Mapping French Laypeople's Views Regarding Living Organ Donation.

BACKGROUND: French laypeople's views on living organ donation (LOD) were examined. METHODS: From 2010 to 2014, 327 adults (including 21 nurses) judged the acceptability of LOD in 60 realistic scenarios composed of all combinations of 5 factors: 1. type of organ; 2. whether it could have been obtained from a cadaver; 3. donor-recipient relationship; 4. donor's level of autonomy; 5. financial compensation; and 6. patients' level of responsibility for their illness. In all scenarios, the patients were in need of a kidney or liver transplantation. The ratings were subjected to cluster analysis and analyses of variance. RESULTS: Five qualitatively different positions were found that were termed Free Market (22%), Pragmatism (15%), Altruism (48%), Always Acceptable (7%), and Undetermined (8%). Nurses comprised the majority (90%) of the members of the altruism cluster. Younger and more-educated people were, more frequently than older and less-educated people, members either of the pragmatism or of the free market cluster. CONCLUSIONS: Half of French adults support the altruism model of LOD. A substantial minority, however, mostly young and more educated people, support alternative models allowing the introduction of financial incentives.

Telling children their mother is seriously ill or dying: mapping French people's views.

BACKGROUND: What to tell children when their mother's life is seriously endangered is a largely unstudied issue. METHODS: We had 255 lay persons in France judge the appropriateness of the parents' behaviour in 48 scenarios of parents dealing with this problem. The scenarios comprised according to a four within-subject orthogonal design: child's age (4, 6, 8 or 10 years), severity of disease (lethal or worrisome but curable), child's concern or not about his or her mother's illness and parents' decision about how much to tell (tell nothing, minimize or tell the full truth). RESULTS: Cluster analysis revealed four clusters, labelled 'always tell the truth' (33%), 'tell the truth or minimize' (16%), 'tell nothing or minimize' (22%) and 'depends on child's age and level of concern' (29%). Women and participants who had already faced breaking bad news like this to children were more frequently members of the two 'tell the truth' clusters than other participants. CONCLUSIONS: People who have already experienced a situation of having to tell a child about their mother's bad health tend to think, more than others, that telling the truth is the best policy.

Lay people's and health professionals' views about breaking bad news to children.

BACKGROUND: Bad health news is difficult to communicate, especially when parents must give bad news to their children. METHODS: We had 170 lay persons, 33 nurses and six physicians in Toulouse, France, judge the appropriateness of the parents' behaviour in 64 scenarios of parents dealing with this problem. The scenarios were composed according to a four within-subject orthogonal design: child's age (4, 6, 8 or 10), severity of disease (lethal or worrisome but curable), child's concern or not about his illness and parents' decision about communicating the news (tell nothing, minimize, tell the truth or ask the physician to tell the truth). RESULTS: Cluster analysis revealed four clusters, labelled 'Always Tell the Truth' (33%, including a majority of doctors and nurses), 'Tell Nothing or Minimize' (16%, with an older average age), 'Tell the Truth Except in Cases of Incurable Illness' (22%) and 'Depends on Child's Characteristics' (29%). CONCLUSIONS: Physicians in training and in practice need to be aware that lay people--and likely parents as well--have diverse and complex opinions about when and how parents should give bad health news to their children.

Emotional-motivational barriers to blood donation among Togolese adults: a structural approach.

BACKGROUND: Although the number of blood donors has been rapidly increasing in Togo since 2003, it is nevertheless insufficient to cover the demand. OBJECTIVES: To increase needed blood donation in Togo, it is necessary to understand why most people are reluctant to do it. METHODS: A sample of 400 adult volunteers in Lomé, mostly university educated, rated, on a scale of 0-10, the relevance to them of a comprehensive list of reasons that might deter people from donating blood. The ratings of 250 participants were subjected to factor analysis, and the resulting factorial structure was confirmed on the ratings of the other 150 participants. RESULTS: The resulting six factors were labelled (in order of their ratings of a representative sample of items): Lack of Courage and Lack of Information (mean 5·43 of 10), Concerns about the Use of Blood (4·72), Risk Aversion (4·37), Fear of Medical Settings (2·41), Conformity with Tradition (1·88) and Indifference to Others and Hostility to the Procedure (1·69). CONCLUSION: To increase blood donation, a public information campaign should address the emotional-motivational barriers found even in the most educated segment of Togolese society.

