Mindfulness Among Genetic Counselors Is Associated with Increased Empathy and Work Engagement and Decreased Burnout and Compassion Fatigue

Genetic counselors experience high rates of compassion fatigue and an elevated risk for burnout, both of which can negatively impact patient care and retention in the profession. In other healthcare professions, mindfulness training has been successfully used to address similar negative psychological sequelae and to bolster empathy, which is the foundation of our counseling work. We aimed to assess associations between mindfulness and key professional variables, including burnout, compassion fatigue, work engagement, and empathy. Data were collected via an anonymous, online survey that included validated measures of mindfulness and these key professional variables. The survey was completed by 441 genetic counselors involved in direct patient care. Half of the respondents (50.1%) reported engaging in yoga, meditation, and/or breathing exercises. Mindfulness was positively correlated with work engagement (r?=?0.24, p?<?0.001) and empathy (as measured through four subscales: perspective taking (r?=?0.15, p?=?0.002), empathic concern (r?=?0.11, p?=?0.03), fantasy (r?=???0.11, p?=?0.03) and personal distress (r?=???0.15, p?=?0.001)). Mindfulness was negatively correlated with compassion fatigue (r?=???0.48, p?<?0.001) and burnout (r?=???0.50, p?<?0.001). Given these findings, mindfulness training may be a valuable addition to graduate and continuing education for genetic counselors. The integration of mindfulness into the genetic counseling field will likely improve professional morale and well-being, while promoting workforce retention and bolstering the relational and counseling aspects of our clinical work.     

Emotion Regulation in Families of Children with Behavior Problems and Nonclinical Comparisons

The current study compared parents’ emotion regulation (ER) in clinical (those with a child with externalizing behavioral problems) and low-risk comparison families. Additionally, mediation models were explored with parent ER predicting child behavior problems through child ER. Participants were 60 families with children (71.7% boys; 73% Caucasian) ages 2 through 8 years (M?=?4.62; SD?=?1.69) from a rural population in the United States: 34 clinical families referred for parent training and 26 nonclinical families. A blocking design was used to balance the two groups on key demographic characteristics. Parents’ and children’s ER was assessed using parent-report surveys and structured behavioral observations. Analyses indicated higher rates of parental emotion dysregulation (specifically, more difficulty when upset with achieving goal-directed behaviors, p?=?.01, d?=?0.67; controlling impulses, p?=?.01, d?=?0.64; limited use of ER strategies, p?=?.02, d?=?0.62; and more negative verbalizations to their child during the observed task, p?<?.01, d?=?0.73) and child emotion dysregulation (specifically, more difficulty as reported by parents, p?<?.01, d?=??2.42) in the clinical group. Mediational analyses indicated there were indirect paths from parental ER to children’s behavioral problems through child ER. Findings from this research suggest a need to measure and target ER in both parents and their children when working with families who are referred for treatment of child behavior problems.     

Reproductive Health CHOICES for Young Adults with Sickle Cell Disease or Trait: Randomized Controlled Trial Outcomes over Two Years

Interventions to assist reproductive health decision-making in populations affected by sickle cell disease (SCD) or trait (SCT) lack proven efficacy over time. Our aim was to compare effects of CHOICES, a Web-based multimedia education program on implementing informed reproductive plans, and usual care education (e-Book) on reproductive knowledge, intention, and behavior over 24 months. We randomized 234 participants with SCD (n?=?138) or SCT (n?=?96) (age 18–35 years, 35 % male, 94 % African American) to CHOICES and e-Book groups. Participants completed a sickle cell-specific reproductive measure before and four times after the intervention (6, 12, 18 and 24 months). Compared to the e-Book group the CHOICES group had significantly more improvement in knowledge over time (p?=?.004) but not intention (p?=?.18) or behavior (p?=?.69). At baseline, 114 (48.7 %) participants reported having partners who would not put the couple at risk for their children inheriting SCD. Of the 116 (49.6 %) at-risk participants, a higher poroportion of those who were in the CHOICES group chose partners that reduced their risk by the last visit than the e-Book group (p?=?.04). Study findings provide important insights for designing a national trial of the CHOICES intervention focusing on subjects whose partner status puts them at risk for having a child with SCD.     

