Review and Comparison of Electronic Patient-Facing Family Health History Tools

Family health history (FHx) is one of the most important pieces of information available to help genetic counselors and other clinicians identify risk and prevent disease. Unfortunately, the collection of FHx from patients is often too time consuming to be done during a clinical visit. Fortunately, there are many electronic FHx tools designed to help patients gather and organize their own FHx information prior to a clinic visit. We conducted a review and analysis of electronic FHx tools to better understand what tools are available, to compare and contrast to each other, to highlight features of various tools, and to provide a foundation for future evaluation and comparisons across FHx tools. Through our analysis, we included and abstracted 17 patient-facing electronic FHx tools and explored these tools around four axes: organization information, family history collection and display, clinical data collected, and clinical workflow integration. We found a large number of differences among FHx tools, with no two the same. This paper provides a useful review for health care providers, researchers, and patient advocates interested in understanding the differences among the available patient-facing electronic FHx tools.     

Therapists’ Perspectives of the Cotherapy Experience in a Training Setting

The experience of cotherapy has been sparsely addressed in the literature. This qualitative study’s goals were to explore (a) the usefulness of cotherapy as a training model (b) the impact of cotherapy on services provided; (c) the impact of being trained in a cotherapy model; and (d) factors that both facilitated and hindered the process of cotherapy. The authors conducted a focus group interview with seven participants who graduated from a COAMFTE accredited MFT master’s program. Participants unanimously reported they believed cotherapy impacted client outcomes and training. They also expressed that cotherapists’ unwillingness to address issues within the cotherapy team negatively impacted the cotherapy relationship and client outcomes. Data analysis yielded four main themes, including cotherapy as a vehicle for personal growth, accountability in the cotherapy relationship, need for safety in the cotherapy relationship, and cotherapy team’s need for supervision.     

Rebound or Resignation: Developing a Predictive Model of Return to Subjective Wellbeing Set-Point

Though subjective wellbeing (SWB) is generally stable and consistent over time, it can fall below its set-point in response to adverse life events. However, deviations from set-point levels are usually only temporary, as homeostatic processes operate to return SWB to its normal state. Given that income and close interpersonal relationships have been proposed as powerful external resources that are coincident with higher SWB, access to these resources may be an important predictor of whether or not a person is likely to recover their SWB following a departure from their set-point. Under the guiding framework of SWB Homeostasis Theory, this study considers whether access to a higher income and a committed partner can predict whether people who score lower than normal for SWB at baseline will return to normal set-point levels of SWB (rebound) or remain below the normal range (resigned) at follow-up. Participants were 733 people (53.3 % female) from the Australian Unity Longitudinal Wellbeing Study who ranged in age from 20 to 92 years (M = 59.65 years; SD = 13.15). Logistic regression analyses revealed that participants’ demographic characteristics were poor predictors of whether they rebounded or resigned. Consistent with homeostasis theory, the extent of departure from the proposed normal SWB set-point at baseline was significantly associated with rebound or resignation at time 2. These findings have implications for the way that SWB measures can be used in professional practice to identify people who are particularly vulnerable to depression and to guide the provision of appropriate and effective therapeutic interventions.     

Within-Family Effects of Smoking during Pregnancy on ADHD: the Importance of Phenotype

We sought to test within- and between- family associations of smoking during pregnancy (SDP) and attention deficit-hyperactivity disorder (ADHD) symptoms using a structured interview based on the conventional Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) symptoms and the Strengths and Weaknesses of ADHD-Symptoms and Normal-Behavior (SWAN) scale, which is a population based measure that grew out of the notion that an ADHD diagnosis exists on the extreme end of a continuum of normative behaviors and includes both above- and below- average performance on attention and activity. We used a sibling-comparison approach in a sample of 173 families including siblings aged 7–16 years (52% male) drawn from the state of Missouri, USA, wherein mothers smoked during one pregnancy but not the other. There was a within-family effect of smoking during pregnancy on SWAN hyperactivity/impulsivity and SWAN total ADHD behaviors. The associations between SDP and DSM-IV-based ADHD symptom dimensions as well as SWAN inattention were explained by familial confounds. These findings suggest that SDP exerts a potentially causal effect on increased ADHD hyperactive/impulsive behaviors and that this SDP effect is best captured when hyperactivity/impulsivity is assessed more normatively across the population, rather than specifically assessing problematic behaviors via DSM symptoms. Thus, any potentially causal effect of SDP on ADHD symptom dimensions may be restricted to hyperactive/impulsive behaviors rather than inattention, and normative, non-DSM-IV based behavioral measures may provide a more sensitive test of mechanisms of SDP-ADHD symptom associations, particularly in non-clinical samples.     

The accuracy of reaching movements in brief delay conditions.

We tested the hypothesis that a highly accurate target representation is available to the visuomotor system in brief (< 2 s) delay conditions. Participants reached to single midsagittal targets (20, 25, 30, 35, 40 cm amplitude) in full vision, open-loop and delay conditions (500, 1,000, 1,500 or 2,000 ms). Radial endpoint error was significantly greater for open-loop than full vision reaches, and was greater still for all delay conditions, which did not differ from one another. Radial error was greater for farther targets, although this tended to hold only for delayed reaches. These data suggest that the visuomotor system switches from on-line visual information to a degraded, stored representation very soon (< 500 ms) if not immediately after target occlusion.     

GENETIC AND ENVIRONMENTAL CONTRIBUTIONS TO VARIANCE IN AGE AT FIRST SEXUAL INTERCOURSE

Abstract— Little is known about the relative importance of genetic and environmental factors as determinants of age at first sexual intercourse. In this study, subjects were 5,080 individuals from the Australian Twin Registry (3,310 females, 1,770 males, age range 27–70 years, median 40 years) who completed a semistructured interview by telephone in 1992–1993. Self-reported age at first intercourse correlated higher for identical (monozygotic) twins than for nonidentical (dizygotic) twins. Structural equation model fitting found that the genetic contribution to variance was considerably greater among twins aged 40 years or less (72% for males and 49% for females) than for those aged from 41 to 70 years (0% for males and 32% for females). Among the older cohort, there was evidence that somewhat different aspects of the shared social environment influenced age at onset in males and females. In a more laissez-faire social climate in recent decades, it is likely that biological and psychological characteristics that are partly under genetic control significantly influence the age at which a person commences sexual activity.     

A sequential theory of psychological discrimination

A theory of discrimination which assumes that subjects compare psychological values evoked by a stimulus to a subjective referent is proposed. Momentary differences between psychological values for the stimulus and the referent are accumulated over time until one or the other of two response thresholds is first exceeded. The theory is analyzed as a random walk bounded between two absorbing barriers. A general solution to response conditioned expected response times is computed and the important role played by the moment generating function (mgf) for increments to the random walk is examined. From considerations of the mgf it is shown that unlike other random walk models [Stone, 1960; Laming, 1968] the present theory does not imply that response conditioned mean correct and error times must be equal. For two fixed stimuli and a fixed referent it is shown that by controlling values of response thresholds, subjects can produce Receiver Operating Characteristics similar or identical to those predicted by Signal Detection Theory, High Threshold Theory, or Low Threshold Theory.