The acceptability among French lay persons of ending the lives of damaged newborns.

BACKGROUND: Lay persons' judgements of the acceptability of the not uncommon practice of ending the life of a damaged neonate have not been studied. METHODS: A convenience sample of 1635 lay people in France rated how acceptable it would be for a physician to end a neonate's life-by withholding care, withdrawing care, or active euthanasia-in 54 scenarios in which the neonate was diagnosed either with perinatal asphyxia or a genetic abnormality. The scenarios were all combinations of four factors: three levels of maturity or immaturity, three levels of severity of the health problem, three levels of parents' preference concerning prolonging care and two levels of decision-making (with or without consulting the other caregivers). ANALYSES: Analyses of variance of the participants' responses were performed to determine the importance of each factor; the interactions among factors, with methods of ending life and with other patient characteristics; and the differences between asphyxia and genetic abnormality. A cluster analysis was performed to look for groups with different patterns of responses. RESULTS: Lay people assigned most importance to the parents' request and to the severity of the problem. Except for a small group (12%) always opposed to ending life, they used a simple additive-type rule in integrating the information. IMPLICATIONS: Most of this sample of French lay people are not categorically for or against ending the life of a damaged neonate, but judge its degree of acceptability by adding up those factors that seem most salient to them.

Knowledge of the risks associated with skin bleaching among Togolese users.

We examined the extent of Togolese users' knowledge of the health risks associated with the regular use of bleaching agents. A massive underestimation of some of the main risks was discovered. The more frequent the use of bleaching agents, the higher the underestimation.

Do French lay people and health professionals find it acceptable to breach confidentiality to protect a patient's wife from a sexually transmitted disease?

OBJECTIVE: To determine under what conditions lay people and health professionals find it acceptable for a physician to breach confidentiality to protect the wife of a patient with a sexually transmitted disease (STD). METHODS: In a study in France, breaching confidentiality in 48 scenarios were accepted by 144 lay people, 10 psychologists and 7 physicians. The scenarios were all possible combinations of five factors: severity of the disease (severe, lethal); time taken to discuss this with (little time, much time); intent to inform the spouse about the disease (none, one of these days, immediately); intent to adopt protective behaviours (no intent, intent); and decision to consult an expert in STDs (yes, no), 2 x 2 x 3 x 2 x 2. The importance and interactions of each factor were determined, at the group level, by performing analyses of variance and constructing graphs. RESULTS: The concept of breaching confidentiality to protect a wife from her husband's STD was favoured much more by lay people and psychologists than by physicians (mean ratings 11.76, 9.28 and 2.90, respectively, on a scale of 0-22). The patient's stated intentions to protect his wife and to inform her of the disease had the greatest impact on acceptability. A cluster analysis showed groups of lay participants who found breaching confidentiality "always acceptable" (n = 14), "depending on the many circumstances" (n = 87), requiring "consultation with an expert" (n = 30) and "never acceptable (n = 13)". CONCLUSIONS: Most people in France are influenced by situational factors when deciding if a physician should breach confidentiality to protect the spouse of a patient infected with STD.

The acceptability of ending a patient's life.

OBJECTIVES: To clarify how lay people and health professionals judge the acceptability of ending the life of a terminally ill patient. DESIGN: Participants judged this acceptability in a set of 16 scenarios that combined four factors: the identity of the actor (patient or physician), the patient's statement or not of a desire to have his life ended, the nature of the action as relatively active (injecting a toxin) or passive (disconnecting life support), and the type of suffering (intractable physical pain, complete dependence, or severe psychiatric illness). PARTICIPANTS: 115 lay people and 72 health professionals (22 nurse's aides, 44 nurses, six physicians) in Toulouse, France. MAIN MEASUREMENTS: Mean acceptability ratings for each scenario for each group. RESULTS: Life ending interventions are more acceptable to lay people than to the health professionals. For both, acceptability is highest for intractable physical suffering; is higher when patients end their own lives than when physicians do so; and, when physicians are the actors, is higher when patients have expressed a desire to die (voluntary euthanasia) than when they have not (involuntary euthanasia). In contrast, when patients perform the action, acceptability for the lay people and nurse's aides does not depend on whether the patient has expressed a desire to die, while for the nurses and physicians unassisted suicide is more acceptable than physician assisted suicide. CONCLUSIONS: Lay participants judge the acceptability of life ending actions in largely the same way as do healthcare professionals.