Effects of Individual,Peer, and Family Factors on Child Alcohol Abuse in Ukraine

The present study aims to estimate the relationship between child alcohol problems, sociodemographic characteristics, externalizing behavior, parental and peer alcohol use, and family violence by using a cross-sectional community sample of 320 Ukrainian children (9–16 years of age, 50% boys) and their parents. Participants answered questions from the Drinking and Drug History and Current Use Patterns Questionnaire, the Revised Conflict Tactics Scales, the Alabama Parenting Questionnaire, and the Child Behavior Checklist. Fifty-two percent of children reported alcohol use within the past year and 32% experienced alcohol-related problems. The average number of reported alcohol problems was 11.19 (SD?=?63.65). Five robust regression models examined correlates of early problem drinking in Ukraine. The final model indicated older child age (β?=?0.21, p?<?0.001), more symptoms of externalizing behavior (β?=?0.17, p?<?0.01), and higher peer alcohol use (β?=?0.23, p?<?0.001) were significantly and positively associated with child alcohol problems. Results of the final model explained 32% of the variance in child alcohol problems, F(8, 311)?=?10.76, p?<?0.001. In conclusion, the findings suggest that older age, exposure to high-risk alcohol permeated peer environments, impulsivity, and rule-breaking behaviors are linked with the trajectory of early alcohol abuse among Ukrainian children. Mechanisms that reduce the harmful influence of these risk factors on alcohol consumption need to be in place.     

Eating Disorders in an Israeli Women’s Prison: Correlates of the Risk

Extensive rates of child abuse and neglect (CAN), substance abuse disorders (SUDs), and mental health problems have been reported among incarcerated women. The link between CAN, SUDs, and eating disorders is well-documented, but little is known about the eating-disorder behaviors of incarcerated women. The purpose of this study was (a) to explore eating-disorder behaviors among incarcerated women in Israel; (b) to examine whether certain types of CAN are associated with eating disorders; and (c) to study the link between CAN, SUDs, mental health problems, and eating disorders. This cross-sectional study investigated eating-disorder behaviors in a sample of 62 incarcerated women in Israel. The findings indicated a high prevalence of eating disorders among incarcerated women; almost 70% exhibited the drive for thinness, which is considered a central feature of eating disorders. In addition, the findings revealed a high prevalence of CAN (84.2%), especially emotional abuse (57.9%) and emotional neglect (73.7%). I also found a high rate of co-occurrence of CAN, SUDs, mental health problems, and eating disorders. Bulimia nervosa, ineffectiveness, and low impulse regulation were found to be associated with SUDs and mental health problems (p?=?0.006, p?=?0.032, and p?<?0.001, respectively). The findings highlight the intersection of trauma with self-destructive behaviors, including co-occurrences of SUDs, eating disorders, and severe mental health problems as a result of negative childhood experiences, suggesting a need for simultaneous treatment interventions.     

General and Domain-Specific Effectiveness of Cognitive Remediation after Stroke: Systematic Literature Review and Meta-Analysis

Cognitive remediation (CR) has been shown to improve cognitive abilities following a stroke. However, an updated quantitative literature review is needed to synthesize recent research and build understanding of factors that may optimize training parameters and treatment effects. Randomized controlled trials of CR were retrieved from seven electronic databases. Studies specific to adult stroke populations were included. Treatment effects were estimated using a random effects model, with immediate and longer-term follow-up outcomes, and moderator effects, examined for both overall and domain-specific functioning. Twenty-two studies were identified yielding 1098 patients (583 in CR groups). CR produced a small overall effect (g?=?0.48, 95% CI 0.35–0.60, p?<?0.01) compared with control conditions. This effect was moderated by recovery stage (p?<?0.01), study quality (p?=?0.04), and dose (p?=?0.04), but not CR approach (p?=?0.63). Significant small to medium (g?=?0.25–0.75) post-intervention gains were evident within each individual outcome domain examined. A small overall effect (g?=?0.27, 95% CI 0.04–0.51, p?=?0.02) of CR persisted at follow-up (range 2–52 weeks). CR is effective and efficient at improving cognitive performance after stroke. The degree of efficacy varies across cognitive domains, and further high-quality research is required to enhance and sustain the immediate effects. Increased emphasis on early intervention approaches, brain-behavior relationships, and evaluation of activity and participation outcomes is also recommended.     

