Social anxiety disorder in children and youth: A research update on aetiological factors

Social Anxiety Disorder (SAD) is a heterogeneous and distressing problem for many children and youth. This review focuses on the etiology and maintenance of SAD, and examines research findings in several key areas of investigation: genetic or hereditary factors (twin and family studies), temperament characteristics (behavioural inhibition), and parent–child interactions (attachment, parenting styles). It is concluded that genetic influences, behavioural inhibition, and parent–child interactions play significant and interactive roles in the development and maintenance of SAD. Other influences such as peer relationships, social skills deficits, and traumatic experiences are also acknowledged. Ultimately, an understanding of such pathways should facilitate effective early screening and intervention of children at risk for severe social anxiety.     

Religiosity and Spirituality: Influence on Quality of Life and Perceived Patient Self-Efficacy among Cardiac Patients and Their Spouses

The purpose of this study was to determine the influence of spirituality, religiosity, and religious coping on quality of life and self-efficacy among couples following a first time cardiac event. There was no significant association between measures for spirituality and religiosity and couples’ ratings for quality of life and self-efficacy. Negative forms of religious coping were associated with lower levels of quality of life and decreased confidence in the patient’s ability to perform physical tasks. Spouses’ measures for quality of life, self-efficacy, spirituality, religiosity, and religious coping were associated with patients’ measures for the same study variables. Joan F. Miller, RN, Ph.D., is Assistant Professor of Nursing, Bloomsburg University, Bloomsburg, Pennsylvania 17815 and Director of the Bloomsburg University Nursing Wellness Center. The author gives special thanks to Timothy R. McConnell, Ph.D., and Troy A. Klinger, M.S., for their research support and helpful feedback.     

Presumed consent for organ preservation in uncontrolled donation after cardiac death in the United States: a public policy with serious consequences

Organ donation after cessation of circulation and respiration, both controlled and uncontrolled, has been proposed by the Institute of Medicine as a way to increase opportunities for organ procurement. Despite claims to the contrary, both forms of controlled and uncontrolled donation after cardiac death raise significant ethical and legal issues. Identified causes for concern include absence of agreement on criteria for the declaration of death, nonexistence of universal guidelines for duration before stopping resuscitation efforts and techniques, and assumption of presumed intent to donate for the purpose of initiating temporary organ-preservation interventions when no expressed consent to donate is present. From a legal point of view, not having scientifically valid criteria of cessation of circulation and respiration for declaring death could lead to a conclusion that organ procurement itself is the proximate cause of death. Although the revised Uniform Anatomical Gift Act of 2006 provides broad immunity to those involved in organ-procurement activities, courts have yet to provide an opinion on whether persons can be held liable for injuries arising from the determination of death itself. Preserving organs in uncontrolled donation after cardiac death requires the administration of life-support systems such as extracorporeal membrane oxygenation. These life-support systems can lead to return of signs of life that, in turn, have to be deliberately suppressed by the administration of pharmacological agents. Finally, allowing temporary organ-preservation interventions without expressed consent is inherently a violation of the principle of respect for a person's autonomy. Proponents of organ donation from uncontrolled donation after cardiac death, on the other hand, claim that these nonconsensual interventions enhance respect for autonomy by allowing people, through surrogate decision making, to execute their right to donate organs. However, the lack of transparency and the absence of protection of individual autonomy, for the sake of maximizing procurement opportunities, have placed the current organ-donation system of opting-in in great jeopardy. Equally as important, current policies enabling and enhancing organ procurement practices, pose challenges to the constitutional rights of individuals in a pluralistic society as these policies are founded on flawed medical standards for declaring death.     

Researching and Teaching the Ethics and Social Implications of Emerging Technologies in the Laboratory

Ethicists and others who study and teach the social implications of science and technology are faced with a formidable challenge when they seek to address “emerging technologies.” The topic is incredibly important, but difficult to grasp because not only are the precise issues often unclear, what the technology will ultimately look like can be difficult to discern. This paper argues that one particularly useful way to overcome these difficulties is to engage with their natural science and engineering colleagues in laboratories. Through discussions and interactions with these colleagues ethicists can simultaneously achieve three important objectives. First they can get a great deal of assistance in their research into the social implications of future technologies by talking with people that are actively creating those futures. Second their presence in the lab and the discussions that result can be a very powerful method for educating not only students, but faculty about the ramifications of their work. And third, because the education is directly linked to the students’ everyday work it is likely that it will not just be a theoretical exercise, but have direct impact on their practice.

