Neurocognitive outcomes in children with chronic kidney disease: Current findings and contemporary endeavors

Given the rise in chronic kidney disease (CKD) in both children and adults, CKD has recently been targeted as a public health priority. Childhood onset kidney disease is generally a noncurable and progressive condition that leads to kidney failure by early adulthood. Fortunately, improved identification of kidney problems allows for early intervention, which is thought to slow progression toward end-stage renal disease. In addition, medical interventions for pediatric end-stage renal disease have also improved, allowing children to take advantage of lifesaving renal replacement treatments such as dialysis and kidney transplantation. In spite of improvements in identification and treatment, CKD causes both direct and indirect insults to a variety of organ systems. This paper reviews recently published studies pertaining to the neurocognitive and psychosocial impact of CKD on children of various ages and at various stages of kidney failure. Specific attention is focused on summarizing peer reviewed research that describes associations between kidney functioning and cognitive functioning, language acquisition, visual spatial abilities, memory, and executive functioning. In addition, peer reviewed research describing psychosocial outcomes associated with CKD related to academic achievement, social-behavioral functioning, and quality of life are summarized. The authors also identified disease-specific factors that likely mediate neurocognitive outcomes (e.g., anemia, hypertension, cardiovascular) and endorse the importance of continued interdisciplinary research collaborations that will provide a better understanding of the mechanisms responsible for improved neurocognitive functioning after transplantation. The authors conclude this review by describing a multicenter, prospective, longitudinal, National Institutes of Health funded study that is currently examining the developmental outcomes of children with mild to moderate CKD. The authors speculate that the Chronic Kidney Disease in Children Prospective Cohort Study (CKiD) findings will provide additional evidence-based guidance for clinicians and researchers working with children and adolescents with deteriorating kidney function to improve medical and developmental outcomes.     

Psychopathy in women: a review of its clinical usefulness for assessing risk for aggression and criminality

Despite a flurry of studies examining psychopathy in women, and the recent release of the second version of the Hare Psychopathy Checklist--Revised manual, there is still little consensus whether the lateral extension of the current conceptualization of psychopathy to women is appropriate. In particular, very little agreement exists concerning the clinical utility of the Hare psychopathy measures to assess women's risk of future offending and violence. This article presents a comprehensive review of studies of the association between psychopathy, antisocial behavior, and violence, in diverse samples of women, and looks at similarities and differences between these constructs in males and females. Findings from inmates and offenders, civil and forensic psychiatric patients, substance abusers, and community samples indicate a consistently lower base rate of psychopathy among women than among men. With some exceptions, correlates of psychopathy in women relevant to risk assessments for crime and violence tend to be modest and significant, generally mirroring what we see in men. Clinicians and policy makers charged with the care and management of women at risk for criminal offending and violence are likely to find the PCL-R and PCL:SV have clinical utility; however, cautious application is called for and ongoing research is required.     

Community violence, family conflict, and preschoolers' socioemotional functioning

This study examined the relations among family conflict, community violence, and young children's socioemotional functioning and explored how children's social cognition and mothers' psychological functioning may mediate the outcomes associated with this exposure. Mothers of 431 Head Start preschoolers completed questionnaires about their family demography, exposure to community violence, family conflict, and children's distress symptoms. Children were administered a social cognition assessment, and teachers rated their behavior. Results showed that mothers' reports of children's co-witnessing of community violence were positively associated with police department crime rates, children's distress symptoms, and teachers' ratings of aggression. A path analysis revealed that children's social awareness and mothers' depressive symptoms partially mediated the effects of community violence and family conflict on outcomes for children.     

Daily hassles,their antecedents and outcomes among professional first responders: A systematic literature review

Occupational groups such as firefighters, military officers, paramedics and police officers are exposed to a combination of acute, severe and accumulated everyday stress. Drawing on the daily hassles perspective on stress, the aim was to synthesize existing research on daily hassles in professional first responder settings into a theoretical model. A systematic mixed studies review with an integrated design was undertaken. The selection process resulted in 40 articles meeting the inclusion criteria. The selected papers represented two literature reviews, one qualitative study, eight longitudinal studies and 29 cross‐sectional studies. Five superior categories emerged in the analysis: Individual antecedent and continuously framing factors, Environmental antecedent and continuously framing factors, Appraisal and coping processes, Daily hassles and Outcome. Suggestions for future research are presented.     

