Happy but not so approachable: the social judgments of individuals with generalized social phobia.

BACKGROUND: We examined social approachability judgments in a psychiatric population that frequently experiences interpersonal difficulties and reduced social satisfaction, individuals with generalized social phobia (gSP). METHODS: Our objective was to broaden the understanding of the social cognitive tendencies of individuals with gSP by systematically investigating their interpretation of positive facial expressions. We hypothesized that approachability ratings would be lower for positive as well as negative emotional faces in the gSP group compared to the healthy comparison group. Each participant evaluated 24 emotional faces presented on a computer screen. Participants first labeled the faces as either happy, disgust, or angry in emotional expression, and then they rated each face's approachability. Analysis of variance and post hoc analyses were used to identify group, emotion, and group by emotion rating differences. RESULTS: Happy face approachability ratings were higher than disgust and anger in both groups. The central finding was that individuals with gSP rated happy faces as less approachable than the healthy participants and that degree of social anxiety was associated with lower approachability ratings within the gSP sample. Explicit approachability judgments of negative faces did not differ as predicted. CONCLUSIONS: Consistent with earlier indirect evidence of interpretation biases of positive social emotional information, this study reveals that individuals with gSP demonstrate explicit, subjective social interpretation biases of overtly positive social feedback. The therapeutic relevance of these results is discussed.

Bedside differentiation of depressive pseudodementia from dementia.

The authors analyzed the pretreatment clinical presentations of 14 patients with depressive pseudodementia and 28 patients with primary degenerative dementia as measured by the Mini-Mental State, the Blessed Dementia Rating Scale, and the Hamilton Rating Scale for Depression. They found that patients with pseudodementia showed significantly greater pretreatment early morning awakening, higher ratings of psychological anxiety, and more severe impairment of libido. Patients with dementia, however, showed significantly more disorientation to time, greater difficulty finding their way about familiar streets or indoors, and more impairment with dressing. The authors suggest that these findings be considered preliminary.

Independent ventilation and ECMO for severe unilateral pulmonary edema after SLT for primary pulmonary hypertension.

Single lung transplantation (SLT) is now accepted therapy for selected cases of severe pulmonary hypertension. A recognized complication is the postoperative development of reperfusion edema in the graft, a potentially fatal cause of respiratory failure. Because reperfusion edema may be a reversible process, temporizing support measures can be life-saving. We report the case of a 48-year-old woman who developed severe reperfusion edema following right SLT for primary (unexplained) pulmonary hypertension. Extracorporeal membrane oxygenation (ECMO) was instituted. Independent lung ventilation was later begun and resulted in markedly improved oxygenation allowing withdrawal of ECMO. We conclude that reperfusion edema following SLT for pulmonary hypertension may be uniquely amenable to treatment with independent lung ventilation and ECMO if needed.

Dosimetry measurements and analyses of 10-MV x rays for Clinac-18.

Radiation parameters for two Varian Clinac-18 10-MV x-ray units were measured and compared with the same parameters for the Toshiba LMR-13 and the Arco Mevatron XII. Comparison of the percentage depth dose, surface dose, and depth of maximum ionization as a function of field size are presented.

Comparison of moving-strip therapy using a Cobalt-60 teletherapy unit, a Varian 4-MV linear accelerator, and a Varian 10-MV linear accelerator.

Cobalt-60 gamma rays and 4- and 10-MV x rays are compared for moving-strip therapy in terms of the dose uniformity and the given dose needed to deliver a prescribed tumor dose. Dose distributions in phantoms of 14--32-cm thickness were calculated for each therapy unit. Individual given doses which would deliver the most uniform dose along the midline of the treatment volume were determined by computer and were verified experimentally by thermoluminescent dosimetry. Using computer optimization techniques, the midplane dose uniformity is improved significantly for the three therapy units considered.

Diuresis with continuous infusion of furosemide after cardiac surgery.

We prospectively evaluated the diuretic effect of furosemide administered by bolus injection and by continuous infusion in 18 cardiac surgery patients. Nine patients were randomly assigned to receive 0.3 mg/kg of furosemide as a bolus injection at time 0 and again 6 hours later (nine patients) or 0.05 mg/kg per hour of furosemide as a constant infusion for 12 hours (nine patients). There were no significant differences between groups with respect to age, weight, creatinine clearance, changes in serum sodium and potassium levels, total urinary concentrations of sodium and potassium, or total urine volume for 12 hours. Diuresis during continuous infusion of furosemide was less variable from hour to hour than after bolus injection of furosemide and was sustained throughout the infusion period. Although the continuous infusion of furosemide will not provide the rapid and vigorous diuresis that is necessary in some clinical situations, it may be useful whenever a gentle, sustained diuresis is desired.