The Effectiveness of Family History Questionnaires in Cancer Genetic Counseling

The number of individuals receiving genetic counseling for hereditary breast and ovarian cancer syndrome has steadily risen. To triage patients for genetic counseling and to help reduce the amount of time needed by a genetic counselor in direct patient contact, many clinics have implemented the use of family history questionnaires. Although such questionnaires are widely used, scant literature exists evaluating their effectiveness. This article explores the extent to which family history questionnaires are being used in Ontario and addresses the utility of such questionnaires in one familial cancer clinic. By comparing the pedigrees created from questionnaires to those updated during genetic counseling, the accuracy and effectiveness of the questionnaires was explored. Of 121 families recruited into the study, 12% acquired changes to their pedigree that led to a revised probability estimate for having a BRCA1 or BRCA2 mutation and 5% acquired changes that altered their eligibility for genetic testing. No statistically significant difference existed between the eligibility for genetic testing prior to and post counseling. This suggests that family history questionnaires can be effective at obtaining a family history and accurately assessing eligibility for genetic testing. Based on the variables that were significantly associated with a change in probability estimate, we further present recommendations for improving the clarity of such questionnaires and therefore the ease of use by patients.     

Engaged Lifestyle, Personality, and Mental Status Among Centenarians

This study assessed engaged lifestyle activities (e.g., volunteering, traveling, and public speaking) for centenarians of the Georgia Centenarian Study. A total of 285 centenarians and near-centenarians (i.e., 98 years and older) and their proxy informants participated in this study. The Mini-Mental Status Examination (MMSE) was assessed for all centenarians, and proxy informants reported on lifestyle activities and personality traits of the centenarians. Results suggested that participants who had volunteered, traveled, and those who had given public talks and balanced their checkbooks were more likely to show relatively high mental status scores (i.e., MMSE > 17). Personality traits were found to be moderators in the relationship between engaged lifestyle and mental status: Participants with high levels of Emotional Stability, Extraversion, Openness, and Conscientiousness and with high levels of engaged lifestyle were more likely to show relatively high mental status scores (i.e., MMSE > 17), whereas participants with low levels of Emotional Stability, Extraversion, Openness, Agreeableness, and Conscientiousness and with low levels of engaged lifestyle were more likely to show relatively low mental status scores (i.e., MMSE < 18). The results suggest that engaged lifestyle, particularly in combination with personality traits, plays an important role in the level of cognitive functioning among oldest old adults.     

The United States Revised Uniform Anatomical Gift Act (2006): New challenges to balancing patient rights and physician responsibilities

Advance health care directives and informed consent remain the cornerstones of patients' right to self-determination regarding medical care and preferences at the end-of-life. However, the effectiveness and clinical applicability of advance health care directives to decision-making on the use of life support systems at the end-of-life is questionable. The Uniform Anatomical Gift Act (UAGA) has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing procurement opportunities of organs medically suitable for transplantation. Some states have enacted the Revised UAGA (2006) and a few of those have included amendments while attempting to preserve the uniformity of the revised Act. Other states have introduced the Revised UAGA (2006) for legislation and remaining states are likely to follow soon.     

Effects of texture and shape on perceived time to passage: Knowing “what” influences judging “when”

In the present study, we examined whether it is easier to judge when an object will pass one’s head if the object’s surface is textured. There are three reasons to suspect that this might be so: First, the additional (local) optic flow may help one judge the rate of expansion and the angular velocity more reliably. Second, local deformations related to the change in angle between the object and the observer could help track the object’s position along its path. Third, more reliable judgments of the object’s shape could help separate global expansion caused by changes in distance from expansion due to changes in the angle between the object and the observer. We can distinguish among these three reasons by comparing performance for textured and uniform spheres and disks. Moving objects were displayed for 0.5–0.7 sec. Subjects had to decide whether the object would pass them before or after a beep that was presented 1 sec after the object started moving. Subjects were not more precise with textured objects. When the disk rotated in order to compensate for the orientation-related contraction that its image would otherwise undergo during its motion, it appeared to arrive later, despite the fact that this strategy increases the global rate of expansion. We argue that this is because the expected deformation of the object’s image during its motion is considered when time to passage is judged. Therefore, the most important role for texture in everyday judgments of time to passage is probably that it helps one judge the object’s shape and thereby estimate how its image will deform as it moves.