Prevalence of alcohol, drug use and psychoactive substance consumption in samples of French and Congolese high school students.

The aim of this study was to make a first comparative approach to teenagers'consumption of psychoactive substances within samples drawn in France and in Brazzaville the Congo. The samples consisted of 1637 French high-school students and 155 Congolese students. An anonymous questionnaire with 13 closed items was completed. Whilst 82.1% of the male and 74.5% of the female French students had already consumed some alcoholic drinks, only 42.4% of the male and 44.0% of female Congolese students had consumed alcohol. French high school students were more affected by tobacco addiction: 22.2% (male) and 22.9% (female) of the French students smoked daily; only 3.0% (male) and 1.9% (female) Congolese students were smokers. The consumption of psychotropic medicines (sedatives, anxiolytics or hypnotics) appeared overall to be less among French high school students than the Congolese, particularly in boys (11.9% versus 17.2%). This consumption was mainly from medicine taken without medical prescription or misused. The use of cannabis appeared overall to be higher among French high school students (45.9% of males and 31.6% of females) than the Congolese (12.5% of males and 7.4% of females).

When is physician assisted suicide or euthanasia acceptable?

OBJECTIVES: To discover what factors affect lay people's judgments of the acceptability of physician assisted suicide and euthanasia and how these factors interact. DESIGN: Participants rated the acceptability of either physician assisted suicide or euthanasia for 72 patient vignettes with a five factor design--that is, all combinations of patient's age (three levels); curability of illness (two levels); degree of suffering (two levels); patient's mental status (two levels), and extent of patient's requests for the procedure (three levels). PARTICIPANTS: Convenience sample of 66 young adults, 62 middle aged adults, and 66 older adults living in western France. MAIN MEASUREMENTS: In accordance with the functional theory of cognition of N H Anderson, main effects, and interactions among patient factors and participants' characteristics were investigated by means of both graphs and ANOVA. RESULTS: Patient requests were the most potent determinant of acceptability. Euthanasia was generally less acceptable than physician assisted suicide, but this difference disappeared when requests were repetitive. As their own age increased, participants placed more weight on patient age as a criterion of acceptability. CONCLUSIONS: People's judgments concur with legislation to require a repetition of patients' requests for a life ending act. Younger people, who frequently are decision makers for elderly relatives, place less emphasis on patient's age itself than do older people.

[Predictors of quality of life in refractive surgery]. / Les prédicteurs de qualité de vie en chirurgie réfractive.

PURPOSE: To investigate predictors of quality of life in refractive surgery: psychological status, quality of vision, visual acuity, and patient satisfaction. METHODS: In a prospective study, 143 patients were evaluated preoperatively and after the third postoperative month using the same questionnaire. Quality of vision, visual acuity, well-being, self-esteem, coping, and patient satisfaction were analyzed with 47 parameters. Refractive procedures included PRK, LASIK, and phakic IOL. Four groups of low (G1), medium (G2), and high myopia (G3) and hyperopia (G4) were individualized to compare the results. RESULTS: We noted a mean postoperative best corrected visual acuity (BCVA) of 20/25 or more for the G1, G2, and G4 groups. For the G3 group, the mean BCVA was increased, with a gain of two Snellen Lines from 20/50 to 20/32. Postoperative patient satisfaction improved, with a significant difference (p<0.05) in all groups. We noted no significant difference in all myopic groups in well-being and no significant decrease in G4. Concerning self-esteem and coping, scores improved, with a significant difference in G3 group (p<0.05). Quality of vision was directly correlated with improvement of quality of life (psychological status), satisfaction scores, and BCVA preoperatively and postoperatively in all patients, but no correlation was noted between visual acuity and patient satisfaction. CONCLUSION: In spite of good refractive results, modification of patient satisfaction depends on quality of vision and quality of life (psychological status) scores. These results give us a new tool that provides useful additional information in refractive surgery.

Prevention and treatment of post-partum depression: a controlled randomized study on women at risk.

