulsive personality traits, possibly through effects on serotonergic neurotransmission. CONCLUSIONS: Effective interventions for problem drinking may help reduce suicide rates. At a public health level, reducing overall alcohol consumption may be beneficial, and the measures shown to be most effective in this regard are those that aim to restrict availability of alcohol.     

Developing, integrating, and perpetuating new ways of applying sociology to health, medicine, policy, and everyday life

As a framework for presenting ideas on developing ways to make sociology more applicable, we focus on the recent state of medical sociology research. Data for this paper were generated through a content analysis of a twelve-year period (1993-2004) of the Journal of Health and Social Behavior (JHSB) and Social Science & Medicine (SSM). The analysis aims to determine if the content of JHSB and SSM reflect the breadth of the sub-discipline of medical sociology as well as the stated goals of the journals. The selected issues of JHSB and SSM were coded on the basis of the following attributes: (1) Primary Substantive Topic, (2) Methodology, (3) Data Type and Analytic Technique, and (4) Research and Policy Recommendations. We found that the orientation of JHSB articles was towards generating research and theory that shy away from policy, interdisciplinary approaches, and applied issues. SSM content tends to display more interdisciplinary breadth and variety, but also reflects a dearth of applied recommendations. Our discussion focuses on what JHSB and SSM could be. We present ideas on how the sociological discipline in general-and JHSB and SSM in particular-can help generate and nourish new forms of inquiry that can impact the way research questions are framed. We conclude that such a shift is needed in order to maximize the applicability of social scientific evidence to everyday life, and we share examples situated within a socio-medical context, where there is a particular need for the application of social evidence to practice.     

Personality factors and medical training: a review of the literature

Medical Education 2011: 45 : 132–140 Context It has been acknowledged that certain personality characteristics influence both medical students’ and doctors’ performance. With regard to medical students, studies have been concerned with the role of personality, and performance indicators such as academic results and clinical competence. In addition, the link between personality and vulnerability to stress, which has implications for performance, has been investigated at both undergraduate and postgraduate levels. Most of the studies cited in the literature were published before the year 2000. The authors therefore undertook a literature search to determine whether any prospective systematic studies have been published since 2000. Methods A review of the literature for 2000–2009 was performed, using the databases MEDLINE, PsycINFO and CINAHL. The search terms used were ‘personality’, ‘performance’, ‘stress’ and ‘medical student’. Specific inclusion criteria required studies to be cohort studies carried out over a minimum period of 2 years, which measured medical student scores on valid and reliable personality tests, and used objective measures of performance and stress. Results The authors identified seven suitable studies. Four of these looked at personality factors and academic success, one looked at personality factors and clinical competence, and two looked at personality factors and stress. The main personality characteristic repeatedly identified in the literature was conscientiousness. Conclusions The personality trait known as conscientiousness has been found to be a significant predictor of performance in medical school. The relationship between personality and performance becomes increasingly significant as learners advance through medical training. Additional traits concerning sociability (i.e. extraversion, openness, self‐esteem and neuroticism) have also been identified as relevant, particularly in the applied medical environment. A prospective national study with the collaboration of all medical schools would make it possible to further investigate these important but initial findings.     

Depersonalization, Self-Esteem and Body Image in Male-to-Female Transsexuals Compared to Male and Female Controls

Whether postoperative male-to-female transsexuals differ in regard to measures of self- and body image from a nontranssexual control group was investigated. A group of 30 postoperative male-to-female transsexuals and control groups of 30 males and 30 females completed self-report measures (depersonalization, self-esteem, gender identity traits, body image). Results showed that transsexuals and males scored higher on self-esteem and dynamic body image than the females did. No differences between the groups were found in terms of depersonalization and satisfaction. Transsexuals and females described themselves as more feminine than males. Regarding sex-role orientation, more androgynous subjects were found among transsexuals than in the control groups. General satisfaction is associated with feminine and masculine traits in transsexuals. Results are discussed in context of the function of these personality features for the identity development of male-to-female transsexuals.     