Making good choices: toward a theory of well-being in medicine

The principle of beneficence directs healthcare practitioners to promote patients’ well-being, ensuring that the patients’ best interests guide treatment decisions. Because there are a number of distinct theories of well-being that could lead to different conclusions about the patient’s good, a careful consideration of which account is best suited for use in the medical context is needed. While there has been some discussion of the differences between subjective and objective theories of well-being within the bioethics literature, less attention has been given to the questions of what work a theory of well-being needs to do in bioethics and which standards of success ought to be used in selecting a theory of well-being for use in medicine. In this article, I argue that traditional theories of well-being developed in philosophy are not well suited to meet the needs of the medical context. For the principle of beneficence to be most useful, the underlying account of well-being should satisfy two conditions: first, it needs to lead to a concrete, action-guiding determination of the patient’s good; and, second, any recommendations it offers need to be justifiable to patients. Standard accounts of well-being have difficulty satisfying both conditions. Exploring the limitations of these theories when applied to treatment dilemmas helps point the way toward the development of an account of well-being better suited to healthcare.     

Care Versus Control: The Identity Dilemmas of UK Homelessness Professionals Working in a Contract Culture

UK voluntary and community sector organizations (VCOs) play a key role in caring for homeless people. However, there are widespread concerns about the impact of increasing government contracting on the quality of their services. This paper examines understandings of homelessness and identities as homelessness professionals, as expressed by VCO professionals. By so doing, it considers how ‘partnership working’ enables or undermines their capacities to care. The paper uses 24 in‐depth interviews and four focus groups with London‐based homelessness professionals. Professionals expressed deep tensions in their experience of their role. On one hand, they reported a deep ethical commitment to care and to develop quality supporting relationships to respond to their clients' complex needs. On the other, their capacity to care was undermined by their dependence on statutory resources and the controls this involved over the way VCOs delivered care. Professionals had to adjust to statutory monitoring frameworks and hard performance targets, which detached them from the human and intimate encounter with their clients and constrained their person‐centred caring interventions. The findings highlight the contradictory nature of contemporary systems of ‘joined up’ welfare that neglect the very human and complex nature of the issues that they were originally created to address. Copyright © 2013 John Wiley & Sons, Ltd.     

Conceptualizing Genetic Counseling as Psychotherapy in the Era of Genomic Medicine

Discussions about genetic contributions to medical illness have become increasingly commonplace. Physicians and other health-care providers in all quarters of medicine, from oncology to psychiatry, routinely field questions about the genetic basis of the medical conditions they treat. Communication about genetic testing and risk also enter into these conversations, as knowledge about genetics is increasingly expected of all medical specialists. Attendant to this evolving medical landscape is some uncertainty regarding the future of the genetic counseling profession, with the potential for both increases and decreases in demand for genetic counselors being possible outcomes. This emerging uncertainty provides the opportunity to explicitly conceptualize the potentially distinct value and contributions of the genetic counselor over and above education about genetics and risk that may be provided by other health professionals. In this paper we suggest conceptualizing genetic counseling as a highly circumscribed form of psychotherapy in which effective communication of genetic information is a central therapeutic goal. While such an approach is by no means new—in 1979 Seymour Kessler explicitly described genetic counseling as a “kind of psychotherapeutic encounter,” an “interaction with a psychotherapeutic potential”—we expand on his view, and provide research evidence in support of our position. We review available evidence from process and outcome studies showing that genetic counseling is a therapeutic encounter that cannot be reduced to one where the counselor performs a simple “conduit for information” function, without losing effectiveness. We then discuss potential barriers that may have impeded greater uptake of a psychotherapeutic model of practice, and close by discussing implications for practice.     

“I’m not a lesbian; I’m just a freak”: A Pilot Study of the Experiences of Women in Assumed-Monogamous Other-Sex Unions Seeking Secret Same-Sex Encounters Online,their Negotiation of Sexual Desire,and Meaning-Making of Sexual Identity

This pilot study looked to examine the experiences of women who are “undercover,” the meaning-making of their sexual identity, how they came to negotiate their same-sex sexual desires alongside their primary other-sex unions, and their experience of a secret, compartmentalized life. The study sought to understand their experiences as well as their meaning-making in the course of maintaining a public heterosexual persona while balancing their secret desire for sex with women. The thirty-four women in this study report lifelong incidence of attraction to and encounters with other women as well as men. They are not transitioning toward a lesbian identity nor experiencing fluidity; rather, clandestine encounters are part of an ongoing means to negotiate their opposite-sex marriages. For them, our culture’s limited notions of sexual identity are less than useful. It was important to their self-concept that their sexuality be understood in terms of its intensity and their desire for frequency and diversity of acts. They defined themselves on their own terms and by their sexual personalities and inclination toward what they considered “hypersexuality” or “freakiness.” Despite conventional ideas that women are emotionally driven in their extra-relational affairs and need to “fall in love” to participate in extra-relational sexual activity, all of the women were clear in their desire to limit their association with their same-sex partners to sexual encounters only.