A Qualitative Study of the Activities and Outcomes of Domestic Violence Coordinating Councils

Efforts to promote systems change frequently involve the creation of councils, coalitions, and other collaborative settings. However, research, to date, reports limited empirical evidence that they achieve desired outcomes (Roussos and Fawcett, Annu Rev Public Health 21:369–402, 2000). The precise nature of this evidence base has received less attention. In particular, formal investigations into council effectiveness (a) rarely highlight the specific nature of collaborative efforts; (b) emphasize fairly distal markers as the “gold standard” for effectiveness; (c) focus largely on formative “outcomes” (e.g., action plan quality); and (d) utilize primarily quantitative research approaches. The current study extends previous research by employing a qualitative approach to investigate the particular activities and proximal outcomes of 41 domestic violence coordinating councils. Study findings suggest that councils engage in six primary activities: discussing issues, sharing information, identifying weaknesses in the system’s response, providing training for key stakeholders, engaging in public/community education, and lobbying key stakeholders who are not council members. Three proximal outcomes were consistently identified in council efforts: the promotion of knowledge, relationships, and institutionalized change. Attending more directly to proximal outcomes and concrete activities in our research has important implications for conceptualizing and researching the effectiveness of councils and collaborative settings.     

Autism Spectrum Symptomatology in Children: The Impact of Family and Peer Relationships

This study examines the potential impact of family conflict and cohesion, and peer support/bullying on children with autism spectrum disorder (ASD). While such impacts have been established for a range of non-ASD childhood disorders, these findings may not generalize to children with ASD because of unique problems in perspective-taking, understanding others’ emotion, cognitive rigidity, and social reasoning. A structural model-building approach was used to test the extent to which family and peer variables directly or indirectly affected ASD via child anxiety/depression. The sample (N = 322) consisted of parents of children with ASD referred to two specialist clinics. The sample contained parents of children with Autistic Disorder (n = 76), Asperger Disorder (n = 188), Pervasive Disorder Not Otherwise Specified (n = 21), and children with a non-ASD or no diagnosis (n = 37). Parents completed questionnaires on-line via a secure website. The key findings were that anxiety/depression and ASD symptomatology were significantly related, and family conflict was more predictive of ASD symptomatology than positive family/peer influences. The results point to the utility of expanding interventions to include conflict management for couples, even when conflict and family distress is low. Further research is needed on the potentially different meanings of family cohesion and conflict for children with ASD relative to children without ASD.     

Disease Rarity,Carrier Status,and Gender: A Triple Disadvantage for Women with Fabry Disease

Fabry disease is a multi-systemic X-linked genetic disorder which has progressive and deadly consequences for those it afflicts. Fabry disease symptoms are widely recognized as a substantive burden for affected males. In comparison, female heterozygotes have traditionally been viewed as relatively symptom-free, though a debate continues about whether and how much they suffer with the disease. Previous research suggests that females with Fabry disease may be triply disadvantaged in healthcare settings owing to: (1) disease rarity, (2) devalued carrier status, and (3) gender. The combined effects of these three factors suggest that female heterozygotes may suffer substantially with Fabry disease symptoms. A qualitative analysis of a brief disease-specific questionnaire provides supportive evidence. The female Fabry disease participants described experiencing significant symptoms that interfered with their lives. They also described unsatisfying experiences with healthcare professionals related to disease rarity, carrier status, and gender. The results of this study corroborate the suggestion that this triple disadvantage exists and may preclude appropriate management and treatment of females with Fabry disease. The role of healthcare professionals, including genetic counselors, in remedying this disadvantage is reviewed.     

Constitutive activation of the G-protein subunit Galphas within forebrain neurons causes PKA-dependent alterations in fear conditioning and cortical Arc mRNA expression

Memory formation requires cAMP signaling; thus, this cascade has been of great interest in the search for cognitive enhancers. Given that medications are administered long-term, we determined the effects of chronically increasing cAMP synthesis in the brain by expressing a constitutively active isoform of the G-protein subunit Galphas (Galphas*) in postnatal forebrain neurons of mice. Previously, we showed that Galphas* mice exhibit increased adenylyl cyclase activity but decreased cAMP levels in cortex and hippocampus due to a PKA-dependent increase in total cAMP phosphodiesterase (PDE) activity. Here, we extend previous findings by determining if Galphas* mice show increased activity of specific PDE families that are regulated by PKA, if Galphas* mice show PKA-dependent deficits in fear memory, and if these memory deficits are associated with PKA-dependent alterations in neuronal activity as mapped by Arc mRNA expression. Consistent with previous findings, we show here that Galphas* mice exhibit a significant compensatory increase in cAMP PDE1 activity and a trend toward increased cAMP PDE4 activity. Further, inhibiting the presumably elevated PKA activity in Galphas* mice fully rescues short- and long-term memory deficits in a fear-conditioning task, while extending the training session from one to four CS-US pairings partially rescues these deficits. Mapping of Arc mRNA levels suggests these PKA-dependent memory deficits may be related to decreased neuronal activity specifically within the cortex. Galphas* mice show decreased Arc mRNA expression in CA1, orbital cortex, and cortical regions surrounding the hippocampus; however, only the deficits in cortical regions surrounding the hippocampus are PKA dependent. Our results imply that chronically stimulating targets upstream of cAMP may detrimentally affect cognition.     