Medical school selection: Screening for dysfunctional tendencies

AIM: One of the aims of medical selection is to deselect students who have personal characteristics that would impact negatively on their ability to interact with patients, supervisors and peers and impede their ability to cope with the stress of medical training. The arduous requirements of the formal curriculum, the customs and rituals of the socialisation process and the mistreatment and abuse reportedly experienced by students all contribute to stress, mental illness, suicide, lowered self-confidence in clinical ability, decreased ability to learn and alcohol and substance abuse. There has been little research on the effectiveness of the selection interview in deselecting students with negative personal characteristics. Our research profiles the dysfunctional interpersonal tendencies of students already selected into a medical programme through the process of academic merit, application and interview. METHODS: During 2001 and 2002, 159 students enrolled in an Australian undergraduate medical programme completed the Hogan Development Survey (HDS), which is a self-report measure of dysfunctional personality characteristics that inhibit the development of working relationships with others. RESULTS: The HDS identified negative personality characteristics in medical students that were not detected in the selection interview. CONCLUSIONS: The presence of patterns of dysfunctional behaviour in medical training has implications for the selection, teaching and pastoral care of medical students. The HDS has the potential to identify negative personal characteristics that are hard to detect during a selection interview, and may be a valuable adjunct to the interview.     

Medical students' personality characteristics and academic performance: a five-factor model perspective

OBJECTIVES: This study investigates: (1) which personality traits are typical of medical students as compared to other students, and (2) which personality traits predict medical student performance in pre-clinical years. DESIGN: This paper reports a cross-sectional inventory study of students in nine academic majors and a prospective longitudinal study of one cohort of medical students assessed by inventory during their first preclinical year and by university examination at the end of each pre-clinical year. SUBJECTS AND METHODS: In 1997, a combined total of 785 students entered medical studies courses in five Flemish universities. Of these, 631 (80.4%) completed the NEO-PI-R (i.e. a measure of the Five-Factor Model of Personality). This was also completed by 914 Year 1 students of seven other academic majors at Ghent University. Year end scores for medical students were obtained for 607 students in Year 1, for 413 in Year 2, and for 341 in Year 3. RESULTS: Medical studies falls into the group of majors where students score highest on extraversion and agreeableness. Conscientiousness (i.e. self-achievement and self-discipline) significantly predicts final scores in each pre-clinical year. Medical students who score low on conscientiousness and high on gregariousness and excitement-seeking are significantly less likely to sit examinations successfully. CONCLUSIONS: The higher scores for extraversion and agreeableness, two dimensions defining the interpersonal dynamic, may be beneficial for doctors' collaboration and communication skills in future professional practice. Because conscientiousness affects examination results and can be reliably assessed at the start of a medical study career, personality assessment may be a useful tool in student counselling and guidance.     

医务人员人格特质对知识共享绩效的影响

目的分析医务人员不同人格特质对知识共享绩效的影响。方法以五大人格理论为基础,提出研究假设,采取问卷调查方式,对各层级医护人员进行调查,以检验各项假设是否成立。结果医务人员的亲和性与开放性人格特质对医院知识共享具有正向支持（P＜0.05）,与知识共享绩效具有相关性（P＜0.05）,并且其通过知识共享间接影响知识共享绩效。结论医院应重视医务人员人格特质差异,改进人员选拔与考核机制,制定医务人员职业发展体系,营造支持知识共享的组织氛围,以提高知识共享绩效。     

The movement of patients across borders: challenges and opportunities for public health

In a globalizing world, public health is no longer confined to national borders. In recent years we have observed an increasing movement of patients across international borders. The full extent of this trend is yet unknown, as data are sparse and anecdotal. If this trend continues, experts are convinced that it will have major implications for public health systems around the globe. Despite the growing importance of medical travel, we still have little empirical evidence on its impact on public health, especially on health systems. This paper summarizes the most recent debates on this topic. It discusses the main forces that drive medical travel and its implications on health systems, in particular the impacts on access to health care, financing and the health workforce. This paper also offers guidance on how to define medical travel and how to improve data collection. It advocates for more scientific research that will enable countries to harness benefits and limit the potential risks to public health arising from medical travel.     

