What Therapists Learn from Psychotherapy Clients: Effects on Personal and Professional Lives

While considerable research has examined how clients learn from psychotherapists, there is only sparse literature on what therapists learn from their therapy clients. In a qualitative, exploratory study, nine researchers interviewed 61 psychologists from across North America in order to see what psychotherapists may have learned and how they have been affected by their clients both personally and professionally. Participants responded to nine open-ended questions on learning about life-lessons, relationships, ethical decision-making, coping, courage, wisdom, psychopathology, personality, cultural differences, lifespan development and more. Participants’ richly elaborated responses were coded thematically and narrative data illustrates the most frequent themes. Therapists reported learning a great deal across each of the questions, consistently expressing respect for their clients\u27 resilience, courage and moral sensibilities

Expression of the neuroprotective slow Wallerian degeneration (WldS) gene in non-neuronal tissues

<p>Abstract</p> <p>Background</p> <p>The slow Wallerian Degeneration (<it>Wld</it>^<it>S</it>) gene specifically protects axonal and synaptic compartments of neurons from a wide variety of degeneration-inducing stimuli, including; traumatic injury, Parkinson's disease, demyelinating neuropathies, some forms of motor neuron disease and global cerebral ischemia. The <it>Wld</it>^{<it>S </it>}gene encodes a novel Ube4b-Nmnat1 chimeric protein (Wld^Sprotein) that is responsible for conferring the neuroprotective phenotype. How the chimeric Wld^Sprotein confers neuroprotection remains controversial, but several studies have shown that expression in neurons <it>in vivo </it>and <it>in vitro </it>modifies key cellular pathways, including; NAD biosynthesis, ubiquitination, the mitochondrial proteome, cell cycle status and cell stress. Whether similar changes are induced in non-neuronal tissue and organs at a basal level <it>in vivo </it>remains to be determined. This may be of particular importance for the development and application of neuroprotective therapeutic strategies based around <it>Wld</it>^<it>S</it>-mediated pathways designed for use in human patients.</p> <p>Results</p> <p>We have undertaken a detailed analysis of non-neuronal <it>Wld</it>^{<it>S </it>}expression in <it>Wld</it>^{<it>S </it>}mice, alongside gravimetric and histological analyses, to examine the influence of <it>Wld</it>^{<it>S </it>}expression in non-neuronal tissues. We show that expression of <it>Wld</it>^{<it>S </it>}RNA and protein are not restricted to neuronal tissue, but that the relative RNA and protein expression levels rarely correlate in these non-neuronal tissues. We show that <it>Wld</it>^{<it>S </it>}mice have normal body weight and growth characteristics as well as gravimetrically and histologically normal organs, regardless of Wld^Sprotein levels. Finally, we demonstrate that previously reported <it>Wld</it>^<it>S</it>-induced changes in cell cycle and cell stress status are neuronal-specific, not recapitulated in non-neuronal tissues at a basal level.</p> <p>Conclusions</p> <p>We conclude that expression of Wld^Sprotein has no adverse effects on non-neuronal tissue at a basal level <it>in vivo</it>, supporting the possibility of its safe use in future therapeutic strategies targeting axonal and/or synaptic compartments in patients with neurodegenerative disease. Future experiments determining whether Wld^Sprotein can modify responses to injury in non-neuronal tissue are now required.</p

Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data, 2010-23.

Background Key population HIV programmes in sub-Saharan Africa require epidemiological information to ensure equitable and universal access to effective services. We aimed to consolidate and harmonise survey data among female sex workers, men who have sex with men, people who inject drugs, and transgender people to estimate key population size, HIV prevalence, and antiretroviral therapy (ART) coverage for countries in mainland sub-Saharan Africa. Methods Key population size estimates, HIV prevalence, and ART coverage data from 39 sub-Saharan Africa countries between 2010 and 2023 were collated from existing databases and verified against source documents. We used Bayesian mixed-effects spatial regression to model urban key population size estimates as a proportion of the gender-matched, year-matched, and area-matched population aged 15–49 years. We modelled subnational key population HIV prevalence and ART coverage with age-matched, gender-matched, year-matched, and province-matched total population estimates as predictors. Findings We extracted 2065 key population size data points, 1183 HIV prevalence data points, and 259 ART coverage data points. Across national urban populations, a median of 1·65% (IQR 1·35–1·91) of adult cisgender women were female sex workers, 0·89% (0·77–0·95) were men who have sex with men, 0·32% (0·31–0·34) were men who injected drugs, and 0·10% (0·06–0·12) were women who were transgender. HIV prevalence among key populations was, on average, four to six times higher than matched total population prevalence, and ART coverage was correlated with, but lower than, the total population ART coverage with wide heterogeneity in relative ART coverage across studies. Across sub-Saharan Africa, key populations were estimated as comprising 1·2% (95% credible interval 0·9–1·6) of the total population aged 15–49 years but 6·1% (4·5–8·2) of people living with HIV. Interpretation Key populations in sub-Saharan Africa experience higher HIV prevalence and lower ART coverage, underscoring the need for focused prevention and treatment services. In 2024, limited data availability and heterogeneity constrain precise estimates for programming and monitoring trends. Strengthening key population surveys and routine data within national HIV strategic information systems would support more precise estimates

