Case Report: Direct Access Genetic Testing and A False-Positive Result For Long QT Syndrome

We report the case of a woman who pursued direct access genetic testing and then presented with concerns regarding a positive test result for Long-QT syndrome. Although the result ultimately proved to be a false positive, this case illustrates that costs associated with follow-up of direct access genetic testing results can be non-trivial for both the patient and for health care systems. Here we raise policy questions regarding the appropriate distribution of these costs. We also discuss the possibility that, when confronted by a direct access genetic test result that reports high risk for one or more actionable diseases, a family physician might feel compelled to act out of a desire to avoid liability, even when information regarding the accuracy and validity of the testing were not easily accessible. This case outlines lessons that can easily be translated into clinical practice, not only by genetic counselors, but also by family physicians, medical specialists and members of the public.     

Diverging Paths: Understanding Racial Differences in Civic Engagement Among White,African American,and Latina/o Adolescents Using Structural Equation Modeling

There is increasing concern about the large civic engagement gap between Whites and Latina/o and African American youth. Some suggest this may be because traditional models and measures of civic engagement may not be as applicable for youth from historically marginalized groups. With an urban sample of middle and high school‐age youth (n = 903, 52% female), we used structural equation modeling to identify differences in civic pathways between youth from different racial/ethnic backgrounds. We found significant differences between groups including much stronger relationships between exposure to democratic practices and civic self‐efficacy and knowledge for African American and Latina/o youth than for White youth and a stronger relationship between civic knowledge and future civic engagement for Whites and Latina/os than for African Americans. These findings suggest that educators and researchers interested need to take into account the diversity of youths' racial experiences when examining youth civic development.     

Expectations About Couple Therapy Over Time

One common factor of therapy, expectations, has been demonstrated to be a significant contributor to outcome in individual therapy. Despite this, little is known about expectations about couple therapy. This paper presents the qualitative results of a study exploring clients’ expectations before beginning couple therapy and after six sessions. Results indicate that clients form pre-therapy expectations about their therapist, the process of therapy, and their partner. Results also showed that after six sessions, clients’ expectations about therapy were often met or modified in ways that were positive. Implications for therapists and researchers are included.     

Executive and attentional contributions to Theory of Mind deficit in attention deficit/hyperactivity disorder (ADHD)

Attention deficit/hyperactivity disorder (ADHD) in children has been associated with attentional and executive problems, but also with socioemotional difficulties possibly associated with deficits in Theory of Mind (ToM). Socioemotional problems in ADHD are associated with more negative prognoses, notably interpersonal, educational problems, and an increased risk of developing other psychiatric disorders that emphasize the need to clarify the nature of their ToM deficits. In this study, we hypothesized that ToM dysfunction in children with ADHD is largely attributable to their attentional and/or executive deficits. Thirty-one children with ADHD (8–12 years, IQ > 85) and 31 typically developing (TD) children were assessed using executive functions (inhibition, planning, and flexibility) and attentional tasks, as well as two advanced ToM tasks (Reading the Mind in the Eyes and Faux Pas) involving different levels of executive control. Children with ADHD performed more poorly than TD children in attentional, executive function, and ToM tasks. Linear regression analyses conducted in the ADHD group indicated that inhibition scores predicted performance on the “Faux Pas” task the best, while attention scores were the best for predicting performance on the Reading the Mind in the Eyes task. When controlled for inhibition and attentional variables, ToM performance in children with ADHD was actually similar to TD children. Contrarily, controlling for ToM scores did not normalize performance for inhibition and attentional tasks in children with ADHD. This unidirectional relationship suggests that deficits in the EF and attentional domains are responsible for ToM deficits in ADHD, which therefore may contribute to their socioemotional difficulties.     

Associations between parental gendered attitudes and behaviours and children’s gender development across middle childhood

The present study used a longitudinal, multi-informant approach to examine which specific elements of parents’ gendered attitudes and behaviours were predictive of multiple dimensions of children’s gender development. One hundred and six families with two children (older sibling M = 7.45 years and younger sibling M = 5.19 years at Time 1) were assessed at two time points four to five years apart. At Time 1, parents reported on division of household labour, their own gender-role attitudes (GRAs), and children’s gendered preferences. At Time 2, children reported on their gendered preferences, GRAs and gendered personality traits. Results from multilevel modelling showed that fathers’ egalitarian GRA and egalitarian division of household tasks were predictive of egalitarian child GRA and outcomes, but child sex did not moderate these relationships. As some gender measures were more strongly correlated than others, these findings highlight the importance of examining multiple dimensions of both children’s and parents’ gendered attitudes and behaviours.     

Situating Moral Justification: Rethinking the Mission of Moral Epistemology

This is the first of two companion articles drawn from a larger project, provisionally entitled Undisciplining Moral Epistemology. The overall goal is to understand how moral claims may be rationally justified in a world characterized by cultural diversity and social inequality. To show why a new approach to moral justification is needed, it is argued that several currently influential philosophical accounts of moral justification lend themselves to rationalizing the moral claims of those with more social power. The present article explains how discourse ethics is flawed just in this way. The article begins by identifying several conditions of adequacy for assessing reasoning practices designed to achieve moral justification and shows that, when used in contexts of cultural diversity and social inequality, discourse ethics fails these conditions. It goes on to argue that the failure of discourse ethics is rooted in its reliance on a broader conception of moral epistemology that is invidiously idealized. It concludes by pointing to the need to rethink both the mission and the method of moral epistemology.     

Trends in Telehealth versus On-site Clinical Genetics Appointments in Manitoba: A Comparative Study

Telehealth involves the use of information and communications technology to deliver health services to patients over distance. Canada is well suited to benefit from telehealth since many individuals live in remote, rural and isolated locations. Manitoba is the easternmost prairie province and MBTelehealth is an active Canadian program that currently has 105 sites in 73 communities. Although studies of patient satisfaction comparing telehealth to on-site clinical visits have been conducted, a comparative study of the types of genetics patients seen via these two modalities has not been performed previously. In this study we: (1) examined the uptake of telehealth in Genetics in Manitoba; (2) contrasted telehealth usage in Genetics with other clinical programs; and (3) performed a comparative study of the types of Genetics referrals seen in 2008 on-site versus via telehealth. Results indicate the uptake of telehealth is increasing and has made genetics outreach clinics unnecessary. The Program of Genetics and Metabolism is consistently one of the top ten utilizers of telehealth within the province. With respect to discipline, chi square analysis revealed the trends were not significantly different for on-site and telehealth encounters, with prenatal referrals being the most common and Hereditary Breast and Ovarian Cancer referrals being the least common. Referrals within each discipline varied depending on the need for fetal assessment and physical examination. Telehealth was utilized regularly for test results sessions across all disciplines.     

A component analysis of a parent‐conducted multi‐component treatment for food selectivity

Treatment packages including differential reinforcement of alternative (DRA) behavior and escape prevention in the form of a non‐removal of the spoon procedure have been shown to successfully increase food consumption. However, when these treatment components are introduced simultaneously, the treatment component(s) responsible for behavior change cannot be determined. The purpose of this study was to conduct a sequential component analysis of the following treatment components: Bite fading, manipulation of reinforcer magnitude, and escape prevention. For two participants, food consumption did not increase until after escape prevention was introduced. For one participant, increased food consumption was observed after the magnitude of reinforcement was increased; therefore, escape prevention was not necessary. Results were maintained at a 12‐week follow‐up for all participants. Copyright © 2010 John Wiley & Sons, Ltd.