Patient-specific devices and population-level evidence: evaluating therapeutic interventions with inherent variation

Designing and manufacturing medical devices for specific patients is becoming increasingly feasible with developments in 3D printing and 3D imaging software. This raises the question of how patient-specific devices can be evaluated, since our ‘gold standard’ method for evaluation, the randomised controlled trial (RCT), requires that an intervention is standardised across a number of individuals in an experimental group. I distinguish several senses of patient-specific device, and focus the discussion on understanding the problem of variations between instances of an intervention for RCT evaluation. I argue that, despite initial appearances, it is theoretically possible to use RCTs to evaluate some patient-specific medical devices. However, the argument reveals significant difficulties for ensuring the validity of such trials, with implications for how we should think about methods of evidence gathering and regulatory approaches for these technologies.     

医学生个性特征与焦虑和抑郁的相关性研究

目的了解医学生个性特征与焦虑、抑郁状况的关系,以便为开展有针对性的心理卫生工作提供依据.方法采用分层抽样的方法,抽取某医学院校本科生639名,进行焦虑自评量表(SAS)、抑郁自评量表(SDS)和艾森克个性问卷(EPQ)的测评.结果医学生的焦虑、抑郁状况与人格特性之间显著相关;不同性别学生的个性特征差异明显.结论塑造健康的个性是降低焦虑、抑郁,减少心理障碍的有效途径.     

Sociomoral Reasoning in Adults with ADHD: A Pilot Study

Attention Deficit Hyperactivity Disorder (ADHD) is frequently linked with antisocial behaviour, yet less is known about its relationship with sociomoral reasoning, and the possible mediating effect of intelligence. A pilot study was designed to investigate the relationship between antisocial personality traits, intelligence and sociomoral reasoning in adults with ADHD. Twenty two adults with ADHD and 21 healthy controls, matched for age, gender and IQ completed a battery of measures including the National Adult Reading Test, Gough Socialisation Scale and Sociomoral Reflection Measure-Short Form. There was no difference between the groups and levels of sociomoral reasoning, despite the ADHD group reporting greater antisocial personality traits. Sociomoral reasoning was positively correlated with intelligence. Results from a hierarchical multiple regressions indicated that both antisocial traits and IQ were significant predictors of sociomoral reasoning, with IQ proving the most powerful predictor. Whilst antisocial personality traits may explain some of the variance in levels of sociomoral reasoning, a diagnosis of ADHD does not appear to hinder the development of mature moral reasoning. Intellectual functioning appears to facilitate the development of sociomoral reasoning. A further analysis showed that both ADHD and low sociomoral reasoning were significant predictors of antisocial traits. The current findings have important treatment implications.     

Illness reporting and demand for medical care in rural Burkina Faso

The issue of illness reporting in modelling demand for health care in low- and middle-income countries can be handled according to either of two conceptually-different constructs: (a) considering illness reporting behaviour as endogenous to demand; or (b) considering demand itself as the outcome of a sample selection phenomenon. In this paper, we take the second viewpoint and estimate the demand for medical care with an estimator that uses Heckman-type. Empirical estimates based on household survey data from rural Burkina Faso suggest that there are some implications of illness reporting behaviour for modelling the demand for medical care.     

New genetics,new ethics? Globalisation and its discontents

The paper discusses the rapid and significant development of new genetic technologies (in health, food and agriculture) in the theoretical context of the globalisation debate. We show how the studies on the ethical, legal and social implications of biotechnological innovation have themselves emerged as an important factor in the technological innovation and product development process. Ethical considerations are becoming integral to attempts to understand techno-scientific developments in late modernity. However, ethical studies have so far been more focused on the medical rather than the overall commercial application of genomics. Their relevance to this wider context of the globalised commodification of new genetics needs to be explored. Of special significance is the introduction of ethical considerations into the debates on globalised risk, which we will explore in relation to increasing disparities between the global North and South.     

