Guidelines for Writing Letters to Patients

Patient letters provide a permanent record of the genetic counseling that was provided and are unique in medical care; rarely do other health care providers send summaries written specifically to their patients and families. We surveyed genetic counseling training program directors and found that while the acquisition of patient letter-writing skills was considered important, there were no specific guidelines made available to students. To develop letter-writing guidelines, we evaluated patient letters, reviewed references on professional correspondence, surveyed the medical literature, and worked with a writing consultant. The guidelines we subsequently developed and present here include a format for writing patient letters, suggestions on presenting medical information in understandable terms, and wording considerations. These patient letter-writing guidelines are intended to serve as a guide for teaching students this important skill and as a resource for practicing health care professionals.     

The Depression Anxiety Stress Scale-21: Spanish Translation and Validation with a Hispanic Sample

The English-language version of the Depression Anxiety Stress Scale-21 (DASS-21) was professionally translated into Spanish and field-tested among 98 bilingual Hispanic adults. Participants who were diagnosed with an anxiety disorder on the Anxiety Disorders Interview Schedule-IV completed the DASS-21, the Beck Depression Inventory-II, and the Beck Anxiety Inventory. Results indicated strong indices of internal consistency and expected patterns of discriminant, convergent, and structural validity. A confirmatory factor analysis compared a model fit of a first order 1-factor model, a first order 3-factor model, and a second order factor model. The latter 2 models were significantly better than the 1-factor model. Psychometric data were comparable to those of an English version. Clinicians and researchers in need of a brief, Spanish-language, screening measure of general psychopathology may want to consider this newly translated DASS-21.     

Emotional expression and physiology in European Americans and Hmong Americans

Ethnographic and clinical observations suggest that Asians are less expressive than European Americans. To examine whether this difference emerged in online emotional responding, 50 Hmong Americans (HAs) and 48 European Americans (EAs) were asked to relive past episodes of intense happiness, pride, love, anger, disgust, and sadness. Facial behavior and physiological reactivity were measured. For most emotions, more cultural similarities than differences were found. There were some exceptions: During happiness, fewer HAs than EAs showed non-Duchenne smiles (i.e., "social" smiles), despite similarities in reported emotional experience and physiological reactivity. Within-group differences between "less Hmong" and "more Hmong" HAs were also found. Implications of these findings for our understanding of culture-emotion relations are discussed.     

Development of categorization in infancy: advancing forward to the animate/inanimate level

Three experiments are reported on the development of object categorization skills during the second year of life. Experiment 1 examined whether 14- and 18-month-old infants were capable of performing categorization at the animate/inanimate (A/I) level using a sequential touching task. The 18-month-olds were significantly above chance and the 14-month-olds were also approaching above-chance significance, which is the highest level of inclusiveness ever tested in infancy. In Experiments 2 and 3, 14-month-old infants participated in a sequential touching task in which the part features of animate and inanimate objects were modified, allowing for a test of partonomic (i.e., legs and wheels) vs. taxonomic (i.e., animates and inanimates) categorization. Infants did not favor partonomic categorization, suggesting that A/I categories are not formed solely based on object parts such as legs and wheels.     

Zebrafish prefer larger to smaller shoals: analysis of quantity estimation in a genetically tractable model organism

Numerical abilities have been demonstrated in a variety of non-human vertebrates. However, underlying biological mechanisms have been difficult to study due to a paucity of experimental tools. Powerful genetic and neurobiological tools already exist for the zebrafish, but numerical abilities remain scarcely explored with this species. Here, we investigate the choice made by single experimental zebrafish between numerically different shoals of conspecifics presented concurrently on opposite sides of the experimental tank. We examined this choice using the AB strain and pet store zebrafish. We found zebrafish of both populations to generally prefer the numerically larger shoal to the smaller one. This preference was significant for contrasted ratios above or equalling 2:1 (i.e. 4 vs. 0, 4 vs. 1, 8 vs. 2, 6 vs. 2 and 6 vs. 3). Interestingly, zebrafish showed no significant preference when each of the two contrasted shoals had at least 4 members, e.g. in a contrast 8 versus 4. These results confirm that zebrafish possess the ability to distinguish larger numbers of items from smaller number of items, in a shoaling context, with a potential limit above 4. Our findings confirm the utility of the zebrafish for the exploration of both the behavioural and the biological mechanisms underlying numerical abilities in vertebrates.     

