Clinician-Stakeholders’ Perspectives on Using Patient Portals to Return Lynch Syndrome Screening Results

Test results for genetic conditions, such as Lynch Syndrome (LS), have traditionally been returned by genetic counselors or other providers who can explain results implications and provide psychosocial support. Returning genetic results through an Electronic Health Record’s patient portal may increase the efficiency of returning results and could activate patient follow-up; however, stakeholder input is necessary to determine acceptability and appropriate implementation for LS. Twenty interviews were conducted with clinicians from six specialties involved in LS screening that represent a range of settings. Data were analyzed using directed content analysis and thematic analysis across content categories. Participants felt that patient portals could supplement personal calls, but the potential sensitive nature of LS screening results indicated the need for caution. Others felt that LS results could be returned through portals if there were clear explanations of the result, reputable additional information available within the portal, urging follow up confirmatory testing, and a referral to a genetics specialist. Patient portals were seen as helpful for prompting patient follow-up and providing resources to notify at-risk family members. There is potential for patient portals to return LS screening and other genetic results, however we raise several issues to resolve before implementation is warranted.     

De l’opportunité d’une nouvelle loi sur la fin de vie ?

This paper deals with the end of life issue. It advocates for putting the legislation about end of life a part from bioethics laws and addresses some legal problems.     

Prevalence of Types of Perpetration: Gender and Patterns of Intimate Partner Violence Within a Prison Sample in Singapore

It has been reported in Western research on intimate partner violence (IPV) that there are similar rates between males and females (Filbert, 2010). The objective of this study was to compare male and female prisoners from Singapore on rates of IPV as well as the Johnson (2006) types of IPV. Women (n = 75) self-reported higher rates of physical IPV perpetration in the past year (64.0%) than (n = 75) did men (46.1%). Women reported similar rates of IPV for themselves and their partners in the past year (64.0%), while men reported slightly more physical IPV for themselves (46.1%) than they did for their female partners (41.3%). In line with Johnson (2006), rates of intimate terrorism were calculated between 5% and 7% for themselves and their partners, with little variation due to gender. Violent resistance (VR) was calculated at between 2.1% and 7%, with more female than male VR reported for women. Much higher rates of situational couple violence was calculated for both males and females, ranging from 53.3% to 66.7% in the past year, while mutual violent control was significantly lower, ranging from between 14.8% to 20.0%, with data being discussed in relation to patriarchal and family violence perspectives. We concluded that the rates of IPV between males and females were very similar as were the types of IPV. Further research with other cultures should be encouraged for comparison with Western samples.     

Predictors of adherence to aerobic exercise in rectal cancer patients during and after neoadjuvant chemoradiotherapy

This pilot study explored predictors of adherence to exercise during and after neoadjuvant chemoradiotherapy (NACRT) in rectal cancer patients. Eighteen rectal cancer patients were prescribed three supervised aerobic exercise sessions/week during NACRT followed by ≥150 min/week of unsupervised aerobic exercise after NACRT. Although not statistically significant, adherence to supervised exercise during NACRT was meaningfully better for patients who were women (d = .82; P = .12), younger (d = ?.62; P = .30), married (d = .62; P = .42), with better mental health (r = .32; P = .21), fewer diarrhea symptoms (r = .48; P = .052), and higher anticipated enjoyment (r = .31; P = .23), support (r = .32; P = .22), and motivation (r = .31; P = .23). After NACRT, adherence was significantly better for patients who reported worse mental health (r = ?.56; P = .046) and meaningfully better for patients who were women (d = .54; P = .38), better educated (d = .77; P = .22), had no comorbidities (d = ?.63; P = .17), and exercised at baseline (d = 1.05; P = .12). Demographics, tumor side effects, and motivational variables may predict adherence to exercise during and after NACRT.     