Antisocial Process Screening Device Subscales Predict Recidivism in an Australian Juvenile Offender Sample

The present study is the first to examine the psychometric properties of the self-report Antisocial Process Screening Device (APSD-SR), and the predictive utility of its subscales for reoffending, among Australian juvenile offenders (N?= 308, M age = 17.00, SD?=?1.49). Exploratory factor analysis supported a modified three-factor structure in which four items loaded differently to prior studies. Total APSD-SR and modified subscale scores were positively associated with criminal history and mental health problems (e.g., internalizing and externalizing problems, alcohol and substance abuse/dependence). Survival analyses indicated that youth scoring high on the APSD-SR total score were faster to reoffend nonviolently (Hazard Ratio [HR]?= 1.31, p?=?.0003) and violently (HR?=?1.42, p?=?.0003) than those scoring low. Whereas the modified grandiose-manipulative subscale predicted faster time to nonviolent recidivism (HR?=?1.18, p?=?.026) as a single predictor, when all subscales were simultaneously entered into the model only callous-unemotional (CU) traits and impulsivity predicted nonviolent recidivism (HR?=?1.19, p?=?.026 and 1.22, p?=?.015, respectively), and only impulsivity predicted violent recidivism (HR?=?1.26, p?=?.014). Findings inform current understanding of the relative contribution of adolescent psychopathy dimensions to designating a particularly high-risk group of Australian youth in custody.     

EFL Teachers’ Verbal and Nonverbal Immediacy: A Study of its Impact on Students’ Emotional States,Cognitive Learning,and Burnout

Effective teacher–student interaction is an essential element of an ideal classroom which promotes the opportunity for expanded learning and stimulates the connections between students and teacher. The focus of the present study is on an instructional communication element that is teacher immediacy. It is defined as the mutual sensory and psychological stimulation between teacher and students. It can be verbal or nonverbal. Verbal immediacy is characterized as stylistic differences in expression from which like–dislike is inferred and includes using humor or personal examples, getting feedback, or even calling students by name. Nonverbal immediacy encompasses behaviors such as appropriate eye contact, the use of gestures, movement about the classroom, smiling, and vocal variety. In particular, the present study sought to explore the impact of English as a foreign language (EFL) teachers’ perceived verbal/nonverbal immediacy on students’ self-actualization, stress-control, and self-esteem. Moreover, it examined the role of EFL teachers’ immediacy behaviors in students’ cognitive learning and emotional exhaustion, which is a burnout subscale. To this end, 206 EFL students participated from selected universities of Mashhad, a city in northeast of Iran. The respondents were asked to complete five inventories about themselves and the previous EFL teacher they had had classes with. The results of structural equation modeling demonstrated that teacher immediacy behavior had a positive significant impact on all student-related variables: stress tolerance (β?=?.65, t?=?7.59), self-actualization (β?=?.69, t?=?8.02), self-esteem (β?=?.63, t?=?7.71), burnout (β?=?.31, t?=?4.05), and cognitive learning (β?=?.45, t?=?6.08). The highest impact was exerted on self-actualization and self-esteem.     

The Treatment of Childhood Disruptive Behavior Disorders in Ambulatory Mental Health Centers

Over the years, evidence-based treatments for children with disruptive behavior disorders (DBDs; e.g., conduct disorder, oppositional defiant disorder) have been developed, however, there is not much information about the treatment children receive in usual mental healthcare settings. This study examined the common treatment provided in US ambulatory mental health clinics to children aged 3 to 9 years who are diagnosed with DBDs. An online survey was filled by appropriate respondents from 145 ambulatory mental health centers across 33 states within the US. The most common treatment provided for childhood DBDs was a combination of child therapy (CT) and parent training (PT) (n?=?81, 56%), followed by family therapy (n?=?42, 29%), CT (n?=?17, 12%), and PT (n?=?5, 3%). Behavioral and cognitive principles were reported as the most common treatment orientations across all types of treatment (n?=?116/145, 80%). The mean number of sessions administered was 31.38?±?22.72, and PT as a standalone treatment required approximately a third of sessions (10.6?±?1.34). In treatments combining CT and PT, the utilization of specific parenting programs was associated with fewer administered sessions. Results suggest that the importance of parental involvement in treating DBDs is acknowledged in routine practice. However, more studies are needed to determine why certain types and orientations of treatments are favored over others.     