Enemies and friends in the neighborhood: orthographic similarity effects in semantic categorization

Studies investigating orthographic similarity effects in semantic tasks have produced inconsistent results. The authors investigated orthographic similarity effects in animacy decision and in contrast with previous studies, they took semantic congruency into account. In Experiments 1 and 2, performance to a target (cat) was better if a previously studied neighbor (rat) was congruent (i.e., belonged to the same animate-inanimate category) than it was if it was incongruent (e.g., mat). In Experiments 3 and 4, performance was better for targets with more preexisting congruent neighbors than for targets with more preexisting incongruent neighbors. These results demonstrate that orthographic similarity effects in semantic categorization are conditional on semantic congruency. This strongly suggests that semantic information becomes available before orthographic processing has been completed.     

Clinical status of at-risk individuals 5 years later: further validation of the psychometric high-risk strategy

The authors hypothesized that at-risk individuals identified on the basis of their Chapman scale scores would be diagnosed with schizophrenia-spectrum disorders at follow-up. In the present study, the authors interviewed 135 young adults approximately 5 years following their initial assessment. The at-risk groups included high scorers on the Perceptual Aberration and/or Magical Ideation Scales (n=59) and high scorers on the revised Social Anhedonia Scale (n=32). The control participants (n=44) scored below 0.5 SD of the same-sex group means on all the scales. At the follow-up, the groups differed in terms of their likelihood of having a schizophrenia-spectrum diagnosis, Chi2(2)=9.79, p<.01. The at-risk groups reported more frequent and severe psychotic-like experiences relative to the control group. These findings support the predictive validity of the Chapman psychosis-proneness scales and may enhance the power of early detection efforts.     

Posttraumatic stress disorder is associated with limited executive resources in a working memory task

Patients with posttraumatic stress disorder (PTSD) can show declines in working memory. A dual-task design was used to determine whether these impairments are linked to executive control limitations. Participants performed a Sternberg memory task with either one or four letters. In the dual-task condition, the maintenance period was filled with an arrow flanker task. PTSD patients were less accurate on the working memory task than were controls, especially in the dual-task condition. In the single-task condition, both groups showed similar patterns of brain potentials from 300 to 500 ms when discriminating old and new probes. However, when taxed with an additional task, the event-related potentials (ERPs) of the PTSD group no longer differentiated old and new probes. In contrast, interference resolution processes in both the single- and dual-task conditions of the flanker task were intact. The lack of differentiation in the ERPs reflects impaired working memory performance under more difficult, dual-task conditions. Exacerbated difficulty in performing a working memory task with concurrent task demands suggests a specific limitation in executive control resources in PTSD.     

Patients’ Views of Treatment-Focused Genetic Testing (TFGT): Some Lessons for the Mainstreaming of <Emphasis Type="Italic">BRCA1</Emphasis> and <Emphasis Type="Italic">BRCA2</Emphasis> Testing

This paper explores patients’ views and experiences of undergoing treatment-focused BRCA1 and BRCA2 genetic testing (TFGT), either offered following triaging to clinical genetics (breast cancer) or as part of a mainstreamed care pathway in oncology (ovarian cancer). Drawing on 26 in-depth interviews with patients with breast or ovarian cancer who had undergone TFGT, this retrospective study examines patients’ views of genetic testing at this point in their care pathway, focusing on issues, such as initial response to the offer of testing, motivations for undergoing testing, and views on care pathways. Patients were amenable to the incorporation of TFGT at an early stage in their cancer care irrespective of (any) prior anticipation of having a genetic test or family history. While patients were glad to have been offered TFGT as part of their care, some questioned the logic of the test’s timing in relation to their cancer treatment. Crucially, patients appeared unable to disentangle the treatment role of TFGT from its preventative function for self and other family members, suggesting that some may undergo TFGT to obtain information for others rather than for self.     

“Inside out”: Appraisals for achievement emotions from constructive,positive, and negative feedback on writing

Even with the recent surge of research on achievement emotions, few studies have investigated emotions in feedback situations and the appraisals associated with such emotions. The purpose of this study was to examine emotion appraisals of constructive criticism, negative, and positive feedback, to aid us in determining whether these appraisals differed by feedback type. In a task asking them to provide open-ended responses as they imagined receiving feedback on a writing task, undergraduates (N?=?270) gave reasons for why they might experience unpleasant emotions from positive feedback and pleasant emotions from negative feedback along with reasons for both pleasant and unpleasant emotions emanating from constructive feedback. Open coding of responses yielded categories for each emotion-feedback pairing that, across all emotions, were collapsed into five appraisal categories: feedback suggests ways to improve, a mismatch between feedback and task exists, feedback targets the self or one’s ability, feedback says something about the relationship between feedback giver and receiver, and the task is judged for its value. Distributions of appraisal categories distinguished constructive feedback from positive and negative feedback. Implications are drawn for control-value theory and for classroom feedback practices.