Genetic Counseling as a Tool for Type 2 Diabetes Prevention: A Genetic Counseling Framework for Common Polygenetic Disorders

Advances in genetic epidemiology have increased understanding of common, polygenic preventable diseases such as type 2 diabetes. As genetic risk testing based on this knowledge moves into clinical practice, we propose that genetic counselors will need to expand their roles and adapt traditional counseling techniques for this new patient set. In this paper, we present a genetic counseling intervention developed for a clinical trial [Genetic Counseling/Lifestyle Change for Diabetes Prevention, ClinicalTrials.gov identifier: NCT01034319] designed to motivate behavioral changes for diabetes prevention. Seventy-two phenotypically high-risk participants received counseling that included their diabetes genetic risk score, general education about diabetes risk factors, and encouragement to participate in a diabetes prevention program. Using two validated genetic counseling scales, participants reported favorable perceived control and satisfaction with the counseling session. Our intervention represents one model for applying traditional genetic counseling principles to risk testing for polygenetic, preventable diseases, such as type 2 diabetes.     

Have We Solved the Non-Identity Problem?

Our pollution of the environment seems set to lead to widespread problems in the future, including disease, scarcity of resources, and bloody conflicts. It is natural to think that we are required to stop polluting because polluting harms the future individuals who will be faced with these problems. This natural thought faces Derek Parfit’s famous Non-Identity Problem (1984, pp. 361–364). The people who live on the polluted earth would not have existed if we had not polluted. Our polluting behaviour does not make these individuals worse off. It may therefore seem that we do not harm them by polluting. Parfit argues that we should replace person-affecting principles with an impersonal principle of beneficence, Principle Q (1984, p. 360.). I argue that Principle Q cannot give an adequate account of our duties to refrain from polluting. I consider attempts to solve the Non-Identity Problem by denying that to harm someone an agent must make them worse off. I argue that such responses provide a partial solution to the Non-Identity Problem. They do show that we harm future individuals in a morally relevant sense by polluting. Nonetheless, this is only a partial solution. The Non-Identity Problem still suggests that our harm-based reasons not to pollute are less strong than we intuitively believe. Thus on its own an appeal to the claim that we harm future individuals is not able to give a fully satisfactory account of why we are required not to pollute.     

High Behavioral Approach System (BAS) sensitivity, reward responsiveness, and goal-striving predict first onset of bipolar spectrum disorders: a prospective behavioral high-risk design

A prospective, behavioral high-risk design provided a theoretically guided examination of vulnerability to first onset of bipolar spectrum disorder based on the Behavioral Approach System (BAS) model. Adolescents (ages 14-19) at an "age of risk" for bipolar disorder onset were screened on BAS sensitivity by interviewers blind to current symptoms, lifetime history, and family history of psychopathology. Participants were selected with high versus moderate levels of BAS sensitivity and administered a lifetime diagnostic interview. Those with a bipolar spectrum disorder, psychosis, or hypomanic episode with onset prior to the BAS sensitivity assessment were excluded. High BAS (n = 171) and moderate BAS (n = 119) sensitivity participants in the final sample completed baseline measures of symptoms, goal-setting, and reward responsiveness and were followed prospectively with semistructured diagnostic interviews every 6 months. Consistent with the vulnerability hypothesis of the BAS model of bipolar disorder, high BAS participants had a greater likelihood, and shorter time to onset, of bipolar spectrum disorder than moderate BAS participants across an average of 12.8 months of follow-up (12.9% vs. 4.2%), controlling for baseline depressive and hypomanic symptoms, and family history of bipolar disorder. High reward responsiveness on a behavioral task and ambitious goal-striving for popular fame and financial success (but not impulsivity) also predicted first onset of bipolar spectrum disorder controlling for the covariates and BAS risk group, and ambitious goal-striving partially mediated the BAS risk group effect. We discuss implications of the findings for the BAS model of bipolar disorder and early intervention efforts.     

Deconstructing the age-prevalence curve of alcohol dependence: why "maturing out" is only a small piece of the puzzle

Epidemiological studies have consistently demonstrated that heavy alcohol use and alcohol dependence (AD) tend to increase in adolescence and emerging adulthood and then show a large decline in the late 20s, a phenomenon called maturing out. This decline has been explained as an effect of "role incompatibility" in which involvement in new roles and activities interferes with a heavy drinking lifestyle. However, maturing out has been conceived mostly as a decrease in offset, with little attention paid to reductions in new onset or recurrence across decades of life. Moreover, although role incompatibility processes have been studied with young samples, little is known about the effect of life transitions (e.g., marriage, parenthood, changes in employment status) on AD later in life and whether similar effects are observed. Using longitudinal data from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative epidemiologic survey, we examined the patterns of stability and change in AD across the life span and the differential effect of life transitions on AD across different age strata. Results showed that persistence of AD tended to increase with age, although not dramatically, and that onset and recurrence tended to decrease with age. Moreover, the effects of life transitions on the course of AD varied across the life span and were different for men and women. These results indicate that life transitions differentially affect the patterns of stability and change in younger versus older people, have a different impact for men and women, and highlight the need to consider the unique aspects of each stage of adult development on the course of AD.     

Emotional responses to rejection of gestures of intergroup reconciliation

Four experiments examine the emotional and attitudinal consequences of victim group rejection of a gesture of reconciliation from a transgressor group. Participants were reminded about an ingroup transgression and were told that their ingroup provided an apology (Studies 1 and 4) or an offer of repair (Studies 2 and 3). The authors varied whether the victim group rejected or accepted these gestures. As predicted, rejection resulted in greater anger and lower levels of satisfaction directed toward the victim group. Victim group response had little systematic effect on anxiety or shame, however. Appraisals of the response as illegitimate mediated the effects of victim group response (Studies 3 and 4). Furthermore, Study 4 showed that the emotional backlash toward victim groups who reject an offer of reconciliation leads to heightened racism and reduced intentions to financially compensate victim groups. Implications for how groups reconcile in the face of historical transgressions are discussed.     

Specialised use of working memory by Portia africana,a spider-eating salticid

Using expectancy–violation methods, we investigated the role of working memory in the predatory strategy of Portia africana, a salticid spider from Kenya that preys by preference on other spiders. One of this predator’s tactics is to launch opportunistic leaping attacks on to other spiders in their webs. Focussing on this particular tactic, our experiments began with a test spider on a ramp facing a lure (dead prey spider mounted on a cork disc) that could be reached by leaping. After the test spider faced the lure for 30 s, we blocked the test spider’s view of the lure by lowering an opaque shutter before the spider leapt. When the shutter was raised 90 s later, either the same lure came into view again (control) or a different lure came into view (experimental: different prey type in same orientation or same prey type in different orientation). We recorded attack frequency (number of test spiders that leapt at the lure) and attack latency (time elapsing between shutter being raised and spiders initiating a leap). Attack latencies in control trials were not significantly different from attack latencies in experimental trials, regardless of whether it was prey type or prey orientation that changed in the experimental trials. However, compared with test spiders in the no-change control trials, significantly fewer test spiders leapt when prey type changed. There was no significant effect on attack frequency when prey orientation changed. These findings suggest that this predator represents prey type independently of prey orientation.     

Exploratory decisions of Trinidadian guppies when uncertain about predation risk

Animal Cognition - Animals can reduce their uncertainty of predation risk by gathering new information via exploration behaviour. However, a decision to explore may also be costly due to increased...