Intention to communicate BRCA1/BRCA2 genetic test results to the family.

Guided by the theory of planned behavior, this analysis explores the communication skills of women who had genetic testing for BRCA1 and BRCA2. The key outcome was intention to tell test results to adult first-degree relatives. The theory predicts that global and specific attitudes, global and specific perceived social norms, and perceived control will influence the communication of genetic test results. A logistic regression model revealed that global attitude (p < .05), specific social influence (p < .01), and perceived control (p < .05) were significant predictors of intention to tell. When gender and generation of relatives were added to the regression, participants were more likely to convey genetic test results to female than to male relatives (p < .05) and were also more likely to communicate test results to children (p < .01) or siblings (p < .05) than to parents. However, this association depended on knowing the relative's opinion of genetic testing. Intention to tell was lowest among participants who did not know their relative's opinion. These results extend the theory of planned behavior by showing that gender and generation influence intention when the relative's opinion is unknown.     

Mentoring Nurses in Familial Cancer Risk Assessment and Counseling: Lessons Learned From a Formative Evaluation

Background. As familial cancer genetic services moves into community practice increased numbers of trained health professionals are needed to counsel individuals seeking cancer risk information. Nurses have been targeted to provide cancer risk assessment and counseling. To help prepare nurses for this role, a 5-day training in familial cancer risk assessment and counseling followed by a long-distance mentorship to support continued skill development in the work environment was conducted by Fox Chase Cancer Center, Philadelphia, PA. Methods. Four cohorts (N = 41) have completed the training and were randomized to either an immediate or delayed mentorship. A formative evaluation assessed the nurse’s ability to consult with other genetic health professionals and build self-efficacy in counseling skills via responses to questionnaire. A post-mentorship interview evaluated the usefulness, timing and length of the mentorship. Results. For both groups, there was a statistically significant improvement in self-efficacy for all skills from baseline to 6 months and an increased number of nurses consulting with genetic health professionals. All the nurses reported the value of the mentorship and those with less cancer risk counseling experience prior to the training needed support and resources for further skill and program development. Lessons learned from this formative evaluation are provided.     

On the equivalence between elimination-by-aspects and generalised extreme value models of choice behaviour

Elimination-by-aspects and generalised extreme value offer competing paradigms for the representation of a common behaviour, that of individual discrete choice. Observing certain consistencies in their mathematical structure, several eminent authors have commented on the degree of equivalence between the two paradigms. Most contributions to this debate have, however, been less than definitive. More fundamentally, the contributions lack consensus. We advance the debate by establishing formal mathematical conditions under which three-alternative tree models from the two paradigms are exactly equivalent. We then extend our analysis to consider more general models, showing that equivalence can be established for general tree models, but not for cross-nested models.     

Psychosocial Treatments for Children with Attention Deficit/Hyperactivity Disorder

This article reviews studies examining the efficacy of behavioral interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). A specific emphasis is placed on evidence-based interventions that include parent training, classroom, academic, and peer interventions. Results indicate that school-aged children respond to behavioral interventions when they are appropriately implemented both at home and in the classroom setting. Combined treatments (behavioral management and stimulant medication) represent the gold standard in ADHD treatment and are often recommended as the first-line treatment option due to the many problems faced by children with ADHD. Diversity issues, although an important consideration in the treatment of ADHD, continue to remain an understudied area. Recommendations for future research are made pertaining to treatment sequencing with regard to behavior management as well as for subgroups of ADHD children who may respond best to specific treatments.     

Ecological influences in youth crisis shelters: Effects of social density and length of stay on youth problem behaviors

For 472 consecutive days we monitored the number of youths residing in a crisis shelter for adolescents, the average length of stay for the youths residing in the shelter on each day, and the number of problem behaviors occurring within the shelter on a daily basis. We analyzed these data using a combination of time series and logistic regression techniques to fit a model that would predict the occurrence of a problem behavior on any given day. After controlling for significant time trends in the data, our results indicate that both the number of youths in the shelter and the proportion of youths who have resided in the shelter longer than 14 days are significantly associated with a problem behavior occurring on any given day. The number of youths in the shelter and the probability of a problem behavior occurring correlated significantly. However, as the proportion of youths who resided in the shelter longer than 14 days increased, the probability of a problem behavior occurring decreased.