Gay, Lesbian, and Bisexual Patients’ Recommendations for Genetic Counselors: A Qualitative Investigation

Gay, lesbian, and bisexual (GLB) individuals comprise a growing patient population in genetic counseling. However, only one article from a genetic counseling journal provides empirical data on GLB patients' genetic counseling experiences and genetic counselor attitudes and practices regarding GLB patients. The present study, an extension of the aforementioned article, gathered further information about patients' genetic counseling experiences through semi-structured telephone interviews. Twelve of the previous study's 29 patient respondents (n?=?10 lesbian women, n?=?1 gay man, n?=?1 bisexual woman) participated. Interview questions concerned the use of medically inclusive forms, factors influencing patient disclosure, counselors' ability to relate to them, and their expectations of genetic counselors. Inductive analysis of the interviews yielded seven themes: 1) Medically inclusive forms with gender neutral terms are important; 2) Genetic counselor ability to relate to a GLB person depends more on the relationship established during the session and less on external symbols; 3) The presence of GLB-friendly symbols increases comfort when disclosing one's orientation; 4) Inclusion of the patient's partner is important and best done by encouraging their active participation in sessions; 5) When GLB patients disclose their orientation, they expect to be treated like any other patient; 6) Providers should ask about orientation if medically pertinent and the remaining discussion should take orientation into consideration; and 7) When a provider inquires about orientation it should be done in a safe and appropriate way. Illustrative quotations, genetic counseling practice implications, and research recommendations are presented.     

Service Coordination and Children’s Functioning in a School-Based Intensive Mental Health Program

Coordination of mental health services in children with serious emotional disturbance (SED) has shown a preliminary relationship to positive outcomes in children. Yet, research in this area is sparse. Therefore, the relation between service coordination activities and adaptive functioning was examined for 51 children SED who were treated in the school-based Intensive Mental Health Program for elementary school students (IMHP; average treatment length was 12?months; mean age 9.37 at intake). Systematic review of detailed case records identified 16,669 episodes of service coordination that could be coded reliably for frequency, quality, and purpose (planning, linking, monitoring) of the service coordination component. Adaptive functioning was measured by Child and Adolescent Functional Assessment Scale (CAFAS) ratings and daily points earned on the behavior management system of the IMHP at intake, 6, 12?months, and discharge. Findings indicated that the frequency, quality, and purpose of the service coordination component varied from case to case and by time in treatment. Although service coordination activities overall decreased as treatment progressed, concentrated high quality service coordination (measured by frequency, quality, and component of service coordination) consistently predicted improved functioning on both CAFAS ratings and daily points earned. Results have both practice and policy implications for training interagency teams and clinicians on when and how to optimally coordinate services.     

Barriers to and Motivations for Physician Referral of Patients to Cancer Genetics Clinics

Although it is well known that under-referral of colon cancer patients to cancer genetics clinics is a chronic problem, no study has yet examined why physicians may be ordering testing independently rather than referring patients to cancer genetics clinics. The current study explored variables which may impact a physician’s preference for ordering testing independently or referring patients to outside cancer genetics experts. An online questionnaire, distributed to the membership of the American College of Gastroenterology and the American Society of Colorectal Surgeons, yielded responses from 298 physicians. Motivations to refer to cancer genetics clinics rather than order testing independently included fear of genetic discrimination and a belief that patients benefit from genetic counseling about the risks, benefits and consequences of testing. These results suggest that in order to increase referrals, genetic counselors must educate physicians about the unique benefits patients receive from participating in genetic counseling.     

Kv4.2 knockout mice have hippocampal-dependent learning and memory deficits

Kv4.2 channels contribute to the transient, outward K(+) current (A-type current) in hippocampal dendrites, and modulation of this current substantially alters dendritic excitability. Using Kv4.2 knockout (KO) mice, we examined the role of Kv4.2 in hippocampal-dependent learning and memory. We found that Kv4.2 KO mice showed a deficit in the learning phase of the Morris water maze (MWM) and significant impairment in the probe trial compared with wild type (WT). Kv4.2 KO mice also demonstrated a specific deficit in contextual learning in the fear-conditioning test, without impairment in the conditioned stimulus or new context condition. Kv4.2 KO mice had normal activity, anxiety levels, and prepulse inhibition compared with WT mice. A compensatory increase in tonic inhibition has been previously described in hippocampal slice recordings from Kv4.2 KO mice. In an attempt to decipher whether increased tonic inhibition contributed to the learning and memory deficits in Kv4.2 KO mice, we administered picrotoxin to block GABA(A) receptors (GABA(A)R), and thereby tonic inhibition. This manipulation had no effect on behavior in the WT or KO mice. Furthermore, total protein levels of the α5 or δ GABA(A)R subunits, which contribute to tonic inhibition, were unchanged in hippocampus. Overall, our findings add to the growing body of evidence, suggesting an important role for Kv4.2 channels in hippocampal-dependent learning and memory.     