Personality differences between doctors and their patients: implications for the teaching of communication skills

OBJECTIVE: To establish, as part of a wider study into specialty choice and job satisfaction, whether the personality profiles of a sample of doctors differed from those of the UK population at large, i.e. their potential patients, and the implications this might have for the doctor/patient consultation process. DESIGN: The Myers-Briggs Type Indicator (MBTI), which measures normal personality differences, was administered by post to five cohorts of doctors (n = 464) who had qualified from a London medical school during the 1980s. SETTING: United Kingdom. PARTICIPANTS: 313 (67.5%) of the medical graduates. MAIN OUTCOME MEASURES: Personality profiles of the respondents compared to those of the UK adult population norms, a proxy for their potential patients. RESULTS: The doctors in this sample differed significantly from the UK adult population norms on most of the dimensions of personality measured, including those which measure an individual's preferred mode of perception, i.e. how one likes to take in information and learn about things. This suggests potential points for miscommunication in the doctor/patient consultation process. CONCLUSIONS: This research should be replicated to see if the results are generalizable. Nevertheless, the findings do indicate that these doctors might benefit from education in the concept of psychological type differences and how these could affect communication with their patients. Training in how to "flex" their consultation style, when necessary, to take into account possible personality differences between themselves and their patients could enhance the outcome of the interaction for both parties.     

What difference does ("good") HRM make?

The importance of human resources management (HRM) to the success or failure of health system performance has, until recently, been generally overlooked. In recent years it has been increasingly recognised that getting HR policy and management "right" has to be at the core of any sustainable solution to health system performance. In comparison to the evidence base on health care reform-related issues of health system finance and appropriate purchaser/provider incentive structures, there is very limited information on the HRM dimension or its impact.Despite the limited, but growing, evidence base on the impact of HRM on organisational performance in other sectors, there have been relatively few attempts to assess the implications of this evidence for the health sector. This paper examines this broader evidence base on HRM in other sectors and examines some of the underlying issues related to "good" HRM in the health sector.The paper considers how human resource management (HRM) has been defined and evaluated in other sectors. Essentially there are two sub-themes: how have HRM interventions been defined? and how have the effects of these interventions been measured in order to identify which interventions are most effective? In other words, what is "good" HRM?The paper argues that it is not only the organisational context that differentiates the health sector from many other sectors, in terms of HRM. Many of the measures of organisational performance are also unique. "Performance" in the health sector can be fully assessed only by means of indicators that are sector-specific. These can focus on measures of clinical activity or workload (e.g. staff per occupied bed, or patient acuity measures), on measures of output (e.g. number of patients treated) or, less frequently, on measures of outcome (e.g. mortality rates or rate of post-surgery complications).The paper also stresses the need for a "fit" between the HRM approach and the organisational characteristics, context and priorities, and for recognition that so-called "bundles" of linked and coordinated HRM interventions will be more likely to achieve sustained improvements in organisational performance than single or uncoordinated interventions.     

Personality indicators of psychosocial adjustment in first-year medical students

One aspect of the Rush Medical College Longitudinal Study is concerned with the identification of personality traits that predict various kinds of psychosocial adjustments and impairments among medical students and physicians. Two orthogonal traits, masculinity and femininity, were selected for study as independent variables because of their implications for mental health and their relevance to the work of physicians. Ninety percent (N = 106) of a class of first-year medical students completed measures of masculinity and femininity during orientation and, 8 months later, completed a broad array of dependent measures of psychological well-being, interpersonal satisfaction, humanistic attitudes and alcohol consumption. Analyses of the data revealed strong and consistent main effects of masculinity on depression, confidence, pleasure capacity, extraversion, locus of control, neuroticism and interpersonal satisfaction. Femininity was associated with depression, pleasure capacity, extraversion, neuroticism, interpersonal satisfaction, concern for the opinion of others and humane attitudes toward patient care. Low femininity was also associated with high alcohol consumption. These results suggest that masculinity and femininity scores may help to identify at the outset medical students at risk for impairment, and that androgynous individuals (who are high in both masculinity and femininity) may be especially well-suited to assume the demanding and varied roles that physicians are called on to play.     

