Advance directives in action in a regional palliative care service: "road testing" the provisions of the Medical Treatment Act 1988 (VIC)

In order to explore the usefulness and acceptability of the provisions of the Medical Treatment Act 1988 (Vic) for palliative care patients in a rural region in Victoria, Australia, between July and December 2004 patients were given information explaining the Act and the opportunity to discuss it with the research officer. Grounded theory methodology was used to evaluate client responses. Findings suggested that palliative care patients are willing to engage in advance care planning but they have to be well enough and need skilled, practical, face-to-face assistance to complete the required legal forms. Written materials alone are not adequate, but provide the opportunity for medical staff to have conversations about death and dying. Doctors and nurses should understand the provisions of the Act to assist patients and families. It is recommended that advance care planning, appropriate to the jurisdiction, be an integral part of the palliative care assessment process.     

Mitochondrial DNA typing screens with control region and coding region SNPs

Mitochondrial DNA (mtDNA) analysis has found an important niche in forensic DNA typing. It is used with highly degraded samples or low-copy number materials such as might be found from shed hair or bones exposed to severe environmental conditions. The primary advantage of mtDNA is that it is present in high copy number within cells and therefore more likely to be recovered from highly degraded specimens. A major disadvantage to traditional forensic mtDNA analysis is that it is time-consuming and labor-intensive to generate and review the 610 nucleotides of sequence information commonly targeted in hypervariable regions I and II (HVI and HVII) of the control region. In addition, common haplotypes exist in HVI/HVII mtDNA sequences that can reduce the ability to differentiate two unrelated samples. In this report we describe the utility of two newly available screening assays for rapid exclusion of non-matching samples. The LINEAR ARRAY mtDNA HVI/HVII Region-Sequencing Typing Kit (Roche Applied Science, Indianapolis, IN) was used to type 666 individuals from U.S. Caucasian, African American, and Hispanic groups. Processing of the LINEAR ARRAY probe panels "mito strips" was automated on a ProfiBlot workstation. Observable variation in 666 individuals is reported and frequencies of the mitotypes within and between populations are presented. Samples exhibiting the most common Caucasian mitotype were subdivided with a multiplexed amplification and detection assay using eleven single nucleotide polymorphisms in the mitochondrial genome. These types of screening assays should enable more rapid evaluation of forensic casework samples such that only samples not excluded would be subjected to further characterization through full HVI/HVII mtDNA sequence analysis.     

Screening for Malingering in a Correctional Setting

This study outlines the development of the Screening SIRS, an abbreviated version of the Structured Interview of Reported Symptoms (SIRS), for use as a screening measure of malingering in a correctional setting. Seventy-five inmates complaining of psychological impairment were tested for malingering. A subset of the participants was given both the original SIRS and the Screening SIRS as a separate test with the test order counterbalanced; the remainder were given the original SIRS and a derived classification was determined by extracting the Screening SIRS scale scores. Using Receiver Operating Characteristic analyses, classification based on the Screening SIRS was significantly better than chance. With a sensitivity of 87% and specificity of 73%, the Screening SIRS was highly predictive of classifications based on the original SIRS. These findings have instrumental implications in correctional settings where identification of possible malingerers through a screening procedure may facilitate optimal allocation of resources.     

Body Dissatisfaction Among Adolescent Boys and Girls: The Effects of Body Mass,Peer Appearance Culture and Internalization of Appearance Ideals

Body image dissatisfaction is a significant risk factor in the onset of eating pathology and depression. Therefore, understanding predictors of negative body image is an important focus of investigation. This research sought to examine the contributions of body mass, appearance conversations with friends, peer appearance criticism and internalization of appearance ideals to body dissatisfaction among adolescents. The sample was comprised of 239 (54% female) adolescents, with a mean age of 16 years. Self-report questionnaires were completed on body dissatisfaction, peer appearance conversations and criticism, internalization of appearance ideals, height and weight. For girls and boys, body mass, appearance conversations with friends, peer appearance criticism and internalized appearance ideals emerged as significant predictors of body dissatisfaction. Gender moderated the effect of body mass on body dissatisfaction. Internalization mediated the relationship between peer appearance conversations and criticism, and body dissatisfaction. These findings suggest that while body mass exerts a differential risk for body dissatisfaction among boys and girls, internalisation may represent a key psychological process that underpins body dissatisfaction among both boys and girls.     