Prepubertal social gender transitions: What we know; what we can learn—A view from a gender affirmative lens

ABSTRACT

?Background: This article provides a review and commentary on social transition of gender-expansive prepubertal youth, analyzing risks, and benefits based on a synthesis of research and clinical observation, highlighting controversies, and setting forth recommendations, including the importance of continued clinical research.

Methods: This article involved: (1) a review and critique of the WPATH Standards of Care 7th edition guidelines on social transition; (2) a review and synthesis of empirical research on social transition in prepubertal children; (3) a discussion of clinical practice observations; (4) a discussion of continuing controversies and complexities involving early social transition; (5) a discussion of risks and benefits of social transition; and (6) conclusions and recommendations based upon the above.

Results: Results suggest that at this point research is limited and that some of the earliest research on young gender-expansive youth is methodologically questionable and has not been replicated. Newer research suggests that socially transitioned prepubertal children are often well adjusted, a finding consistent with clinical practice observations. Analysis of both emerging research and clinical reports reveal evidence of a stable transgender identity surfacing in early childhood.

Discussion: The authors make recommendations to support social transitions in prepubertal gender-expansive children, when appropriate, as a facilitator of gender health, defined as a child's opportunity to live in the gender that feels most authentic, acknowledging that there are limitations to our knowledge, and ongoing research is essential.     

The sound of enemies and friends in the neighborhood

Previous studies (e.g., Pecher, Zeelenberg, & Wagenmakers, 2005) found that semantic classification performance is better for target words with orthographic neighbors that are mostly from the same semantic class (e.g., living) compared to target words with orthographic neighbors that are mostly from the opposite semantic class (e.g., nonliving). In the present study we investigated the contribution of phonology to orthographic neighborhood effects by comparing effects of phonologically congruent orthographic neighbors (book-hook) to phonologically incongruent orthographic neighbors (sand-wand). The prior presentation of a semantically congruent word produced larger effects on subsequent animacy decisions when the previously presented word was a phonologically congruent neighbor than when it was a phonologically incongruent neighbor. In a second experiment, performance differences between target words with versus without semantically congruent orthographic neighbors were larger if the orthographic neighbors were also phonologically congruent. These results support models of visual word recognition that assume an important role for phonology in cascaded access to meaning.     

Concealable Stigmatized Identities and Psychological Well‐Being

Many people have concealable stigmatized identities: Identities that can be hidden from others and that are socially devalued and negatively stereotyped. Understanding how these concealable stigmatized identities affect psychological well‐being is critical. We present our model of the components of concealable stigmatized identities including valenced content– internalized stigma, experienced discrimination, anticipated stigma, disclosure reactions, and counter‐stereotypic/positive information – and magnitude– centrality and salience. Research has shown that negatively valenced content is related to increased psychological distress. However, smaller identity magnitude may buffer this distress. We review the research available and discuss important areas for future work.     

Language characteristics of black children: Implications for assessment

After delineating a number of phonological and syntactic characteristics of black English a review of recent comparative studies is presented. The authors conclude that, while evidence is mixed concerning the question of whether whether a language deficit exists among the lower-class balck children along with a dialect difference, there is clear evidence of the existence of a dialect. The problem facing educators is that no standardized tests have been developed for use with speakers of the dialect. The authors conclude that the use of available tests with dialect speaking children may result in gross errors in educational placement of these children.     

The disadvantaged as a social and professional phenomenon

Being culturally disadvantaged is a social condition which is created, managed, and maintained by both social and professional institutions. When institutions attempt to sustain societal norms by selecting certain attributes and calling them desirable, these institutions are relegating large segments of the population to a deviant status if it does not share these attributes. The “culturally disadvantaged” are such a group. This phenomenon not only results in differential perceptions and expectations, but also influences their self-evaluation, academic success, and career opportunities. The transformation of deviance into incompetency has also led to formally sanctioned methods of managing deviancy. Methods, such as compensatory education, ability grouping, and special class placement can be viewed as maintaining the position that the culturally disadvantaged are indeed deviant and incompetent.