A Survey of Patients’ Experiences with the Cancer Genetic Counseling Process: Recommendations for Cancer Genetics Programs

In order to promote ongoing quality improvement of not only the Penn State Cancer Genetics Program, but also other cancer risk assessment programs throughout the country, we developed, piloted and conducted a survey to explore patient expectations, experiences, and satisfaction with the cancer genetic counseling process. The comprehensive survey was mailed to 340 eligible patients, 156 (45.9%) of whom returned the completed survey within the allotted time. Responses to closed-ended questions were tallied and open-ended questions were content analyzed. Major findings show that: (1) Patients were seeking cancer-related information and support throughout the cancer risk assessment process and were interested in participating in available research studies; (2) The setting in which patients are seen for cancer risk assessment may pose potential emotional ramifications; (3) Misperceptions regarding insurance discrimination and lack of insurance coverage persist; (4) Patients view the genetic counselor as responsible for updating them about new discoveries. Specific recommendations for cancer genetics programs are included.     

A cognitive behavioral workshop for subclinical obsessions and compulsions

The present study investigates the effectiveness of a 3-h cognitive behavioral workshop for individuals, ages 18-22, with subclinical obsessions and compulsions. It was hypothesized that, compared to individuals in an assessment-only waitlist group (n = 42), individuals assigned to the workshop group (n = 43) would experience a significant decrease in obsessive-compulsive (OC) symptomatology, comorbidity, and thought action fusion endorsement at 1-month and 5-month follow-up assessments. An additional outcome of interest was the number of incident cases of obsessive-compulsive disorder (OCD) over the course of the study. The results indicated that the workshop group reported a significantly fewer number of OC symptoms at 5-month follow-up and endorsed significantly less thought action fusion at both follow-up points. However, there were no differences between groups in severity of OC symptoms and number of comorbid diagnoses endorsed. Only one incident case of OCD was observed during the study, from a participant in the waitlist group. These results are discussed in reference to treatment of subclinical anxiety symptoms.     

Contextual basis of maternal perceptions of infant temperament

To elucidate the differential saliency of infant emotions to mothers across interactive contexts, the authors examined the moderating role of observed infant affect during interactions with mother in the relation between maternal and laboratory-based ratings of infant temperament. Fifty-nine developmentally healthy 9-month-old infants were judged for degree of infant positive, infant negative, and mother-infant mutually positive affect during the course of object-focused and routine home-based activities with mother. Mothers completed the Infant Behavior Questionnaire (M. K. Rothbart, 1981), and infants underwent the Laboratory Temperament Assessment Battery (H. H. Goldsmith & M. K. Rothbart, 1999). Results revealed that maternal and observer ratings of infant negativity converged when infants manifested high degrees of negative affect during routine home-based activities. Maternal and observer ratings of infant positivity converged when infants experienced low mutually positive affect during play. These findings support the hypothesis that maternal perceptions are based on mothers' experiences with their infants but that the salience of infant temperamental characteristics to mothers varies across emotion and interactive context.     

Ethnic identity and risky health behaviors in school-age Mexican-American children

The study examined the relationship between ethnic identity and risky health behaviors in 1,892 Mexican-American students (M age= 14.6, SD= 1.35; 50.3% male) in South Texas. The Ethnic Identity Scale assessed ethnic identity and questions from the Youth Risk Behavior Survey measured risky health behaviors (mixed use of alcohol and drugs, heavy drinking, driving under the influence, regular marijuana use, regular cigarette smoking, lack of regular exercise, not eating breakfast regularly, and carrying a gun or knife to school). Logistic regression tested the relationships between ethnic identity and report of risky health behaviors controlling for potential confounders (sex, free school lunch status, grade, and self-reported school grade). Adjusted odds ratio (AOR) and confidence intervals were calculated. Results indicated that being associated with Mexican-American cultural identity was significantly associated with a decreased mixed use of alcohol and drugs (AOR= .97), heavy drinking (AOR= .98), and regular marijuana use (AOR= .97). A stronger ethnic identity was protective against engaging in risky health behaviors among these Mexican-American adolescents.     