BACKGROUND: Research is needed to evaluate the efficacy of prevention and treatment for post-partum depression. METHOD: Subjects were screened with the Edinburgh Post-natal Depression Scale (EPDS) at the obstetric clinic. Mothers at risk (N = 258) (EPDS scores > or = 9) were randomly assigned to a prevention/treatment group or a control group. The prevention group received one cognitive-behavioural prevention session during hospitalization. At 4 to 6 weeks post-partum, subjects were screened again with the EPDS, after drop-out rates (refusals plus no return of the second EPDS) of 25.4% (33/130) in the intervention group and 10.9% (14/128) in the control group. Mothers with probable depression (EPDS scores > or = 11) were assessed using the Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI). Mothers with major depression continued in the treatment group (N = 18) or in the control group (N = 30). Treated subjects received a cognitive-behavioural programme of between five and eight weekly home-visits. RESULTS: Compared with the control group, women in the prevention group had significant reductions in the frequency of probable depression (30.2 % v. 48.2%). Recovery rates based on HDRS scores of < 7 and BDI scores of < 4 were also significantly greater in the treated group than in the control group. CONCLUSIONS: The study suggests that this programme for prevention and treatment of post-partum depression is reasonably well-accepted and efficacious.

Fístula perianal: un reto terapéutico / Perianal fistula: a therapeutic challenge

La fístula perianal es una entidad de frecuente consulta diaria la cual se representa con múltiples variantes clínicas y anatómicas y con complicaciones marcadas debido a tratamiento inadecuado. La incontinencia fecal es la complicación más temida; se han desarrollado muchas técnicas quirúrgicas para su manejo; se han desarrollado incluso adhesivos tisulares con el fin de evitar procedimientos invasivos en la region perianal. Se intenta dar una visión amplia de esta patología y de su tratamiento.

Personality correlates of risk perception.

The aim of the present study was to systematically examine the variations of the effects of (1) transitional anxiety states and enduring anxiety dispositions, and (2) worldviews (hierarchic, egalitarian, individualist, and fatalist), as a function of the type of hazard considered. Ten risk factors were identified. Transitional anxiety contributed significantly to the prediction of four of these risk factors. The more anxious the respondents, the higher were their scores for the Common Individual Hazards, Pollutants, and Outdoor Activities factors, and the lower were their scores for the Public Transportation and Energy Production factor. Enduring anxiety contributed significantly to the prediction of the Psychotropic Drugs factor. The more anxious the respondents, the lower were their scores. The four worldview factors contributed significantly to the prediction of three of these risk factors. The more fatalistic the respondents, the lower were their scores for the Pollutants factor, and the higher were their scores for the Public Transportation and Energy Production factor; the more egalitarian the respondents, the higher were their scores for the Pollutants factor; the more hierarchic the respondents, the lower were their scores for the Public Transportation and Energy Production factor; and the more individualistic the respondents, the higher were their scores for the Pollutants and Deviance, Sex, and Addiction factors.

[Survey on sexual behavior by Congolese and French high-school students in an AIDS context]. / Comparaison des comportements sexuels de lycéens congolais et français dans le contexte du SIDA.