The reliability and factor structure of the index of spouse abuse with African-American women.

This study investigated the reliability and validity of the Index of Spouse Abuse (ISA) when used with a sample of 504 African-American women. The initial factor validity analysis for the ISA (Hudson & McIntosh, 1981) resulted in two subscales: a physical abuse scale (ISA-P) and a nonphysical abuse scale (ISA-NP). Factor analysis with this sample of African-American women revealed three factors instead of two. Coefficient alpha estimates of reliability were over .90 for the original ISA subscales and with the African-American sample. The discussion compares and contrasts the factor structure observed with the sample of African-American with the factor structure reported in the original validation studies. The study demonstrates the need to critically evaluate the extent to which instruments developed to measure spouse or partner abuse are valid and reliable when used with diverse groups that may not have been represented in the samples used for initial instrument development and validation work.

Abuse during and before pregnancy: prevalence and cultural correlates.

This study examined the prevalence of abuse during pregnancy and the influence of cultural norms and acculturation on abuse in 1,004 Mexican American, Puerto Rican, Cuban American, Central American, African American and Anglo American women. Women were recruited from consecutive delivery logs in general community hospitals in Florida and Massachusetts. The Index of Spouse Abuse and the Abuse Assessment Screen ascertained history of adult physical, sexual, and emotional abuse, abuse during pregnancy, and childhood sexual abuse. An Interview Protocol assessed cultural attitudes, acculturation, and demographic information. Hispanic American women, as a whole, did not differ significantly from Anglo American women in their prevalence of abuse during pregnancy, after controlling for sociodemographic variables. However, Cuban American and Central American partners were significantly less likely to abuse their pregnant partners than were other groups even after adjustment. Women who spoke only Spanish (less acculturated) were less likely to report physical abuse from their partners both before and during pregnancy. Cultural norms, such as a partner's belief in wife/mother role supremacy and cultural group acceptability of men hitting women, were significantly positively related to both physical and emotional abuse. Other risk factors for abuse were the abuser not being the biological father of the baby, low income and little education, and being unmarried.

Increasing minorities in higher education in nursing: faculty consultation as a strategy.

This article describes some of the issues surrounding cultural diversity in higher education in nursing. The representation of minority faculty in higher education in general, and in nursing education in particular, is inadequate to support the needs of students, faculties, and the institutions. Examples of common concerns and dilemmas faced by minority faculty demonstrate the urgent need for change to enhance the academic environment for minorities. Because the numbers of minority faculty in higher education are unlikely to change substantially within the next few years, the authors present faculty consultation as a strategy to support the cultural diversity mission of the college.

Public schools as a clinical setting for RN students.

The challenge to select meaningful clinical sites for RN students is a problem for educators. The significance of the public schools as an initial clinical site, the contribution of RNs to school health programs, student responses, and adaptations to the school setting are presented. Outcomes of the experience will interest nurse educators attempting to provide a professional education for RN to BSN students and provide a service to the community.

Biological and environmental influences in mental health care.

Principles of Preventive Psychiatry offer a logical and economical approach to mental health care delivery. This article describes two perspectives on mental health care, biological and environmental. If mental illness and related distress are perceived as biologically based, the problems are thought to be under the skin. They can then be treated with chemicals and other scientific technologies. On the other hand, if mental illness and related distress are perceived as developing from environmental factors, the problems are thought to be linked to forces external to the individual. Treatment is addressed by a modification in the environment. This approach requires changes to public policy and legislative mandates. Mental health issues including, suicide, runaway youths, homicide, the elderly and other disenfranchised groups prevalent in American society are highlighted. An integration of the biological and environmental perspectives is delineated as an approach to early diagnosis, effective treatment, and rehabilitation. Recommendations are presented that focus on population-specific interventions necessary to effectively address these conditions.

Family paradigm theory and family rituals: implications for child and family health.

Family paradigm theory explains variations in families that are based on their shared beliefs about the social world and their family's place within it. Key concepts of the theory and some of the supporting research are presented. Family rituals provide a window for viewing the family's efforts to maintain this shared concept of family identity. Suggestions for evaluating ritual use in families during times of stress and/or transition are provided. Ritual evaluation may give clues to difficulties families face in maintaining a shared identity during challenging periods of change or conflict.

Nursing care of African-American battered women: Afrocentric perspectives.

The focus of this article is on prominent Eurocentric beliefs, attitudes, and behaviors that may prevent African-American battered women from receiving effective intervention by health care professionals and other providers. Afrocentric perspectives are presented to provide an alternative context for understanding the traditions, beliefs, and behaviors that should be considered when providing care for African-American battered women. These perspectives are integrated into discussions of suspected contributions to the incidence of violence in the lives of African-American women. They also are incorporated into suggested interventions and a case study exploring nursing considerations that may be unique to providing effective care for African-American battered women.