Effect of Body Image on Tunisian Women’s Sexual Functioning

The objective of this study was to identify the perception of body image by Tunisian women and their spouses and to examine its impact on female sexuality. Our study involved 300 Tunisian women who had been married for at least 1 year and consulted in primary care medicine during the months of June and July 2016. Each participant completed a questionnaire covering four areas: women’s perception of their body, the perception of the spouses of the latter as it was reported by the participants, sexual activity, and the impact of body perception on sexual activity. The participants were satisfied with their bodies in 51% of cases. This satisfaction was associated with perceiving the body as physically attractive (p?=?0.007), young (p?=?0.047) and as a source of confidence (p?<?0.001). Compared to women dissatisfied with their bodies, those satisfied declared satisfaction of sexual desire (p?=?0.005), reaching orgasm (p?=?0.001), taking the initiative in sexual activity (p?=?0.003) and preparation for sex (p?=?0.006). Perceived satisfaction of the partner with the female body was related to a more positive sexuality in women, specifically to women’s sexual satisfaction (p?=?0.018), women taking sexual initiative (p?=?0.014) and preparation for sex (p?=?0.001). Our study indicates the important impact of a positive perception of the body image of Tunisian women by themselves and by their spouses on their sexuality. It would be interesting to consider these aspects in the management of female sexual disorders.     

Exploring the Relationships Between Maternal Mental Health Symptoms and Young Children’s Functioning in a Low-Income,Minority Sample

Poor maternal mental health, including depression and high stress levels, can negatively impact many domains of child development, particularly among low-income, ethnic minority families experiencing multiple stressors. Low-income minority mothers, particularly Hispanic mothers, are also at increased risk of experiencing exposure to community violence and other types of trauma. However, studies exploring the additional impact of maternal trauma symptoms on children’s functioning are rare. This study aims to address this gap by examining the impact of maternal trauma symptoms on young children’s functioning in a low-income, predominantly Hispanic sample through the mechanisms of maternal depressive symptoms, and mother’s experiences of parenting stress and strain. The sample consisted of 158 biological mothers (58% Hispanic, 13% African American, 5.7% White American) who were participating in community-based mental health treatment for their children (M_AGE?=?3.7, SD?=?1.2). Mothers completed questionnaires providing information on their children’s behaviors and their own mental health and stress levels at intake. Path analysis indicated that there was a significant indirect effect of maternal trauma symptoms on children’s behavior problems through maternal depressive symptoms and maternal stress in the parent-child relationship (β?=?0.09, p?<?0.01). In addition, there was a direct effect of maternal trauma symptoms on children’s behavior problems (β?=?0.32, p?<?0.001). The results suggest that maternal trauma symptoms, in addition to maternal depressive symptoms, contribute to poor maternal and child functioning.     

Exploration of Male Attitudes on Partnerships and Sexuality with Female <Emphasis Type="Italic">BRCA1/2</Emphasis> Mutation Carriers

Women with BRCA mutations are inundated with decisions about managing cancer risks and childbearing considerations. Decisions become more complicated when women face disclosing their mutation and risk-reduction options to a romantic partner. This study identifies the concerns and perspectives of male romantic partners regarding these unique decisions. Twenty-five male participants completed an online survey posted to cancer support group message boards. Participants reported relationship changes regarding intimacy levels (n?=?9), attraction (n?=?2), and communication (n?=?22) after mutation disclosure. Participants whose partners had not undergone prophylactic mastectomy (n?=?14) reported concerns regarding sexual relations (n?=?5), post-surgical appearance (n?=?2), post-surgical attraction (n?=?5), and health/lifespan (n?=?9). Participants did not express attitude changes toward childbearing. While mutation disclosure conversations and surgical options are concerns for many BRCA mutation carriers in relationships, male partners share these concerns. Aspects of the relationship may change, but male study participants continued to support their partners. This information can benefit female BRCA mutation carriers, their current or future partners, and genetic counselors working with this particular population.     