The social and economic impact of AIDS add to those of a recent civil war in 1997. There were fratricidal confrontations before and after this period. Pointe-Noire, the second city of Congo and the economic Capital, was on the whole spared. We carried out a survey of 292 high-school students: 39% of girls and 61% of boys, from 14 old to 25 years old (average age of 19 years). They were from 5 general and technical schools, which are representative of the school recruitment of the city of Pointe-Noire. This study made in 1998 was the second part of a work achieved in France in 1997 with 1,859 high-school students: 70% of girls and 30% of boys, mean age 17.7 years, range 15-25 years. They came from 3 general, technical and professional schools of two departments of the region "Centre" ("Indre-et-Loire" and "Loir-et-Cher"). The material, corresponding to this study, is an anonymous self-questionnaire of 55 closed items presented in the form of assertions to which the student respond either yes or no. Items investigated: 1) pubertal maturation and subjective maturation; 2) different aspects of sexual experience in adolescence (components of sexual experience) [9] and 3) sexual behaviour (including sexual risk taking). All items have been formulated in the most accessible possible way for the youngsters. Previously, in 1996, we had made a pre-test with this material near sample of French people from 16 to 68 years old. The results of the study highlight that the Congolese youngsters present more risk than their French homologues. Although the pubertal status (the menarche and the spermarche) occurs slightly later, Congolese boys present a greater number of sexual partners and greater sexual precocity. Among 54% of Congolese pupils from the sample which had already had a sexual intercourse (68% of boys and 42% of girls) versus 52% of French pupils (58% of boys and 49% of girls), 88% of the Congolese boys have sexual intercourse at the age of 15, versus 72% of the girls at 16.5 versus 65% of the French boys in their 15.5 and 52% of the girls at 16. These differences are significant (p < 0.001) like all the following ones. Congolese students declare more sexual partners (4 during the last 12 months and 5 for all their life versus 3.2 and 4.4 for the French students); the boys more than the girls (6.5 sexual partners on the whole versus 3.7 for the girls in Congo and 5.7 versus 3.8 in France). Congolese girls generally have fewer sexual relations (over 12 months or during their entire life) than French high-school girls (respectively 5.9, 6.9 versus 8.7 and 9.3). We can see with French and Congolese students, a "traditional" dichotomy between boys and girls: that is to say girls tend to engage later in sexual relations and to favour the long and regular relations, while the boys have more short, and spaced sentimental relations. The relations of these last ones tend to evolve on a more preparatory mode, genital and intermittent, contrary to those girls who seem more sentimental and continuous. The use of the condom concerns 72% of the French pupils for the first sexual intercourse (74% of boys versus 72% of girls) - which is close to results of French reference surveys [1, 3]. On the other hand, they are only 39% to make use of it in Congo in this circumstance (36% of the boys and 34% of the girls). All Congolese young people present more STD (6% versus 4% for the French pupils) and more pregnancy (11% versus 3%). The other risky situations appear also more important in Congo: as the fact of having sexual intercourse after having drunk too much (6% of case where it arrives systematically versus 2% in France); to have sexual intercourse with a injecting drug user (4% versus 1%); paying or to have been paid (in a systematic way 7% versus 1%). The Congolese answers concerning the recourse to prostitution are more dissimilar and alarming concerning Congolese young people, especially if one takes into account all the situations where it occurred at least once (29% of the boys and 13% of the Congolese girls who declare to have had a sexual intercourse by paying (with money). Homosexual relations are more frequent in Congo (4 and 6% versus 2 and 3% for France). Homosexual experience concerned 13% of the Congolese pupils versus less than 5% of the French ones. The answers concerning a sexual partner who is "not sure" (20% in Congo versus 2% in France) can get clearer in the Congolese context with an elevated prevalence rate of infection by HIV. However, other cultural factors should not be neglected. The same applies for the answers relative to the sexual intercourse under duress (29% for Congo versus less than 7% in France). The answers relative to the fact of having a sexual intercourse with a much older partner (21% versus 13%) do not seem surprising for Congo. But it does not free risks. All these elements are not associated with a better estimate of the personal risk. (ABSTRACT TRUNCATED)

[Approach to sexuality in an AIDS context in Congo]. / Approche de la sexualité au Congo dans le contexte du sida.