Cultural competence in the care of abused women.

This article explains the concept of cultural competence, adding advocacy to models of culturally competent health care already in the literature and demonstrating how it relates to domestic violence. Abuse stages according to Landenburger's model of entrapment and recovery are presented with applicable cultural differences and specificities. Cultural issues related to specific childbearing-stage abuse interventions are also discussed. The principles of cultural competence, abuse- and childbearing-stage specificity, and empowerment are used as the basis for this model of clinical intervention with abused women.

Nursing interventions classification: a content analysis of nursing activities in public schools.

Nursing Interventions Classification (NIC) is an effort to describe nursing activities by using a standardized nomenclature of nursing treatments (McCloskey & Bulechek, 1992). Limited research focused on community nursing activities has been included in the Iowa Intervention Project to date. The purpose of this study was to investigate how nursing activities performed by RN baccalaureate students in the public school setting conformed to the activities and interventions classifications proposed by the Iowa Intervention Project. Nursing activities were documented by 40 RNs for 1,774 clients in the schools. Those activities conformed to 25 of the 336 NICs. Findings further demonstrated that pain management was the most frequently used NIC, and patterns of clustering of classifications were also common. Although NIC can be used, the fit is not always strong. Specific recommendations are addressed for strengthening NIC use in the public schools.

Something sinistral going on? Asymmetry in arm movement frequency.

In a test of the hypothesis that the dominant arm would be more active than the nondominant arm, 70 young adults (including 34 left-handers) wore instrumented motion recorders on both wrists for 48 hours. Participants' left arms made approximately 80 more movements per hour than did their right arms, which was unexpected. This mean difference reflected a generalised leftward shift in the distribution of the frequency of arm movements. Two-thirds of the individuals in the sample were characterised by a sinistral bias in arm movement frequencies. Degree of sinistral bias in arm movement frequency was unrelated to hand preference as measured by the Waterloo Inventory. Implications of this new asymmetry are discussed.

Optimization of dose distributions in moving-strip therapy using a minicomputer.

Optimized 60-Co dose distributions for the moving-strip technique were calculated for 3 patients using a PC-12 minicomputer program which corrects for field obliquity and changes in patient thickness. Beam profiles were measured using an ionization chamber in a water phantom. A Masonite phantom was constructed to simulate a patient and used to measure optimized and unoptimized midplane dose distributions by thermoluminescent dosimetry. Measured midplane doses agreed with computer-calculated doses within experimental error. The computer optimization technique improved dose uniformity, reducing the midplane dose variation from plus or minus 12-13% to plus or minus 3-4%.

Heart transplantation. Four years' experience with conventional immunosuppression.

This article describes four years' experience with heart transplantation using conventional immunosuppression. Twenty of 32 patients are alive. The one-year survival rates were 75% (1979), 67% (1980), and 75% (1981). Actuarial survival rates for operative survivors were 70% at one year, 60% at two years, and 51% at three years. Patients in the 50- to 55-year age group have survived as well as younger recipients. Rejection resulted in six deaths, infection in three, donor heart failure in two, and multiple organ failure in one. There were 1.5 acute rejections per patient and one infection per patient in the first three posttransplant months. Postoperative hospital stay averaged 62 days and cost a total of $58,351.

Physical and nonphysical partner abuse and other risk factors for low birth weight among full term and preterm babies: a multiethnic case-control study.

This study sought to determine the risk of low birth weight from intimate partner abuse. The case-control design was used in a purposively ethnically stratified multisite sample of 1,004 women interviewed during the 72 hours after delivery between 1991 and 1996. Abuse was determined by the Index of Spouse Abuse and a modification of the Abuse Assessment Screen. Separate analyses were conducted for 252 full term and 326 preterm infants. The final multiple logistic regression models were constructed to determine relative risk for low birth weight after controlling for other complications of pregnancy. Physical and nonphysical abuse as determined by the Index of Spouse Abuse were both significant risk factors for low birth weight for the full term infants but not the preterm infants on a bivariate level. However, the risk estimates decreased in significance in the adjusted models. Although today's short delivery stays make it difficult to assess for abuse, it is necessary to screen for domestic violence at delivery, especially for women who may not have obtained prenatal care. The unadjusted significant risk for low birth weight that became nonsignificant when adjusted suggests that other abuse-related maternal health problems (notably low weight gain and poor obstetric history) are confounders (or mediators) that help to explain the relation between abuse and low birth weight in full term infants.