The complex picture test in dementia.

The newly developed Complex Picture Test (CPT) examines main cognitive domains, especially perceptual and visual-spatial abilities. The potential usefulness of the CPT in the assessment of dementia was evaluated. Patients with different forms of dementia [14 vascular dementia (VaD), 30 Alzheimer's disease (AD), 6 Parkinson's disease dementia (PDD)], 12 subjects with mild cognitive impairment (MCI), and 30 matched controls were examined by the CPT, Mini-Mental State Examination (MMSE), the WAIS-R Digit Span subtest, and the Clock Drawing Test (CDT). The CPT consists of 10 complex pictures, each presenting characteristics paradoxically in opposition to each other. The subjects scored points for naming the object and noticing the paradox. One point was added for commenting on the paradox without prompting (3 points each picture/maximum of 30). CPT scores were significantly higher in the control group (mean ± SD, 29.46 ± 1.43) than in the AD, VaD, MCI, and PDD groups (13.1 ± 2.3, 16.9 ± 3.5, 23.2 ± 1.4, and 23.6 ± 3.4, respectively; p < 0.05). Significant positive correlations between MMSE, Digit Span, CDT, and CPT scores were observed (rho 0.76, 0.35, and 0.56, respectively). These data show perception of complex pictures being compromised in dementia. The correlation between CPT scores and MMSE scores suggests that tests may be used as a brief screening tool for dementia.

Consent to the use of stored DNA for genetics research: a survey of attitudes in the Jewish population.

The use of anonymized stored tissue is a routine practice in genetic research. Investigators who utilize stored samples are neither required nor able to obtain informed consent before each use. Many genetic studies, however, are conducted on specific ethnic populations (e.g., Ashkenazi Jews). The results in these cases, although individually anonymous, are not anonymous with respect to the ethnicity of the participants. This lack of group anonymity has led to concern about the possibility of stigmatization and discrimination based on the results of the genetic research. In the present study we surveyed Jewish individuals about their attitudes regarding the practice of using stored DNA samples for genetic research. Specifically, we were interested in whether attitudes about informed consent and willingness to participate in genetics research using stored DNA would depend on the circumstances in which the material was collected (i.e., clinical setting vs. research setting) and the characteristics of the disease or trait under investigation. Overall, most respondents reported that written informed consent should be required and that they would be willing to provide such consent. Participants were most willing to provide consent, however, when the sample had been collected in a research rather than clinical setting. Further, participants were more likely to endorse the need for obtaining consent when the sample was collected in a clinical setting. Finally, participants were significantly less willing to participate in research that examined stereotypical or potentially stigmatizing traits as opposed to research that examined medical or mental illnesses.

Should schools of nursing develop nursing centers?

This article examines the current debate about the role and worth of academically based community nursing centers. The positions and experiences of national nursing organizations, schools of nursing, organized medicine, government, and the managed care industry are considered. The underlying motivations and perspectives of each player are analyzed, and it is concluded that despite opposition from organized medicine, inconsistent support from government, and mixed messages from academia, schools of nursing should develop nursing centers. Although nursing centers in general can improve patient access to healthcare, academically based nursing centers also provide an avenue for research, training, and faculty practice.

Genetic discrimination and health insurance: a call for legislative action.

Fear of genetic discrimination in health insurance is a growing reality. Individuals who might otherwise choose genetic testing may decline it based on their fear that they or their family members will not be able to obtain or maintain health insurance coverage. This commentary notes the evolving legislative efforts to address genetic discrimination in health insurance and urges physicians to help move this legislative agenda forward.

Cancer genetic susceptibility testing: ethical and policy implications for future research and clinical practice. Cancer Genetic Studies Consortium, National Institutes of Health.

Authors examine the ethical and health policy implications in the Cancer Genetic Studies Consortium projects, which attempt to collect data on the clinical benefits and harms of cancer genetic testing. They suggest that more data are needed on the long-term physical and psychosocial effects of testing and that further examination is needed of the ethical issues raised by testing.

Feminism, law, and bioethics.

Feminist legal theory provides a healthy skepticism toward legal doctrine and insists that we reexamine even formally gender-neutral rules to uncover problematic assumptions behind them. The article first outlines feminist legal theory from the perspectives of liberal, cultural, and radical feminism. Examples of how each theory influences legal practice, case law, and legislation are highlighted. Each perspective is then applied to a contemporary bioethical issue, egg donation. Following a brief discussion of the common themes shared by feminist jurisprudence, the article incorporates a narrative reflecting on the integration of the common feminist themes in the context of the passage of the Maryland Health Care Decisions Act. The article concludes that gender does matter and that an understanding of feminist legal theory and practice will enrich the analysis of contemporary bioethical issues.

The risk of domestic violence and women with HIV infection: implications for partner notification, public policy, and the law.

Partner notification has emerged as an important strategy in the fight against acquired immunodeficiency syndrome (AIDS), and states have now adopted a plethora of laws that encourage or mandate notification, often without the patient's consent. As human immunodeficiency virus (HIV) infection continues to spread among women, the future development of AIDS control strategies and public health laws must be shaped by concern for the safety and autonomy of patients who face a risk of domestic violence. Three distinct recommendations flow from this premise. First, all HIV-infected women should be assessed for the risk of domestic violence and offered appropriate interventions. Second, where a risk of abuse is indicated, partners should never be notified without the patient's consent. State laws that presently permit involuntary notification should be repealed or amended. Third, laws that punish a patient's refusal to notify partners should also be modified or repealed.

Domestic violence and partner notification: implications for treatment and counseling of women with HIV.

Current public health policy encourages partner notification to protect those at risk of HIV infection. Provider experiences with partner notification, domestic violence, and women with HIV compel a reassessment of this strategy. In a survey of 136 health care providers in Baltimore, substantial numbers reported knowledge of their HIV-infected patients' experiences with domestic violence before and after partner notification. Providers believed that fear of physical abuse, emotional abuse, and abandonment are important reasons why many female patients resist partner notification. Provider opposition to partner notification was strong in cases where female patients faced a risk of domestic violence. The realization that HIV-infected women fear and experience domestic violence has broad implications for health care practice. The authors recommend changes in provider practices to insure that the risk of domestic violence is identified and addressed, and that partner notification strategies do not threaten the safety of HIV-infected women. They also highlight areas for further research on the connections among partner notification, domestic violence, and women with HIV.