A Systematic Review of Randomized Controlled Trials to Assess Outcomes of Genetic Counseling

With the advancements in precision medicine and health care reform, it is critical that genetic counseling practice respond to emerging evidence to maximize client benefit. The objective of this review was to synthesize evidence on outcomes from randomized controlled trials (RCTs) of genetic counseling to inform clinical practice. Seven databases were searched in conducting this review. Studies were selected for inclusion if they were: (a) RCTs published from 1990 to 2015, and (b) assessed a direct outcome of genetic counseling. Extracted data included study population, aims, and outcomes. Risk of bias was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions guidelines. A review of 1654 abstracts identified 58 publications of 54 unique RCTs that met inclusion criteria, the vast majority of which were conducted in cancer genetic counseling setting. Twenty-seven publications assessed ‘enhancements’ to genetic counseling, and 31 publications compared delivery modes. The methodological rigor varied considerably, highlighting the need for attention to quality criteria in RCT design. While most studies assessed several client outcomes hypothesized to be affected by genetic counseling (e.g., psychological wellbeing, knowledge, perceived risk, patient satisfaction), disparate validated and reliable scales and other assessments were often used to evaluate the same outcome(s). This limits opportunity to compare findings across studies. While RCTs of genetic counseling demonstrate enhanced client outcomes in a number of studies and pave the way to evidence-based practice, the heterogeneity of the research questions suggest an important need for more complementary studies with consistent outcome assessments.     

Extending the the behavioral immune system to political psychology: Are political conservatism and disgust sensitivity really related?

Previous research suggests that several individual and cultural level attitudes, cognitions, and societal structures may have evolved to mitigate the pathogen threats posed by intergroup interactions. It has been suggested that these anti-pathogen defenses are at the root of conservative political ideology. Here, we test a hypothesis that political conservatism functions as a pathogen-avoidance strategy. Across three studies, we consistently find no relationship between sensitivity to pathogen disgust and multiple measures of political conservatism. These results are contrasted with theoretical perspectives suggesting a relationship between conservatism and pathogen avoidance, and with previous findings of a relationship between conservatism and disgust sensitivity.     

Definitions of Multicultural Competence: Frontline Human Service Providers' Perspective

In this qualitative study, the authors explored definitions of multicultural competence given by 99 frontline human service providers. The providers had no formal training in counseling but served in a helping role. Seven thematic definitions emerged: color blindness, client focused, acknowledgment of cultural differences, textbook consistent, resource driven, skills‐based, and self‐integrated. Implications for multicultural competence are discussed. En este estudio cualitativo, los autores exploraron las definiciones de competencia multicultural ofrecidas por 99 proveedores de servicios humanos de primera línea. Los proveedores no tenían una formación oficial en consejería, pero actuaban en roles de ayuda. Surgieron como resultado siete definiciones temáticas: indiferente al color, enfocada hacia el cliente, reconocimiento de diferencias culturales, libro de texto, guiada por los recursos, habilidades y autointegrada. Se discuten las implicaciones para la competencia multicultural.     

Changes in muscle and joint coordination in learning to direct forces

While it has been suggested that bi-articular muscles have a specialized role in directing external reaction forces, it is unclear how humans learn to coordinate mono- and bi-articular muscles to perform force-directing tasks. Participants were asked to direct pedal forces in a specified target direction during one-legged cycling. We expected that with practice, performance improvement would be associated with specific changes in joint torque patterns and mono- and bi-articular muscular coordination. Nine male participants practiced pedaling an ergometer with only their left leg, and were instructed to always direct their applied pedal force perpendicular to the crank arm (target direction) and to maintain a constant pedaling speed. After a single practice session, the mean error between the applied and target pedal force directions decreased significantly. This improved performance was accompanied by a significant decrease in the amount of ankle angular motion and a smaller increase in knee and hip angular motion. This coincided with a re-organization of lower extremity joint torques, with a decrease in ankle plantarflexor torque and an increase in knee and hip flexor torques. Changes were seen in both mono- and bi-articular muscle activity patterns. The mono-articular muscles exhibited greater alterations, and appeared to contribute to both mechanical work and force-directing. With practice, a loosening of the coupling between bi-articular thigh muscle activation and joint torque co-regulation was observed. The results demonstrated that participants were able to learn a complex and dynamic force-directing task by changing the direction of their applied pedal forces through re-organization of joint torque patterns and mono- and bi-articular muscle coordination.     

Efficacy of constant time delay implemented by peer tutors in general education classrooms

We evaluated the effects of teaching 13 typically developing children to use constant time delay when tutoring three of their peers who had substantial disabilities. We measured the extent to which the tutors used the constant time delay procedure correctly and the tutees' correct performance on the skills being taught. A multiple probe design across behaviors was used. The results indicated that (a) the tutors used each step of the constant time delay with a high degree of procedural fidelity; (b) the students with disabilities acquired the skills that were taught during peer tutoring; and (c) modifications of the procedure were required for 2 of the 3 students with disabilities, and the peers tutors were able to implement the modifications. Implications for practice and future research are described.     

A Postmodern Analysis of a Course on Clinical Supervision

A qualitative study of a supervision course included pre-and post-interviews of the participants in addition to in-class participant observation. In an effort to be consistent with a postmodern perspective, the data were reviewed by the four members of the research team, each of whom shares his or her analysis, or story. Common themes which emerged in response to the focus on student change include greater awareness of isomorphic processes, ethical and legal issues, and evaluative processes.     

Schizophrenia--a high-risk factor for suicide: clues to risk reduction.

Suicide is the chief cause of premature death among schizophrenic persons. The lifetime incidence of suicide for patients with schizophrenia is 10% to 13% compared to a general population estimate of about 1%, and is quite close to that observed among those with major affective disorder. The magnitude of increased risk for suicide among schizophrenics peaks before middle age and declines thereafter, although schizophrenic persons tend to be at increased risk throughout the life span. Among psychiatric patients, schizophrenics are overrepresented among suicides, and often schizophrenics constitute the majority of inpatient suicides. It is important in evaluating suicide risk among schizophrenic persons to assess depression and suicidal ideation especially during index admission and during acute phases of the illness. It is noteworthy that schizophrenic persons often commit suicide as the overall level of psychopathology decreases during a nonpsychotic phase. Research has yielded salient risk factors for suicide in schizophrenic persons and "types" of especially vulnerable patients, even though statistical prediction of individual suicides has not proven effective.