Associations of Quality of Life,Physical Activity and Mood States in Women with Breast Cancer Treated with Curative Intent

This study aims to investigate the associations between quality of life, physical activity and mood states in women with breast cancer. A total of 354 women (mean age, 51.74?±?8.63 years; body mass index (BMI), 28?±?5.67 kg/m²) completed the Baecke Physical Activity Questionnaire, Profile of Mood States (POMS), European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) and European Organisation for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-BR23). Pearson’s correlation and multiple linear regressions were used to verify the relations between outcomes and independent variables. Correlations between scores on POMS, Baecke Physical Activity Questionnaire and global health status/quality of life subscale of EORTC QLQ-C30 found associations (p?<?0.01) between physical activity (r?=?0.191), vigour (r?=?0.333) and fatigue (r?=??0.433). Multiple linear regression analysis of the global health status/quality of life subscale of the EORTC QLQ-C30 showed significant differences for vigour (p?<?0.001), social function (p?=?0.003), side effects of systemic therapy (p?=?0.019), arm and breast symptoms (p?<?0.001) and Baecke physical activity score (p?=?0.006). Physical activity is an independent factor related to the quality of life in women with breast cancer. Understanding these variables may influence clinical decisions during treatment and allow positive interventions regarding symptoms, functions and lifestyle.     

Attitudes Toward Genetic Testing for Celiac Disease

HLA molecular typing for celiac disease (CD) is a genetic test with a high negative predictive value. The aim of this study is to explore knowledge of and attitudes towards genetic testing (GT). A 25-item questionnaire was developed by a multidisciplinary team and distributed to members of CD support groups across the United States. Respondents (n?=?1835) were mainly female (88 %), married (76 %), and college-educated (55 %), with a median age range of 31–50 years. Those who were married (82 vs 75 %, p?=?0.002), had children (82 vs 74 %, p?<?0.001), and had pursued education beyond high school (81 vs 68 %, p?=?0.004) were more likely to be aware of the availability of GT. On multivariable analysis, adjusting for age, sex, education, marital status, region of residence, and having children, college-education (OR 2.05, 95 % CI: 1.33–3.16) and having children (OR 1.56, 95 % CI: 1.15–2.11) remained significant predictors of GT awareness. A majority of patients with a personal or family history of CD planned GT for their children, and the most common concerns regarding GT were cost and impact on health care and/or insurance. In conclusion, awareness of GT is high among CD support group members. Efforts should be made to increase knowledge of GT in those with a lower educational level, and healthcare professionals should attempt to address concerns regarding GT cost and the impact of results on health care and insurance status.     

The Changing Age of Individuals Seeking Presymptomatic Genetic Testing for Huntington Disease

Huntington disease (HD) is a progressive neurodegenerative disorder. Presymptomatic genetic testing allows at-risk individuals to clarify their risk status. Understanding the characteristics and motivations of individuals seeking HD presymptomatic genetic testing better equips genetic counselors and other healthcare professionals to provide comprehensive and personalized care. The aims of this study were to (1) determine whether the average age when individuals seek presymptomatic HD genetic testing has decreased over time, (2) assess motivations for seeking testing, (3) explore whether there is a relationship between age and motivations, and (4) explore genetic counselors’ perceptions of the shift in age. Data from the US HD testing centers (N?=?4) were analyzed. A small but statistically significant decrease in age of individuals seeking presymptomatic testing was observed (p?=?0.045). HD community members (N?=?77) were surveyed regarding presymptomatic testing motivations. Younger individuals were more likely than older individuals to cite “To learn whether or not you would develop HD” and “To make choices about further education or a career” compared to older individuals (p?<?0.05). Conversely, older individuals more frequently cited “To give children a better idea of their risk” (p?<?0.002). Sixteen percent of genetic counselors surveyed (6/37) perceived a change in age of testing. All of these respondents had provided HD testing for ten or more years and anecdotally believed the age at testing has decreased over time. Study results help providers personalize counseling based on patient’s age and serve as a starting point for more research into the relationship between age at testing and motivations for testing.     