The pandemic due to the human immunodeficiency virus (HIV) is extensive in Sub-Saharan Africa and especially in Congo. Congo is a small country on the Atlantic coast and characterized by plentiful equatorial forests and low population density (essentially urban). In Congo, there is a high prevalence of HIV. The social and economic consequences of AIDS add to those of a recent civil war in 1997. There were fratricidal confrontations before and after this period. These confrontations have led to a massive exodus of the inhabitants of the capital, Brazzaville, to the forests and neighbouring cities, essentially towards Pointe-Noire. Pointe-Noire, chief place of the region of Kouilou, in the South of the country, is the second city of Congo and the economic Capital. It is undoubtedly for this reason that it has been globally saved. In this context, a sanitary policy of prevention of sexual risky behavior can appear as a challenge. While it supposes a better knowledge of the sexual activity of the young people, it cannot be dissociated from the analysis of the other factors. These factors can be of socio-economic political or cultural order. Thus the influence of cultural variables in the field of sexuality is certainly preponderant in African countries, where sexuality is taboo. Sexuality is a private matter (personal intimacy and the couple), but concerns also the family (in the sense of membership in an extended domestic group or in a system of relationship) in its aspects related to procreation and to the social field (power, alliances). Such individual behaviour can be lived as a questioning of the social order. In this article, the authors question the place of sexuality in Congo, particularly based on the work of anthropologists [2, 6, 7, 9]. Research in the field of sexuality at adolescence is rather recent in France and investigations that have been done in Congo these last ten years do not exist. Meetings and exchanges in 1998 with high-school pupils and schoolboys and girls of Pointe-Noire, have shown that they had a high level of knowledge (about contamination by HIV). On the other hand, this has also been associated with a number of beliefs, which are higher than in France: relating to the possibilities of interpersonal contagion by saliva (by kissing), food. but also a contagion by mosquito bites. Some of these pupils (essentially boys) have asked us about the greater risk of contagion when the male sexual partner presents an irritation or a wound in the penis. This recurring question seemingly concerns a point of knowledge. However a more attentive analysis lets us think that there could be various interpretations. First of all, if the penis is healthy, the risk is low, nearly absent. The concern about a friction or about a wound in the penis could be associated with the concept of forbidden sexual positions (similar to animal positions). Proscriptions are explained by their traumatic character for the feminine device and because they are able to induce an infertility or dystocia (difficult) childbirth. Other beliefs have connected the origin of AIDS with prohibited sexual practices, committed by foreigners, who passed on them secondarily to the natives of the country. They are clearly blamed in their contributions to the decline of customs and the corruption of tradition. However this unfavourable evolution is not longer only their privilege. Sexual superactivity and "sexual wandering" are also concerned. It is dialectic of the pure and the impure. The rejection or the stigmatisation of foreign values can allow the group to find its led astray identity. Condoms are well known by Congolese pupils, but there is mistrust of their use, notably for the "elders", guarantor for the moral order. This mistrust is probably connected with the beliefs of risks of infertility, infection or weakening of the virile force. Condoms are mechanical barriers, made by foreigners, to protect native people from foreign troubles, which foreigners generate. The investigation of chains of significant from the primary couple "nature/artificial (synthetic)" can establish a bait of understanding. The contraceptive action of condoms is a problem. Reproduction remains family business. Moreover, the place of the "morality", the official speech of condemnation from the Roman Catholic Church and the ambivalent positioning of certain Congolese religious congregations does not encourage condom use. Finally, one should not neglect their cost compared to the standard of living. The religious faith is a source of comfort for many Congolese. AIDS can be lived as a spiritual probation that certain traditional healers would have foreseen. Certain ideologies can be a source of intolerance for people who transgress "ways of life" (alcohol, tobacco, anal sexual intercourse.). The religious congregations have invaded the public space. The medical world and the political institutions cannot ignore them any more. (ABSTRACT TRUNCATED)

Eliciting patient disutilities for the adverse outcomes of cardiopulmonary resuscitation.

BACKGROUND: in helping patients decide about treatments, such as whether to authorize cardiopulmonary resuscitation (CPR), physicians typically present information about the possible outcomes and their likelihoods. The aim of this study was to elicit patient disutilities for the adverse outcomes of cardiopulmonary resuscitation (CPR) using the methodology of NH Anderson's functional theory of cognition and to determine how patients integrate the disutility and the likelihood of an outcome. METHODS: 77 French adults rated scenarios of possible outcomes of CPR on a linear scale with anchors "what would be the best (or worst) for me." In 25 of the 27 scenarios, the result would be either total recovery or one of five adverse outcomes (chest injury, mild reversible brain damage, severe irreversible brain damage, death after intensive care, immediate death) with one of five likelihoods (one to five chances out of ten). In the other two, the only possible result was either total recovery or immediate death. RESULTS: the mean disutilities relative to 0 for chest injury and 100 for severe brain damage were 13 for mild brain injury, 68 for death after intensive care, and 69 for immediate death. The graphs of the ratings of each adverse outcome in relation to its frequency were fan-shaped, showing that participants integrated this information multiplicatively. CONCLUSIONS: the functional theory of cognition provides an alternate method of eliciting patient utilities for the outcomes of CPR and supports clinicians' assumption that people combine utility and likelihood multiplicatively.

Judging the pleasantness of form-color combinations.

The way people with various degrees of aesthetic expertise integrate form and color information in a pleasantness judgment was investigated in 2 experiments. Participants were asked to assign an overall pleasantness value to combinations of forms and colors. In Experiment 1, the factors manipulated were form and color inside the form. In Experiment 2, they were form and color of the ground. In judging the pleasantness of form-color combinations, participants applied a complex rule in which the weight attributed to one element depends on the value of the other element. When the value of an element is medium (when it is neither liked nor disliked), its weight is lower than when its value is low (when it is disliked). As a result, the weight of the other element is proportionally altered. The data support a nonequal averaging combination rule. Very few differences between experts and nonexperts were observed. This result supports the view that the pleasantness judgments were based largely on automatic reactions.