The "what" and the "how" of dispositional mindfulness: using interactions among subscales of the five-facet mindfulness questionnaire to understand its relation to substance use

Although self-report measures of dispositional mindfulness have good psychometric properties, a few studies have shown unexpected positive correlations between substance use and mindfulness scales measuring observation of present-moment experience. The current study tested the hypothesis that the relationship between present-moment observation and substance use is moderated by the tendency to be nonjudgmental and nonreactive toward the observed stimuli. Two hundred and ninety-six undergraduates completed the five-facet mindfulness questionnaire (FFMQ), a calendar measuring periods of substance use, and a measure of the five-factor model of personality. Controlling for FFMQ and personality subscales, significant interactions between the observing and nonreactivity subscales indicated that the observing subscale was negatively associated with substance use at higher levels of nonreactivity but positively associated with periods of substance use at lower levels of nonreactivity. Results support the use of statistical interactions among FFMQ subscales to test for the presence of interactive effects of different aspects of mindfulness.     

Histone acetylation rescues contextual fear conditioning in nNOS KO mice and accelerates extinction of cued fear conditioning in wild type mice

Epigenetic regulation of chromatin structure is an essential molecular mechanism that contributes to the formation of synaptic plasticity and long-term memory (LTM). An important regulatory process of chromatin structure is acetylation and deacetylation of histone proteins. Inhibition of histone deacetylase (HDAC) increases acetylation of histone proteins and facilitate learning and memory. Nitric oxide (NO) signaling pathway has a role in synaptic plasticity, LTM and regulation of histone acetylation. We have previously shown that NO signaling pathway is required for contextual fear conditioning. The present study investigated the effects of systemic administration of the HDAC inhibitor sodium butyrate (NaB) on fear conditioning in neuronal nitric oxide synthase (nNOS) knockout (KO) and wild type (WT) mice. The effect of single administration of NaB on total H3 and H4 histone acetylation in hippocampus and amygdala was also investigated. A single administration of NaB prior to fear conditioning (a) rescued contextual fear conditioning of nNOS KO mice and (b) had long-term (weeks) facilitatory effect on the extinction of cued fear memory of WT mice. The facilitatory effect of NaB on extinction of cued fear memory of WT mice was confirmed in a study whereupon NaB was administered during extinction. Results suggest that (a) the rescue of contextual fear conditioning in nNOS KO mice is associated with NaB-induced increase in H3 histone acetylation and (b) the accelerated extinction of cued fear memory in WT mice is associated with NaB-induced increase in H4 histone acetylation. Hence, a single administration of HDAC inhibitor may rescue NO-dependent cognitive deficits and afford a long-term accelerating effect on extinction of fear memory of WT mice.     

The psychopath magnetized: insights from brain imaging

Psychopaths commit a disproportionate amount of violent crime, and this places a substantial economic and emotional burden on society. Elucidation of the neural correlates of psychopathy may lead to improved management and treatment of the condition. Although some methodological issues remain, the neuroimaging literature is generally converging on a set of brain regions and circuits that are consistently implicated in the condition: the orbitofrontal cortex, amygdala, and the anterior and posterior cingulate and adjacent (para)limbic structures. We discuss these findings in the context of extant theories of psychopathy and highlight the potential legal and policy implications of this body of work.     

Math anxiety: who has it, why it develops, and how to guard against it

Basic math skills are important for success in school and everyday life. Yet many people experience apprehension and fear when dealing with numerical information, termed math anxiety. Recently, researchers have started to probe the antecedents of math anxiety, revealing some surprising insights into its onset, risk factors, and remediation.     

Affect-biased attention as emotion regulation

The affective biasing of attention is not typically considered to be a form of emotion regulation. In this article, we argue that 'affect-biased attention' - the predisposition to attend to certain categories of affectively salient stimuli over others - provides an important component of emotion regulation. Affect-biased attention regulates subsequent emotional responses by tuning one's filters for initial attention and subsequent processing. By reviewing parallel research in the fields of emotion regulation and affect-biased attention, as well as clinical and developmental research on individual differences in attentional biases, we provide convergent evidence that habitual affective filtering processes, tuned and re-tuned over development and situation, modulate emotional responses to the world. Moreover, they do so in a manner that is proactive rather than reactive.