Early Pubertal Timing and Girls’ Problem Behavior: Integrating Two Hypotheses

Girls’ early pubertal timing has been linked in many studies to behavioral problems such as delinquency and substance use. The theoretical explanations for these links have often involved the girls’ peer relationships, but contexts have also been considered important in some explanations. By integrating two theoretical models, the peer-socialization and the contextual-amplification hypotheses, we propose a contextual framework for explaining the link between early pubertal timing and external problem behavior in girls. We hypothesize that early developing girls engage in unhealthy, dangerous, and risky behavior under contextual conditions that promote access to older friends and opposite-sex relationships. Under other conditions it is less likely. We tested this integrated hypothesis in two studies conducted in Sweden. The first was a cross-sectional study with information about school and free-time friends in a community sample (N = 284). Early pubertal timing was linked to having older, more normbreaking friends outside of school, but not in school, thus suggesting that the school context interferes early-developing girls’ selection of older peers. The second study involved both a longitudinal (N = 434) and a cross-sectional sample of girls (N = 634), where we examined a leisure setting that is known to attract delinquent youth. Results showed that early pubertal timing was most strongly linked to delinquency for girls who spent time in this context and were heavily involved with boys and peers. In sum, results from both studies supported our predictions that certain contexts would amplify the peer-socialization effect. Overall, we conclude that the integrated peer-socialization/contextual-amplification model satisfactorily explains the link between pubertal timing and external problem behavior.     

Homelessness Among Lesbian,Gay, and Bisexual Youth: Implications for Subsequent Internalizing and Externalizing Symptoms

Although lesbian, gay, and bisexual (LGB) youth with a history of homelessness (running away or being evicted from their homes by parents) report more psychological symptoms than homeless heterosexual peers, it is unclear whether symptoms are due to homelessness, given the absence of a non-homeless comparison group. This study longitudinally investigates whether LGB youth with a history of homelessness report more subsequent psychological symptoms than non-homeless LGB youth and examines potential mediators of any such relationships. Of the 156 LGB youth interviewed (49% female; 78% non-White), 48% reported past homeless experiences. Homelessness was associated with subsequent symptoms of anxiety, depression, conduct problems, and substance abuse and to changes in symptoms over time even after controlling for childhood sexual abuse and early development of sexual orientation. Stressful life events, negative social relationships, and social support from friends mediated the relationships between homelessness and symptomatology. These findings suggest the need for interventions to reduce stress and enhance social support among LGB youth with a history of homelessness in order to reduce psychological symptoms.     

Timing of menarche,preparation, and initial menstrual experience: Replication and further analyses in a prospective study

The goals of this study were to assess the significance of two timing variables (objective timing of menarche and subjective timing, i.e., the belief—not necessarily true—about one's status as early, average, or late maturing) and two cognitive variables (preparation for menstruation and ego functioning) as predictors of the experience of menarche. Subjects were 92 girls who changed from pre- to postmenarcheal between two test occasions, six months apart. Findings were that subjective timing of menarche and preparation were significant predictors of menarcheal experience, while objective timing and ego functioning were not. The results replicated earlier findings based on cross-sectional analyses. Interpretation of the results suggested some directions for further exploration of determinants of initial menstrual experience.This research was supported by National Institute of Child Health and Human Development Grant 16034 to the first two authors.Received Ph.D. from Clark University. Major interest is in clinical-developmental psychology.Received Ph.D. from Tufts University. Major interests are psychobiology and adolescent development.Received Ph.D. from Brandeis University. Major interest is early adolescent girls' development.     

Consistency of adolescents' self-report of sexual behavior in a longitudinal study

This study examines three issues relevant to adolescent self-reported sexual behavior: the extent to which adolescents rescind reports of sexual intercourse, changes in reporting of lifetime sexual intercourse, and changes in reported age at first sexual intercourse. Data come from a three-year longitudinal study of health-compromising behaviors among a cohort a 758 rural adolescents. Students completed a self-administered questionnaire on health behaviors annually in eighth, ninth, and tenth grades. Findings show that 88.8% of students in eighth grade and 94.3% in ninth grade who reported having had sexual intercourse gave the same answer in a subsequent year. Approximately 15% of students reported fewer numbers of lifetime sexual intercourse experiences in tenth grade than they did in ninth grade. Age at first sexual intercourse was reported inconsistently by 67% of the students. Inconsistency rates differed by racial-gender groups, question sensitivity, and prior sexual experience.Received Ph.D. from Johns Hopkins University. Research interests include adolescent health and early adolescent development.Received Ph.D. from Johns Hopkins University. Research interests include personality, stress, and coping.Received Ph.D. from University of Chicago. Research interests include adolescent delinquency and substance use.Received Dr. P.H. from Johns Hopkins University. Research interests include rural adolescents and international health issues.Received Ph.D. from Johns Hopkins University. Research interests include adolescent sexuality and contraceptive decision making.