Viewpoint and orientation influence picture recognition in the blind

In the first three experiments, subjects felt solid geometrical forms and matched raised-line pictures to the objects. Performance was best in experiment 1 for top views, with shorter response latencies than for side views, front views, or 3-D views with foreshortening. In a second experiment with blind participants, matching accuracy was not significantly affected by prior visual experience, but speed advantages were found for top views, with 3-D views also yielding better matching accuracy than side views. There were no performance advantages for pictures of objects with a constant cross section in the vertical axis. The early-blind participants had lower performance for side and frontal views. The objects were rotated to oblique orientations in experiment 3. Early-blind subjects performed worse than the other subjects given object rotation. Visual experience with pictures of objects at many angles could facilitate identification at oblique orientations. In experiment 5 with blindfolded sighted subjects, tangible pictures were used as targets and as choices. The results yielded superior overall performance for 3-D views (mean, M = 74% correct) and much lower matching accuracy for top views as targets (M = 58% correct). Performance was highest when the target and matching viewpoint were identical, but 3-D views (M = 96% correct) were still far better than top views. The accuracy advantage of the top views also disappeared when more complex objects were tested in experiment 6. Alternative theoretical implications of the results are discussed.     

Life before and after quitting smoking: an electronic diary study

This article describes a multidimensional, multivariate, and multilevel approach to the assessment of nicotine withdrawal. In this prospective study, 70 adult smokers assigned to an active or placebo nicotine patch condition completed multiple daily assessments using an electronic diary. Average and individual growth curves were estimated for affective and nonaffective withdrawal symptoms. All symptoms but hunger increased significantly on the quit day and remained elevated for three weeks. Variability in symptom experiences across individuals increased from pre- to post-quit. Relations between symptom reports (e.g., negative affect or craving) and episodic events (e.g., stressful events or seeing someone smoke) changed from pre-quit to post-quit. Pre-quit increases in negative affect and quit-day increases in craving were inversely related to abstinence three months after the quit day, suggesting that anticipatory and immediate reactions to quitting influence success.     

Ordinary variations in maternal caregiving influence human infants' stress reactivity

ABSTRACT— We sought to extend earlier work by examining whether there are ordinary variations in human maternal caregiving behavior (MCB) that are related to stress reactivity in infants. We observed 185 mother-infant dyads and used standard coding systems to identify variations in caregiving behavior. We then created two extreme groups and found that infants receiving low-quality MCB showed more fearfulness, less positive joint attention, and greater right frontal electroencephalographic asymmetry than infants receiving high-quality MCB. Group differences in stress reactivity were not a result of measured infant temperament. However, infants receiving low-quality MCB manifested significantly more negative affect during caregiving activities than did infants receiving high-quality MCB. The results suggest that ordinary variations in MCB may influence the expression of neural systems involved in stress reactivity in human infants.     

Processing Speed Deficits in Attention Deficit/Hyperactivity Disorder and Reading Disability

The goal of the current study was to test whether deficits in processing speed (PS) may be a shared cognitive risk factor in reading disability (RD) and Attention Deficit/Hyperactivity Disorder (ADHD), which are known to be comorbid. Literature on ADHD and RD suggests that deficits on tasks with a speeded component are seen in both of these disorders individually. The current study examined a wide range of speeded tasks in RD, ADHD, comorbid RD+ADHD, and a control group to test whether RD and ADHD have similar profiles of PS deficits, and whether these deficits are shared by the two disorders. The results suggest that a general PS deficit exists in both clinical groups compared to controls, although children with RD demonstrate greater PS deficits than children with ADHD. Two tests (underadditivity and partial correlations) were conducted to test whether these PS deficits are shared. Since we found that PS deficits were underadditive in the comorbid group and that partialling PS reduced the correlation between RD and ADHD, it appears that PS is a shared cognitive risk factor that may help explain the comorbidity of these two disorders.