The relationship between sleep problems and working memory in children born very preterm

In two studies, the relationship between sleep and working memory performance was investigated in children born very preterm (i.e., gestation less than 32 weeks) and the possible mechanisms underlying this relationship. In Study 1, parent-reported measures of snoring, night-time sleep quality, and daytime sleepiness were collected on 89 children born very preterm aged 6 to 7 years. The children completed a verbal working memory task, as well as measures of processing speed and verbal storage capacity. Night-time sleep quality was found to be associated with verbal working memory performance over and above the variance associated with individual differences in processing speed and storage capacity, suggesting that poor sleep may have an impact on the executive component of working memory. Snoring and daytime sleepiness were not found to be associated with working memory performance. Study 2 introduced a direct measure of executive functioning and examined whether sleep problems would differentially impact the executive functioning of children born very preterm relative to children born to term. Parent-reported sleep problems were collected on 43 children born very preterm and 48 children born to term (aged 6 to 9 years). Problematic sleep was found to adversely impact executive functioning in the very preterm group, while no effect of sleep was found in the control group. These findings implicate executive dysfunction as a possible mechanism by which problematic sleep adversely impacts upon cognition in children born very preterm, and suggest that sleep problems can increase the cognitive vulnerability already experienced by many of these children.     

Development and Evaluation of a Telephone Communication Protocol for the Delivery of Personalized Melanoma Genomic Risk to the General Population

Communicating personalized genomic risk results for common diseases to the general population as a form of tailored prevention is novel and may require alternative genetic counseling service delivery models. We describe the development and evaluation of a communication protocol for disclosing melanoma genomic risk information to the asymptomatic general population and assess participants’ satisfaction and acceptability. Participants (n?=?117) were aged 22–69 years, living in New South Wales, Australia and unselected for family history. They provided a saliva sample and had genomic testing for melanoma for low to moderate penetrant melanoma susceptibility variants in 21 genes. Participants could choose to receive their results from a genetic counselor via telephone, followed by a mailed booklet or to receive their risk result via mailed booklet only with a follow-up call for those at high risk. A follow-up questionnaire was completed by 85% of participants 3-months later. Most participants (80%) elected to receive their result via telephone. Participants were highly satisfied with the delivery of results (mean 3.4 out of 4, standard deviation 0.5), and this did not differ by delivery mode, risk category, age or sex. On follow-up, 75% accurately recalled their risk category, 6% indicated a preference for a different delivery mode, either electronic or face-to-face. The process of disclosing genomic risk results to the general population over the telephone with accompanying written material was feasible and acceptable, and may be useful for communicating polygenic risk for common diseases in the context of increasing demands for genomic testing.     

Clergy Wellness: An Assessment of Perceived Barriers to Achieving Healthier Lifestyles

This study sought to obtain a better understanding of how clergy view their health and to investigate their self-reported health status. Additionally, this study sought to explore personal and professional barriers among clergy to living a healthier life. An electronic 32-item survey was sent to all practicing clergy in Kansas East and West conferences of United Methodist church by the Kansas Area Office of the United Methodist Church. Survey items included participants’ demographic information and health conditions (e.g., diabetes, heart disease, high blood pressure, high cholesterol). The self-reported general health, mental health, and physical health data were also collected to compare to the general population in Kansas. Clergy were also asked to identify perceived barriers to health. A total of 150 clergy participated in the survey. The majority (93.7 %) self-reported their health as good, very good, or excellent. Participating clergy self-reported a higher prevalence of chronic diseases (diabetes, heart disease, high blood pressure, and high cholesterol) than the Kansas general population, but those differences were not statistically significant. More than three-fourths (77.4 %) of the participating clergy reported weights and heights that classified them as either overweight or obese. Lack of family time was the most frequently reported personal barrier to achieving a healthier lifestyle. An unpredictable work schedule was reported as the most frequent professional barrier to achieving a healthier lifestyle. This study suggests that Kansas clergy generally view their overall health status favorably despite being overweight or obese. Clergy also self-reported higher prevalence of chronic diseases than the general Kansas population, though the prevalence was not statistically different. This study provides additional insight into clergy health and offers suggestions to address the barriers preventing clergy from working toward better health.     

Purpose in life in emerging adulthood: Development and validation of a new brief measure

Accruing evidence points to the value of studying purpose in life across adolescence and emerging adulthood. Research though is needed to understand the unique role of purpose in life in predicting well-being and developmentally relevant outcomes during emerging adulthood. The current studies (total n = 669) found support for the development of a new brief measure of purpose in life using data from American and Canadian samples, while demonstrating evidence for two important findings. First, purpose in life predicted well-being during emerging adulthood, even when controlling for the Big Five personality traits. Second, purpose in life was positively associated with self-image and negatively associated with delinquency, again controlling for personality traits. Findings are discussed with respect to how studying purpose in life can help understand which individuals are more likely to experience positive transitions into adulthood.     