Sit Down and Play: A Preventive Primary Care-Based Program to Enhance Parenting Practices

The primary care office offers an ideal setting to encourage parenting behaviors that promote early childhood development. We conducted a pilot study to establish feasibility and acceptability of Sit Down and Play (SDP), a brief primary care-based program to facilitate positive parenting behaviors through take-home play activities. A prospective 1-month study was conducted in an urban primary care clinic. SDP was administered to 30 caregivers of 6–12 month-old children while they waited for their well-child appointment. Caregivers completed baseline and 4-week follow-up surveys. Open-ended interview questions regarding acceptability and usefulness of SDP were administered and analyzed using content analysis. Parenting practices related to child development were measured with standardized measures and changes analyzed using paired t-test and linear mixed effects models. Most caregivers were mothers (90?%) and non-white (97?%); the majority of children received Medicaid (87?%). There were significant increases in parental reports of practices related to child development (p?<?0.001), including families who reported low incomes (i.e. <$25,000) and received a high-school education or less (p?=?0.001). Four main themes emerged from the open-ended interview data: (1) importance of play, (2) noticing a change in their child, (3) reinforcing existing positive parenting behaviors, and (4) satisfaction with the program. This preliminary study suggests that SDP is a feasible and potentially beneficial program that can be delivered during pediatric well-child visits. Further studies are needed to determine the effectiveness of SDP on parenting behaviors and developmental outcomes.     

Mother-Child Interactions and Preschoolers’ Emotion Regulation Outcomes: Nurturing Autonomous Emotion Regulation

Emotion regulation is a complex process that begins in infancy and continues through childhood with parents’ support. Early parent-child interactions shape the way children learn emotion management. We took a sociocultural and social learning approach to exploring the specific components of mother-child interactions that are related to mothers’ perceptions of her child’s regulatory ability and the child’s observed emotion regulation. Thirty mothers and their preschool children were recruited from two New England urban areas: one community sample and one head start sample. Dyads engaged in a free play session, children completed an observed compliance task, and mothers completed a set of questionnaires assessing their perceptions of their child’s regulation. Regression analyses revealed that maternal behaviors during free play predicted child’s observed hostility (F _(2,29)?=?3.137, p?<?.05) and mothers’ perceptions of her child’s regulatory ability predicted observed child compliance (F _{(2, 17)}?=?4.990, p?<?.05). Child behaviors during play significantly predicted child’s compliance (F _(3,20)?=?4.722, p?<?.05) and child’s hostility (F _{(1, 26)}?=?9.220, p?<?.001). Maternal modeling and intentional scaffolding as well as perceptions of her child’s regulatory capacity have a powerful impact on her child’s observed regulation. Results indicate that it is particularly important for mothers of preschoolers to support autonomy while guiding socially appropriate behavior. Interventions that target improving mothers’ negative perceptions of their children, educating on appropriate preschool expectations, and facilitating preschoolers’ mature play may help mothers interact with their children in the ways that foster children’s autonomous emotion regulation.     

Investigation of the Use of a Family Health History Application in Genetic Counseling

The paper-based pedigree is the current standard for family health history (FHH) documentation in genetic counseling. Several tools for electronic capture of family health data have been developed to improve re-use and accessibility, data quality and standardization, ease of updating, and integration with electronic medical records. One such tool, the tablet-based Proband application, provides a flexible approach to data capture in dynamic and diverse clinical settings. This study compared Proband FHH collection to paper-based methods and investigated the usability of Proband in a clinical setting. After one use by 23 genetic counselors and students, Proband had 91% accuracy with a FHH audio scenario, which was significantly less (p?<?0.001) than paper’s 96% accuracy. These differences were attributed to incorrect or missing ages of grandparents (p?<?0.001) and great-aunts/uncles (p?=?0.012) and missing documentation of consanguinity (p?<?0.001). Possible explanations for these differences include greater experience with paper FHH documentation and pre-populated prompts for consanguinity on the paper template used. Proband’s perceived usability increased with use, with individual System Usability Scores increasing between first and last use (p?=?0.033). We conclude that tools for dynamic, provider-driven FHH documentation such as Proband show promise for improving risk assessment accuracy and quality patient care.