Evaluating the Cost-effectiveness of Pharmaceuticals in Canada

Canada adopted guidelines for the economic evaluation of pharmaceuticals in 1994, and a central process for drug assessment in 2003. The context and the way the issue reached the agenda in the two time periods differed. The guidelines were adopted amidst growing academic interest in methods for economic evaluation of pharmaceuticals in Canada and internationally, and were first promoted by an entrepreneur from the pharmaceutical industry. The Common Drug Review (CDR) was adopted in a context of broader intergovernmental negotiations over health reforms, and came onto the agenda as a policy option that addressed pharmaceuticals but avoided the fraught question of public insurance. Both processes aim to harmonize drug assessment in Canada and ensure that publicly reimbursed drugs are cost-effective. Neither is the subject of legislation or regulation, but the CDR enjoys greater uptake as a result of an intergovernmental agreement that all new drugs will be subject to its review. Evaluation of the CDR has been more robust, and finds a split in opinion among stakeholders concerning the CDR’s benefits. This article describes the reforms using information drawn from government and CCOHTA/CADTH documents, published reflections of participants and secondary literature, and nine expert interviews. It finds that although the CDR’s design and implementation respond to some of the shortcomings of the Canadian guidelines, there are still important unresolved tensions between harmonization and transparency in drug assessment, and new challenges regarding pharmaceutical pricing and use of evidence. The way these tensions are resolved has important implications for broader attempts to reform public drug coverage in Canada. Le Canada a adopté en 1994 des recommandations pour l'évaluation des médicaments et, en 2003, un processus centralisé d'évaluation des médicaments. Le contexte et la façon dont le problème a émergé sur l'agenda différaient d'une période à l'autre. Les recommandations ont été adoptées dans un contexte d'intérêt croissant des universitaires pour les méthodes de l'évaluation pharmaco-économique, au Canada comme à l'étranger, et ont été d'abord portées par un entrepreneur politique issu de l'industrie pharmaceutique. Le Programme Commun d'Évaluation des Médicaments (PCEM) a été adopté dans un contexte plus vaste de négociations inter-gouvernementales à propos des réformes de santé, et a émergé sur l'agenda politique comme une solution au problème posé par les médicaments qui évitait de poser la question complexe de leur prise en charge publique. Les deux processus partageaient un objectif d'harmonisation de l'évaluation pharmaceutique au Canada, et de garantie de coût-efficacité des médicaments couverts par l'assurance publique. Aucun n'a fait l'objet d'une loi ou de régulation, mais les décisions du PCEM sont plus suivies en raison de l'accord inter-gouvernemental stipulant que tout nouveau médicament doit être soumis à son approbation. Le PCEM a été plus sérieusement évalué, ce qui a dévoilé une opinion divisée sur son bilan au sein des parties prenantes. Cet article décrit les réformes, en utilisant l'information recueillie dans les documents gouvernementaux et du OCCETS/ACMTS, des réflexions publiées par les participants et les données secondaires, ainsi que neuf entretiens avec des experts. Il montre que, bien que, dans sa conception et sa mise en place, le PCEM ait tenté de répondre à certaines lacunes des recommandations de 1994, il reste des conflits non résolus entre harmonisation et transparence dans le processus d'évaluation, ainsi que des défis nouveaux sur la détermination des prix et l'utilisation de l'évidence. La façon de résoudre ces conflits aura des conséquences importantes sur les tentatives plus générales de réformer la couverture publique des médicaments au Canada

(Re)defining legitimacy in Canadian drug assessment policy? Comparing ideas over time