Exploring Relationships Between Negative Cognitions and Anxiety Symptoms in Youth With Autism Spectrum Disorder

Although cognitions are central to the conceptualization and treatment of anxiety in typically developing (TD) youth, there is scant research investigating automatic thoughts and their relationship with anxiety in youth with autism spectrum disorder (ASD). We sought to examine the types of automatic thoughts experienced by youth with ASD and co-occurring anxiety as well as the predictive relationship of anxiety to different types of automatic thoughts in 97 children, ages 8-14 years. We also explored the relationship of automatic thoughts and intolerance of uncertainty. Consistent with prior data, there was a strong relationship between anxiety and automatic thoughts pertaining to social and physical threat. Anxiety and IU were independently associated with thoughts pertaining to personal failure which raises the hypothesis that personal failure may serve as a common pathway between anxiety, IU, and depression in ASD youth. These findings highlight the importance of assessing and treating negative cognitions in youth with ASD and anxiety.     

“Compliance” to “Concordance”: A Critical View

Advocates of “concordance” describe it as a new model of shared decision-making between physicians and patients based on a partnership of equals. “Concordance” is meant to make obsolete the notion of “compliance,” in which patients are seen as, ideally, following doctors’ orders. This essay offers a critical view of concordance, arguing that the literature itself on concordance, including materials at the web site of Medicines Partnership, the implementation arm in Great Britain of the concordance model, is full of contradiction; concordance, in fact, harbors an ideology of compliance. The essay suggests that an improvement in patient medication use will more likely come from a frank consideration of the relation of compliance issues and commercial ones, and that a key question across domains is, “how are patients/health agents/consumers persuaded to acquire certain drugs and take them as directed?”     

Compulsive perseveration: empirical criticism on the mood-as-input model

It has been proposed that the "Mood as Input" model provides an explanation of the perseverative nature of Obsessive Compulsive (OC) behaviour (MacDonald, B. C., & Davey, G. C. L. (2005). A mood-as-input account of perseverative checking: The relationship between stop rules, mood and confidence in having checked successfully. Behaviour Research and Therapy, 43, 69-91). The model implies that task perseveration occurs when individuals (a) experience a bad mood and (b) ask themselves "did I do as much as I can?" In two earlier experiments with healthy participants (MacDonald, B. C., & Davey, G. C. L. (2005). A mood-as-input account of perseverative checking: The relationship between stop rules, mood and confidence in having checked successfully. Behaviour Research and Therapy, 43, 69-91) it was found that when the allegedly critical conditions were met (negative mood and "did I as much as I can?" stop rule) perseveration occurred on a complex text-correction task. This finding was held to support a "mood as input" explanation of compulsive perseveration. It is important to note, however, that perseveration in clinical samples occurs for very simple "tasks" (e.g. closing a door or washing ones hands) and perseveration does not increase efficacy of performance. In the present study we compared the effects of the original task to effects of text correction tasks that were simpler and more OCD-like. The original effects were replicated: the combination of negative mood and the "did I do as much as I can" stop rule provoked perseveration. Meanwhile, "perseveration" was highly functional: the more "perseveration" the more text-errors were detected. Secondly, to the degree that tasks became simpler and more OCD-like, less checking occurred and the effects of the "did I do as much as I can?" stop rule on detection of errors became smaller. The findings raise questions about the validity of the paradigm as a model of OC perseveration.     

Increasing Utilization of Cancer Genetic Counseling Services Using a Patient Navigator Model

Rarely has utilization of genetic counseling for Hereditary Breast and Ovarian Cancer (HBOC) been studied separately from utilization of testing. At Kaiser Permanente Colorado, consistently only 30% of all members referred for HBOC attend genetic counseling. To increase the volume of genetic counseling appointments, a patient navigator approach was pilot tested in a randomized-controlled trial over 3 months. A total of 125 members were referred for HBOC genetic counseling (55 randomized to PN, 70 randomized to usual care). Utilization of referrals for Navigator-assisted members was 44%, compared to 31% in the usual care arm (p=0.16). The patient navigator significantly decreased time to appointment, with over 80% of Navigator-assisted members seen for genetic counseling less than three months from referral date, compared to 32% in usual care (p=0.002). patient navigator assistance shortens time from referral to appointment for HBOC genetic counseling, and may increase utilization of such services.     

Equality: A Continuing Dialogue

We reply to discussions of Equality: From Theory to Action by Harry Brighouse, Joanne Conaghan, Cillian McBride and Stuart White. We find many of their points helpful and treat them as a useful contribution to a continuing dialogue on egalitarianism.