Eugenics and its relevance to contemporary health care

Psychiatric Medication, African Americans and the Paradox of Mistrust

OBJECTIVES

To examine race differences in how generalized mistrust, mistrust in physicians, and mistrust in psychiatric medication shape the willingness to utilize psychiatric medication.

METHODS

Data was used from two waves (1998 and 2006) of the U.S. General Social Survey a representative sample of non-institutionalized Americans. We analyzed data for 343 African American and 1,920 white adults, ages 18-89. The data included measures of the respondents' willingness to utilize psychiatric medication as well as measures of generalized mistrust, mistrust in physicians, and mistrust in psychiatric medication. We employed ordinary least squares regression to test whether these three forms of mistrust reduce the black-white gap in psychiatric drug usage and whether race moderates the association between any type of mistrust and the willingness to endorse psychiatric medication utilization.

RESULTS

Mistrust in physicians and psychiatric medication is related to less willingness to utilize psychiatric medicines for both African Americans and whites; however, paradoxically, these forms of mistrust decrease psychiatric drug usage more steeply for whites.

CONCLUSIONS

The pattern of findings in this study suggests that trust or low levels of mistrust, rather than high levels of mistrust, actually maintains the black-white difference in the use of psychiatric medication.

The social and ethical implications of changing medical technologies: the views of people living with genetic conditions

This article presents empirical data on subjective levels of health and quality of life for individuals with early- or late-onset genetic conditions. Twelve adults with an early-onset condition (cystic fibrosis) and 12 adults with a late-onset condition in the family (Huntington's disease) participated in semi-structured interviews. Questions investigated perceptions of the body, quality of life and views on medical technology and testing. Transcripts were thematically analysed using a qualitative methodology (interpretative phenomenological analysis). The article focuses on the superordinate theme of 'What is a life worth living?'. Different emphases in judgements and definitions of quality of life were uncovered. At the same time the article emphasizes the convergence between the two groups in terms of overall views of quality of life and confirms that the voices of people living with genetic conditions should form part of wider bioethical debates arising from such advances.

Critical social theory approach to disclosure of genomic incidental findings

Technology has expanded genomic research and the complexity of extracted gene-related information. Health-related genomic incidental findings pose new dilemmas for nurse researchers regarding the ethical application of disclosure to participants. Consequently, informed consent specific to incidental findings is recommended. Critical Social Theory is used as a guide in recognition of the changing meaning of informed consent and to serve as a framework to inform nursing of the ethical application of disclosure consent in genomic nursing research practices.

The Association between Race and Attitudes about Predictive Genetic Testing

Objective: To investigate differences in attitudes about predictive genetic testing for cancer risk between African-American and Caucasian residents of the city of Philadelphia. Methods: Cross-sectional survey of awareness of and attitudes about predictive genetic testing, using an instrument developed through focus groups with the general public, literature review, and expert opinion. Setting: Municipal County Courthouse of Philadelphia. Respondents: Male and female adults waiting to be assigned to jury duty. Results: Of the 430 respondents, 43% (170) were African-American and 45% (181) Caucasian. Awareness of predictive genetic testing was higher among Caucasians (72%) than African-Americans (49%). After adjustment for age, gender, and educational attainment, African-Americans were more likely to report that the government would use genetic tests to label groups as inferior, and less likely to endorse the potential health benefits of testing, including “help my doctor manage my health care,” “help me change my lifestyle,” and “help scientists find cures for diseases.” These associations remained if the sample was restricted to participants who had heard of genetic testing before the survey. Conclusions: In the city of Philadelphia, awareness of and attitudes about predictive genetic testing for cancer risk differ by race, with lower awareness, less belief in the potential benefits of testing, and more concern about racial discrimination from genetic testing among African-Americans than Caucasians. These differences may result in disparities in the uptake of predictive genetic testing in the future.

A multitrait-multisource confirmatory factor analytic approach to the construct validity of ADHD rating scales

Confirmatory factor analysis was used to model a multitrait-multisource design to evaluate the construct validity of attention-deficit/hyperactivity disorder (ADHD) rating scales. The 2 trait factors were the ADHD inattention and hyperactivity/impulsivity dimensions. The 2 source factors were parents and teachers. In Study 1, parents and teachers rated 1,475 Australian elementary school children on the ADHD symptoms. In Study 2, parents and teachers rated 285 Brazilian elementary school children on the ADHD symptoms. Similar results occurred in both studies with most of the ADHD symptoms containing more source than trait variance, thus providing weak evidence for the convergent and discriminant validity of the symptoms as measured by rating scales. The study outlines the implications of such strong source effects for understanding ADHD.