Information Mismatch: Cancer Risk Counseling with Diverse Underserved Patients

As genetics and genomics become part of mainstream Medicine, these advances have the potential to reduce or exacerbate health disparities. Gaps in effective communication (where all parties share the same meaning) are widely recognized as a major contributor to health disparities. The purpose of this study was to examine GC-patient communication in real time, to assess its effectiveness from the patient perspective, and then to pilot intervention strategies to improve the communication. We observed 64 English-, 35 Spanish- and 25 Chinese-speaking (n = 124) public hospital patients and 10 GCs in 170 GC appointments, and interviewed 49 patients who were offered testing using the audio recordings to stimulate recall and probe specific aspects of the communication. Data analyses were conducted using grounded theory methods and revealed a fundamental mismatch between the information provided by GCs and the information desired and meaningful to patients. Several components of the communication that contributed to this mismatch and often resulted in ineffective communication included: (1) too much information; (2) complex terminology and conceptually difficult presentation of information; (3) information perceived as not relevant by the patient; (4) unintentional inhibition of patient engagement and question-asking; (5) vague discussions of screening and prevention recommendations. Our findings indicate a need to transform the standard model of genetic counseling communication using evidence-based principles and strategies from other fields of Medicine. The high rates of limited health literacy in the US, increasing access of diverse populations to genetic services, and growing complexity of genetic information have created a perfect storm. If not directly addressed, this convergence is likely to exacerbate health disparities in the genomic age.     

Mental rotation of letters, pictures, and three-dimensional objects in German dyslexic children.

This study examines mental rotation ability in children with developmental dyslexia. Prior investigations have yielded equivocal results that might be due to differences in stimulus material and testing formats employed. Whereas some investigators found dyslexic readers to be impaired in mental rotation, others did not report any performance differences or even superior spatial performance for dyslexia. Here, we report a comparison of mental rotation for letters, three-dimensional figures sensu Shepard and Metzler, and colored pictures of animals or humans in second-grade German dyslexic readers. Findings indicate that dyslexic readers are impaired in mental rotation for all three kinds of stimuli. Effects of general intelligence were controlled. Furthermore, dyslexic children were deficient in other spatial abilities like identifying letters or forms among distracters. These results are discussed with respect to the hypotheses of a developmental dysfunction of the parietal cortex or a subtle anomaly in cerebellar function in dyslexic readers.     

Normative data on the familiarity and difficulty of 196 Spanish word fragments.

In this article, normative data on the familiarity and difficulty of 196 single-solution Spanish word fragments are presented. The database includes the following indices: difficulty, familiarity, frequency, number of meanings, number of letters given in the fragment, first and/or last letters given, and ratio of letters to blanks. A factor analysis was performed on difficulty, and two factors were obtained. Frequency, familiarity, and number of meanings loaded highly on the first factor, which we consider to measure lexical processes, whereas number of letters in the fragment, first and/or last letters given, and ratio of letters to blanks loaded highly on the second factor, which we judge to be determined by perceptual information. Regression analyses using factor scores as predictors showed that both factors accounted for a significant part of the completion probability scores. The full set of these norms may be downloaded from the Psychonomic Society Web archive at www.psychonomic.org/archive/.     

Normative data on the familiarity and difficulty of 196 Spanish word fragments

In this article, normative data on the familiarity and difficulty of 196 single-solution Spanish word fragments are presented. The database includes the following indices: difficulty, familiarity, frequency, number of meanings, number of letters given in the fragment, first and/or last letters given, and ratio of letters to blanks. A factor analysis was performed on difficulty, and two factors were obtained. Frequency, familiarity, and number of meanings loaded highly on the first factor, which we consider to measure lexical processes, whereas number of letters in the fragment, first and/or last letters given, and ratio of letters to blanks loaded highly on the second factor, which we judge to be determined by perceptual information. Regression analyses using factor scores as predictors showed that both factors accounted for a significant part of the completion probability scores. The full set of these norms may be downloaded from the Psychonomic Society Web archive atwww.psychonomic.org/archive/.     

Orienting ourselves to the gay penguin

This article analyzes the global proliferation of discourse about gay penguins in zoos. Based on internet-based representations, we identify a directional narrative logic of “gay penguin discourses” in which the ideal gay penguin comes out as gay, falls in love, follows natural desires to parent, and may marry as a reward. This discursive chain is animated by the zoo as institutional space of captivity, which incites human subjects to become agents in its reproduction. In contests over penguin actions and morality, zookeepers, gay activists, and conservative family groups reiterate a homonormative politics of identity through talk of discrimination and rights. To identify what makes this discourse seem real, we draw on Ahmed’s Queer Phenomenology to analyze the composition of the zoo as the site of a particular “mode of address” that orients humans to adopt positions of authority, evaluation, and regulation. Three orientations—reason, emotion, and instinct—function as an assemblage whose elements connect and separate, such that when one orientation’s ability to explain penguin behaviors is exceeded, another orientation steps in or connects with the first to supply a logic that confirms the discursive chain for the ideal gay penguin and how humans can meet his needs. Locked into logics of hetero/homo, oriented through reason, instinct, and emotion, and interpellated through emotions, humans can imagine little more than an anthropocentric repetition of our own “progress.” The future, for humans and penguins, is secured.     

The neuropsychological correlates of cognitive insight in healthy participants

Cognitive insight is the ability to monitor and correct one's own erroneous convictions. The Beck Cognitive Insight Scale (BCIS) assesses two sub‐dimensions of cognitive insight: self‐reflectiveness (SR), which is the attitude of questioning one's own judgments; and self‐certainty (SC), which is the unwillingness to modify and correct one's own convictions. There is little information about cognitive insight in healthy participants (HP). Here we investigated the socio‐demographic and neuropsychological correlates of cognitive insight in 50 HP who were administered the BCIS and a comprehensive neuropsychological battery. The global BCIS R‐C index correlated positively with age and WCST perseverative errors. SR correlated positively with age. These data support the hypothesis that a less self‐reflective and more self‐confident style is cognitively functional in HP. Thus, what has been found malfunctioning in mental illnesses is adaptive in HP. Future studies should consider a wider range of factors that might affect this complex construct. Copyright © 2011 John Wiley & Sons, Ltd.