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.     

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.     

A DBT Skills training group for family caregivers of persons with dementia

A Dialectical Behavior Therapy Skills training manual (DBT Skills) was adapted for use with caregivers of individuals with dementia. Implementation occurred in a community clinic with a heterogeneous caregiver group at risk for elder abuse. Sixteen caregivers completed the 9-week group. The results point to improved psychosocial adjustment, particularly increased problem-focused coping, enhanced emotional well-being, and less fatigue. Caregivers tended to utilize individual therapeutic services at a higher rate during the period of group attendance, indicative of appropriate help-seeking behavior in highly demanding situations. Six of the 16 caregivers repeated the training sequence in “booster” groups. Follow-up data from the booster groups suggest that high-risk caregivers may require continuing support to maintain treatment gains. In addition to demonstrating the feasibility of DBT Skills with caregivers, the results warrant a controlled outcome evaluation.     

Heart rate responses to induced challenge situations in greylag geese (Anser anser)

Adequate short-term responses to stressors are of great importance for the health and well-being of individuals and factors modulating the physiological stress response (e.g., controllability, suddenness, familiarity) of a stimulus are well described under laboratory conditions. In the present study we aimed at investigating the stress response in greylag geese (Anser anser) in the field, confronting individuals with naturally occurring stressors. We measured beat-to-beat heart rate (HR) via fully implanted transmitters during three different experimental challenges: (1) catching and holding, (2) confrontation with a model predator, and (3) approach by different humans. We compared this to a control period and HR during agonistic encounters, a naturally occurring stressor. All three experimental situations evoked a HR increase. Highest HR responses were elicited by catching and holding the animals. In the third experiment, HR responses were greatest when the geese were approached by a human stranger (i.e., somebody the geese have never seen before). Hence, geese discriminated between different kinds of stressors and adjusted their physiological response depending on the type of stressor. Our results show that geese were able to discriminate between individual humans. In line with a number of lab studies, we suggest that particularly the controllability of certain situation determines the intensity of the HR response, also in a natural setting in the field.     

Affording cooperation: Embodied constraints,dynamics, and action-scaled invariance in joint lifting

Understanding the physical and interpersonal constraints that afford cooperation during real-world tasks requires consideration of the fit between the environment and task-relevant dimensions of coactors and the coactors’ fit with each other. In the present study, we examined how cooperation can emerge during ongoing interaction using the simple task of two actors’ moving long wooden planks. The system dynamics showed hysteresis: A past-action mode persisted when both solo and joint actions were possible. Moreover, pairs whose arm spans were both short, both long, or mismatched made action-mode transitions at similar points, when scaled by a relational measure. The relational measure of plank length to arm span was dictated by the pair member with the shorter arm span, who, thus, had a greater need to cooperate during the task. The results suggest that understanding affordances for cooperation requires giving more consideration to constraints imposed by the fit between coactors’ action capabilities.