AbstractHow do experts judge the legitimacy of technical policy processes, and do their ideas change as these processes are opened to other stakeholders and the public? This research examines the adoption of public and patient involvement in pharmaceutical assessment in Canada. It finds tensions between scientific legitimacy that prioritizes rigor and objectivity, and democratic legitimacy that values inclusion and a broader range of evidence. In response to policy change, experts incorporate new ideas about democratic inputs and processes, while maintaining scientific policy goals. The research responds to calls for more precise measurement of ideas and ideational change and more evaluation of public and patient involvement in health policy. It helps us understand the significance of, and limits to, ideational change among experts in health policy domains that are highly technical and publicly salient. Understanding the way democratic and scientific legitimacy are negotiated in policy decisions has a wide applicability in health, but is particularly relevant during a global pandemic when evidence is being generated rapidly, decisions must be made quickly, and these decisions have a significant, immediate effect on the lives of all citizens.</jats:p

Pharmaceutical programs and social policy development: comparing Canada, Australia and the UK

Canada is the only OECD country that provides broad public health benefits but lacks a universal, nation-wide system for funding prescription drugs. This puzzle cannot be explained by the literature on national health insurance, which suggests that the tendency to consider all health services as a single policy has missed an important source of cross-national variation. How can we explain the lack of a major pharmaceutical program in Canada, in light of the country’s own extensive health system and the experience of almost all other welfare states? More generally, why do some countries adopt universal, comprehensive pharmaceutical programs, while others do not? To answer these questions, the study compares Canada to the UK and Australia using a process-tracing approach, and finds that the range of services in a country’s public health system is determined by the earliest decisions about how to approach policy development. Where institutional, ideological and electoral conditions allowed for large-scale change and all services were introduced simultaneously, countries tended to maintain the full scope of services. But where institutional barriers, ideological dissensus and low issue salience made radical change difficult, health programs were introduced incrementally, and policy development tended to stall after the first priority. Although incrementalism was initially less politically risky, it was also inherently limiting. Barriers to the introduction of services increased over time, and services that were initially lower priorities (such as pharmaceuticals in Canada) were pushed off the public agenda. In investigating this phenomenon, I provide specific mechanisms by which a more limited “path” of policy development becomes “dependent,” and argue that we must consider not only the role of ideas in policy making, but also the role of ideas over time. The study also investigates the implications of the approach to policy development for subsequent policy outcomes. It finds that factors that support the simultaneous adoption of a full range of health services also make it more difficult to retrench these services later on.Arts, Faculty ofPolitical Science, Department ofGraduat

Evaluating the Cost-effectiveness of Pharmaceuticals in Canada

Canada adopted guidelines for the economic evaluation of pharmaceuticals in 1994, and a central process for drug assessment in 2003. The context and the way the issue reached the agenda in the two time periods differed. The guidelines were adopted amidst growing academic interest in methods for economic evaluation of pharmaceuticals in Canada and internationally, and were first promoted by an entrepreneur from the pharmaceutical industry. The Common Drug Review (CDR) was adopted in a context of broader intergovernmental negotiations over health reforms, and came onto the agenda as a policy option that addressed pharmaceuticals but avoided the fraught question of public insurance. Both processes aim to harmonize drug assessment in Canada and ensure that publicly reimbursed drugs are cost-effective. Neither is the subject of legislation or regulation, but the CDR enjoys greater uptake as a result of an intergovernmental agreement that all new drugs will be subject to its review. Evaluation of the CDR has been more robust, and finds a split in opinion among stakeholders concerning the CDR’s benefits. This article describes the reforms using information drawn from government and CCOHTA/CADTH documents, published reflections of participants and secondary literature, and nine expert interviews. It finds that although the CDR’s design and implementation respond to some of the shortcomings of the Canadian guidelines, there are still important unresolved tensions between harmonization and transparency in drug assessment, and new challenges regarding pharmaceutical pricing and use of evidence. The way these tensions are resolved has important implications for broader attempts to reform public drug coverage in Canada

Framing and policy development for children’s environmental health in the United States and Canada : the influence of institutions

The influence of American environmental policy on Canada has long been a topic of interest to scholars concerned with the diffusion of knowledge and policy across national borders. This research seeks to contribute to this work by examining a relatively new direction in environmental policy, children's environmental health, and asking why a movement to frame and develop policies to address children's unique vulnerabilities to environmental risks has been an important component of US environmental policy for more than a decade, but until recently, has been almost entirely absent in Canada. I choose to focus on changes to pesticide policy that take children's health into account, and I find that Canada's slow adoption of children's environmental health frames and policy is not merely a matter of lagging behind the United States, but may be attributed to significant institutional barriers to the development of parallel policies.Arts, Faculty ofPolitical Science, Department ofGraduat