Improving Service Evaluation in Clinical Genetics: Identifying Effects of Genetic Diseases on Individuals and Families

Outcome measurement in clinical genetics is challenging. Outcome attributes used currently have been developed by service providers or adapted from measures used in other areas of healthcare. Many of the ‘patients’ in clinical genetics are healthy but at risk of developing or transmitting a condition. Usually no pharmacological or surgical treatment is offered, although information-giving is an objective of most consultations. We argue that services should be evaluated on the basis of how well they alleviate the effects of disease, from a patient perspective. This paper describes a qualitative study using seven focus groups with health professionals, patients and patient representatives. Social and emotional effects of genetics diseases were identified. Some differences emerged between the effects identified by health professionals and those identified by patients. These findings will be used to inform the evaluation of existing outcome measures and develop robust measures of outcome for clinical genetics services.     

Licensure of Internationally Educated Nurses Seeking Professional Careers in the Province of Alberta in Canada

While the regulation of nursing practice through licensure ensures that nurses meet minimum standards for safe competent and ethical care, it also inhibits integration of immigrant internationally educated nurses (IENs) into the Canadian professional labour market. With projections of significant nurse workforce shortages by 2010, there is impetus to enhance the numbers of licensed professional nurses through multiple strategies. The licensure processes and accompanying tensions in the Canadian context are described. As professional nurse licensure in Canada is a provincial responsibility, the situation in the Province of Alberta is used as an example. Suggestions for policy development and research include needs for better data and for gender-based analysis to address barriers to IEN licensure. The ability to practice in one’s chosen profession can be a major factor in integration of immigrants into Canadian society and thus a powerful factor in attraction and retention of highly skilled immigrants.     

Cognitive and emotional control and perspective taking and their relations to empathy in 5-year-old children

The experience of empathy has been described as involving both emotional and cognitive components. The primary hypothesis tested in this study is that cognition and emotion are integrated within 2 distinct types of abilities-control and perspective taking-and that interactions between emotional and cognitive control and between affective and cognitive perspective taking would be related to children's empathic responding. We also hypothesized that boys' control and perspective-taking skills would be more strongly related to empathy than would those of girls. Fifty-seven 5-year-olds completed tasks measuring cognitive control, cognitive and affective perspective taking, and empathy, and their mothers completed a measure of children's emotional control. Results indicated that cognitive perspective taking moderated the relation between affective perspective taking and empathy. In addition, the relation between cognitive inhibitory control and empathy was moderated by gender; boys' control was positively related to empathy, but girls' control was marginally negatively related to empathy.     

Differences in risk factors for suicidality between African American and White patients vulnerable to suicide

Risk factors for suicidal ideation and attempts have been shown to differ between African Americans and Whites across the lifespan. In the present study, risk factors for suicidality were examined separately by race/ethnicity in a population of 131 older adult patients considered vulnerable to suicide due to substance abuse and/or medical frailty. In adjusted analyses, social support was significantly associated with suicidality in African American patients, while younger age and the presence of an anxiety disorder were significantly associated with suicidality in White patients. The results suggest that race/ethnicity-specific risk profiles may improve the detection of suicidality in vulnerable populations.     

Groups perform better than the best individuals on letters-to-numbers problems: effects of group size

Individuals and groups of 2, 3, 4, or 5 people solved 2 letters-to-numbers problems that required participants, on each trial, to identify the coding of 10 letters to 10 numbers by proposing an equation in letters, receiving the answer in letters, proposing a hypothesis, and receiving feedback on the correctness of the hypothesis. Groups of 3, 4, and 5 people proposed more complex equations and had fewer trials to solution than the best of an equivalent number of individuals. Groups of 3, 4, and 5 people had fewer trials to solution than 2-person groups but did not differ from each other. These results suggest that 3-person groups are necessary and sufficient to perform better than the best individuals on highly intellective problems.     

Do Extenuating Circumstances Influence African American Women's Attitudes Toward Suicide?

African American women commit suicide less than other U.S. women and men, perhaps partly due to strong, anti-suicide attitudes. To see if suicide attitudes might be softened by extenuating circumstances such as terminal illness, 192 African American and European American women imagined themselves in one of four extenuating circumstances, then completed measures of suicide acceptability and religiosity. Both ethnic groups reported a greater likelihood of suicide when imagining depression, regardless of religiosity. Religiosity, but not extenuating circumstances, corresponded with negative attitudes toward suicide and physician assisted suicide. These African American and European American young women remained steadfastly against suicide, regardless of circumstance.     

Loving, discernment, and distance: pastoral care in schizophrenia

Schizophrenia is very common in our society, yet many people, both clergy and lay, are afraid of it and do not know what to do when confronted with someone who suffers from the disorder. Strange ideas and behavior can be frightening for those who don't understand and often result in further marginalization, even within the church community. This article seeks to outline the main features of schizophrenia and considers how to deal with particular situations which may arise in pastoral care. It suggests ways of dealing with people who express religious delusions and also argues that the "staples" of pastoral care--relationship building, empathy and inclusion--may not always be appropriate in the care of people with schizophrenia, who often need a "safe distance" between themselves and others. Some practical advice for families is also offered.     

German noun plurals: a challenge to the dual-mechanism model

In this article, the authors test one of the central claims of the Dual-Mechanism Model (Pinker and Prince, 1994), that is, that regular inflection equals default inflection. Based on results from an elicitation task with eight agrammatic Broca's aphasics and a lexical decision task with unimpaired subjects, the authors show that this assumption is not borne out. Their data on German plural inflection rather indicate that regular inflection is not necessarily identical to default inflection. To capture the German data, they have to assume regular but input-restricted inflection besides regular default inflection.     

Body tilt effect on the reproduction of orientations: studies on the visual oblique effect and subjective orientations

Body tilt effects on the visual reproduction of orientations and the Class 2 oblique effect (E. A. Essock, 1980) were examined. Body tilts indicate whether the oblique effect (i.e., lower performance in oblique orientations than in vertical-horizontal orientations) is defined in an egocentric or a gravitational reference frame. Results showed that the oblique effect observed in upright posture disappeared in tilted conditions, mainly due to a decrease in the precision of the vertical and horizontal settings. In tilted conditions, the subjective visual vertical proved to be the orientation reproduced the most precisely. Thus, the oblique effect seemed to be not purely gravitationally or egocentrically defined but, rather, to depend on a subjective gravitational reference frame tilted in the same direction as body tilts.