Pretherapy Cognitive Dispositions and Treatment Outcome in Cognitive Behavior Therapy for Insomnia

This study consisted of secondary analyses of data from 2 randomized clinical trials to test whether pretherapy cognitions predict CBT outcomes. The sample consisted of 155 primary insomnia patients with sleep maintenance complaints. Of these, 98 were randomized to CBT, 23 were assigned to progressive muscle relaxation training (PMR), and 34 were assigned to a control (sham therapy or wait-list) condition (CON). All patients completed the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), a sleep-related Self-Efficacy Scale (SES) and nightly sleep diaries for 2 weeks prior to receiving their assigned treatment. They then completed sleep diaries throughout an 8-week acute treatment period and during a 2-week period at a posttherapy follow-up. A subset of the sample (n = 67) also completed polysomnography immediately before and after completing their assigned treatment. Preliminary regression analyses conducted with a small subset (n = 15) of the patients receiving CBT showed those with relatively high levels of unhelpful sleep-related beliefs (Type 1 patients), as reflected by their pretherapy responses to the DBAS and SES questionnaires, showed markedly greater reductions in nocturnal wakefulness in response to CBT than did those (Type 2 patients) reporting less pronounced sleep-related beliefs. Given these findings, we used the regression equation derived from our initial analyses to dichotomize our entire sample into Type 1 (n = 82; 52.9%) and Type 2 (n = 73; 47.1%) subgroups. Subsequent comparisons showed CBT-treated Type 1 patients had significantly less wake time after sleep onset during most of the 8-week treatment phase than did the Type 1 and 2 individuals assigned to either PMR or CON. Relative to patients assigned to the PMR and CON conditions, CBT-treated Type 1 patients showed better performance across multiple subjective and objective benchmarks of clinically significant improvement, whereas the CBT-treated Type 2 patients did not. Results suggest that insomnia patients' pretherapy cognitive dispositions predict CBT outcome, and those with a pronounced sense of sleep-related helplessness are best suited for this treatment which targets this cognitive stance.     

Subtyping children and adolescents with loss of control eating by negative affect and dietary restraint

OBJECTIVE: Research suggests that subtyping adults with binge eating disorders by dietary restraint and negative affect predicts comorbid psychopathology, binge eating severity, and treatment outcome. Little research has explored the validity and clinical utility of subtyping youth along these dimensions. METHOD: Children (aged 8-18 years) reporting loss of control eating (n=159) were characterized based upon measures of dietary restraint and negative affect using cluster analysis, and then compared regarding disordered eating attitudes and behaviors, and parent-reported behavior problems. RESULTS: Robust subtypes characterized by dietary restraint (n=114; 71.7%) and dietary restraint/high negative affect (n=45; 28.3%) emerged. Compared to the former group, the dietary restraint/high negative affect subtype evidenced increased shape and weight concerns, more frequent binge eating episodes, and higher rates of parent-reported problems (all ps<0.05). CONCLUSION: Similar to findings from the adult literature, the presence of negative affect may mark a more severe variant of loss of control eating in youth. Future research should explore the impact of dietary restraint/negative affect subtypes on psychiatric functioning, body weight, and treatment outcome.     

Sex-specific clinical correlates of hoarding in obsessive-compulsive disorder

Little is known about whether the clinical correlates of hoarding behavior are different in men and women with obsessive-compulsive disorder (OCD). In the current study, we evaluated the association of hoarding with categories of obsessions and compulsions, psychiatric disorders, personality dimensions, and other clinical characteristics separately in 151 men and 358 women with OCD who were examined during the OCD Collaborative Genetics Study. We found that, among men but not women, hoarding was associated with aggressive, sexual, and religious obsessions and checking compulsions. In men, hoarding was associated with generalized anxiety disorder and tics whereas, among women, hoarding was associated with social phobia, post-traumatic stress disorder, body dysmorphic disorder, nail biting, and skin picking. In women but not men, hoarding was associated with schizotypal and dependent personality disorder dimensions, and with low conscientiousness. These findings indicate that specific clinical correlates of hoarding in OCD are different in men and women and may reflect sex-specific differences in the course, expression, and/or etiology of hoarding behavior in OCD.     

Prevalence and correlates of hoarding behavior in a community-based sample

Little is known about the prevalence and correlates of hoarding behavior in the community. We estimated the prevalence and evaluated correlates of hoarding in 742 participants in the Hopkins Epidemiology of Personality Disorder Study. The prevalence of hoarding was nearly 4% (5.3%, weighted) and was greater in older than younger age groups, greater in men than women, and inversely related to household income. Hoarding was associated with alcohol dependence; paranoid, schizotypal, avoidant, and obsessive-compulsive personality disorder traits; insecurity from home break-ins and excessive physical discipline before 16 years of age; and parental psychopathology. These findings suggest that hoarding may be relatively prevalent and that alcohol dependence, personality disorder traits, and specific childhood adversities are associated with hoarding in the community.     

Preference for attractive faces in human infants extends beyond conspecifics

Human infants, just a few days of age, are known to prefer attractive human faces. We examined whether this preference is human-specific. Three- to 4-month-olds preferred attractive over unattractive domestic and wild cat (tiger) faces (Experiments 1 and 3). The preference was not observed when the faces were inverted, suggesting that it did not arise from low-level image differences (Experiments 2 and 3). In addition, the spontaneous preference for attractive tiger faces influenced performance in a recognition memory task involving attractive versus unattractive tiger face pairings (Experiment 4). The findings suggest that infant preference for attractive faces reflects the activity of general processing mechanisms rather than a specific adaptation to mate choice.