Researching income and income distribution as determinants of health in Canada: gaps between theoretical knowledge, research practice, and policy implementation

The research identified gaps in Canadian knowledge and research activity concerning the roles that income and its distribution play in Canadians' population health. 241 Canadian research studies on income and health were considered along eight taxonomies: conceptualization of income or its proxies; theoretical underpinnings; income distribution measures; health measures; who/what was studied, pathways mediating between income and health; complexity of these pathways; research design; and presence of policy implications. The study identified the following areas of weakness: (a) poor conceptualization of income and the means by which it influences health; (b) lack of longitudinal studies of the impact of income-related issues upon health across the life-span; (c) lack of linked data bases that allow complex analyses of how income and related issues contribute to health and well-being, and (d) little inter-disciplinary work in identifying pathways mediating the income and health relationship. Advances in health policy to address the health effects of income and its distribution requires a research infrastructure that draws upon recent theoretical developments in the area and is able to access data sources to test these advanced conceptualizations.     

Personality traits and types predict medical school stress: a six-year longitudinal and nationwide study

OBJECTIVES: Personality types (combinations of traits) that take into account the interplay between traits give a more detailed picture of an individual's character than do single traits. This study examines whether both personality types and traits predict stress during medical school training. METHODS: We surveyed Norwegian medical students (n = 421) 1 month after they began medical school (T1), at the mid-point of undergraduate Year 3 (T2), and at the end of undergraduate Year 6 (T3). A total of 236 medical students (56%) responded at all time-points. They were categorised according to Torgersen's personality typology by their combination of high and low scores on the 'Big Three' personality traits of extroversion, neuroticism and conscientiousness. We studied the effects of both personality types (spectator, insecure, sceptic, brooder, hedonist, impulsive, entrepreneur and complicated) and traits on stress during medical school. RESULTS: There was a higher level of stress among female students. The traits of neuroticism (P = 0.002) and conscientiousness (P = 0.03) were independent predictors of stress, whereas female gender was absorbed by neuroticism in the multivariate model. When controlled for age and gender, 'brooders' (low extroversion, high neuroticism, high conscientiousness) were at risk of experiencing more stress (P = 0.02), whereas 'hedonists' (high extroversion, low neuroticism, low conscientiousness) were more protected against stress (P = 0.001). CONCLUSIONS: This is the first study to show that a specific combination of personality traits can predict medical school stress. The combination of high neuroticism and high conscientiousness is considered to be particularly high risk.     

On the Relation Between 2D:4D and Sex-Dimorphic Personality Traits

Several personality traits, including aggressiveness and sensation seeking, have been hypothesized to be influenced by prenatal androgen exposure, though evidence for this proposition is limited. We investigated whether individual differences in aggressiveness, sensation seeking, and several prosocial personality traits can be predicted from differences in the 2D:4D digit ratio, a putative marker of prenatal androgen activity. A total of 164 undergraduates (87 men, 77 women) completed self-report measures of physical and verbal aggression, as well as a standardized measure of sensation seeking, and five scales to assess empathy, nurturance, expressivity/femininity, instrumentality/masculinity, and assertiveness. Two sex-dimorphic tests of spatial ability also were included. Men had a lower 2D:4D ratio than women, confirming the typical sex difference in digit proportions. Significant sex differences were observed on 10 of the 11 personality scales purported to show sex differences and on both tests of spatial ability. The 2D:4D ratio was a significant predictor of scores on three of the four aggression subscales, total aggression, thrill and adventure seeking, and total sensation-seeking, in the sample as a whole and in women. In men, correlations with 2D:4D were significant only for total sensation-seeking and verbal aggression. In both sexes, lower 2D:4D ratios were associated with increased aggressiveness and sensation seeking. For the spatial tests, there was no evidence of any association with 2D:4D in either men or women. The 2D:4D digit ratio may be a valid, though weak, predictor of selective sex-dependent traits that are sensitive to testosterone.