Games in Clinical Genetic Counseling Supervision

Games are defined as ongoing series of complementary ulterior transactions that are superficially plausible but have a concealed motivation to maximize pay-offs and minimize penalties for the initiator. While some games are harmless and part of socialization, others are destructive. Destructive game-playing in clinical supervision, in which game-playing (initiated by either supervisors or students) interferes with a student's realization of internship goals, has been documented in some allied healthcare professions but has not yet been studied in genetic counseling. Genetic counselors and clinical supervisors of genetic counseling students were anonymously surveyed regarding their experiences with destructive game-playing. Results show that such games do occur in genetic counseling clinical supervision. Some games are the same or similar to ones previously described in other health-care professions; others may be unique to genetic counseling. The purpose of this paper is to document these games as a first step to facilitating dialogue, understanding and awareness of them.     

Breast and Ovarian Cancer: The Forgotten Paternal Contribution

Five to 10% of all cases of breast and ovarian cancer are attributed to a heritable genetic predisposition. Transmission of BRCA1 and BRCA2 mutations is equally likely through maternal or paternal lineage; however, fewer referrals to cancer genetics clinics appear to be made for a paternal, than maternal, family history of breast and/or ovarian cancer. To examine this potential bias, a retrospective review of 315 patient and family charts was conducted by one familial cancer clinic in Toronto, Canada. Referral letters, risk estimates, and family histories were analyzed to identify significant differences between patients referred with maternal and paternal family histories. It was determined that patients are approximately five times more likely to be referred with a maternal family history of breast and/or ovarian cancer as compared to those with a paternal family history (p = <.0001). Individuals with a paternal family history were found to have a different, and higher, pattern of risk estimates (p = .00064). No significant difference was seen between the type of referrals sent by general practitioners, oncologists, and gynecologists. Recommendations to increase the awareness of paternal family history in assessing cancer risk are provided.     

Enduring deficits in contextual and auditory fear conditioning after adolescent, not adult, social instability stress in male rats

Adolescence is a time of developmental changes and reorganization in the brain and stress systems, thus, adolescents may be more vulnerable than adults to the effects of chronic mild stressors. Most studies, however, have not directly compared stress experienced in adolescence to the same stress experience in adulthood. In the present study, adolescent (n=46) and adult (n=48) male rats underwent 16 days of social instability stress (daily 1h isolation and change of cage partners) or were non-stress controls. Rats were then tested on the strength of acquired contextual and cued fear conditioning, as well as extinction learning, beginning either the day after the stress procedure or 3 weeks later. No difference was found among the groups during the Training Phase of conditioning. Irrespective of the time between the social stress experience and fear conditioning, rats stressed in adolescence had decreased context and cue memory, and cue generalization compared to control rats, as measured by the percentage of time spent freezing in tests. Social instability stress in adulthood had no effect on any measure of fear conditioning. The results support the hypothesis that adolescence is a time of heightened vulnerability to stressors.     

Property rights and the resolution of social conflict

It has long been argued that ownership depends upon social groups' establishing and adhering to rights such as the right to use and to exclude others from using one's own property. The authors consider the application of such rights in the interactions of young peers and siblings, and the extent to which parents support their children in establishing and maintaining the entitlement of owners. They show that children, but not their parents, give priority to ownership in settling property disputes, and argue that diverging models of children's relationships account for these differing perspectives of children and parents.     

Searching for Happiness: The Importance of Social Capital

After four decades of research, scholars of happiness continue to debate its causes. While it is generally agreed that a combination of internal and external factors play a role, predicting happiness well remains a challenge. Recent research has proposed that social capital may be a vital factor that has been overlooked. This paper attempts to address that omission. According to Coleman’s (1988) seminal work, three dimensions of social capital exist: (1) trust and obligations, (2) information channels, and (3) norms and sanctions. Using bootstrap hierarchical regression on data from the Canadian General Social Survey of Social Engagement Cycle 17 (2003), we identified blocks of social capital variables described by Coleman, as well as an additional factor of belongingness. Even after controlling for major demographic and individual characteristics, the majority of these blocks show significant relationships with happiness. Our findings support social capital as an important piece in predicting happiness.     

Towards the DSM‐5 Criteria for Autism: Clinical,Cultural, and Research Implications

The new edition of the DSM is proposing significant changes to current diagnostic definitions of autism and related conditions. In this article, we will discuss the clinical, research, and cultural implications of these changes. We conclude that the new criteria appear to better reflect current understanding of the autism spectrum disorder than the current DSM‐IV criteria. As expected with any major change in classification systems, there are also significant risks, which will have to be carefully monitored and addressed by both policy makers and the scientific community to ensure that best clinical practice and research are facilitated and advanced.     

The Body Esteem Scale: Construct Validity of the Female Subscales

The female subscales of the Body Esteem Scale (BES) have demonstrated convergent and discriminant validity in two previous studies. However, relationships between BES dimensions, weight, and other body-image measures have not been adequately examined. in this study, 200 women with a mean age of 27.6 years completed the BES, the Eating Disorder inventory, the Self-Consciousness Scale, the Tennessee Self-Concept Scale, a figure rating task, a phototechnical body-size estimation procedure, and items concerning weight satisfaction and attractiveness. BES Weight Concern was most closely related to weight variables and other body image measures whereas BES Sexual Attractiveness and Physical Condition were more strongly associated with less specific self-perceptions and attitudes. Results support the construct validity of the BES female subscales and their utility for research in populations at increased risk for body-image or eating-disorder disturbances.     

Feasibility of Conducting Long-Term Follow-Up of Children and Infants Treated for CNS Tumors on the Same Cooperative Group Clinical Trial Protocol

Given the barriers to conducting long-term assessment of neurocognitive and psychosocial functioning of those treated in infancy for central nervous system (CNS) tumors, a multi-site feasibility study was conducted. The primary objective was to demonstrate that it is feasible to identify, locate and assess the functioning of children treated on the same protocol 10-years post-treatment. Six sites obtained institutional approval, identified and recruited subjects, and obtained comprehensive neurocognitive and psychosocial data. All feasibility objectives were met. Barriers to participation included length of time for Institutional Review Board submission and review, clinical demands, limited eligible participants at individual institutions, difficulty locating long-term subjects and stipend/reimbursement concerns. Results indicate that long-term studies are feasible and essential given the need to address long-term issues of children treated at a young age for CNS tumors, especially as they relate to later academic and vocational planning, but require significant coordination and commitment of cooperative group and institutional resources.     

Research ethics committees: a regional approach

Guidelines for Institutional Review Boards (IRBs) or research ethics committees exist at national and international levels. These guidelines are based on ethical principles and establish an internationally acceptable standard for the review and conduct of medical research. Having attained a multinational consensus about what these fundamental guidelines should be, IRBs are left to interpret the guidelines and devise their own means of implementing them. Individual and community values bear on the interpretation of the guidelines so different IRBs attain different levels of effectiveness. In the Caribbean and Pan American regions there are few IRBs. Obstacles to the establishment and function of IRBs are exacerbated in developing regions like these by differences in language, literacy, and local value systems; education, administrative expertise, facilities, and access to information are also limited. A regional IRB network might facilitate more uniform ethical review in developing countries, and simplify IRB procedures. This revised version was published online in August 2006 with corrections to the Cover Date.