Information Mismatch: Cancer Risk Counseling with Diverse Underserved Patients

As genetics and genomics become part of mainstream Medicine, these advances have the potential to reduce or exacerbate health disparities. Gaps in effective communication (where all parties share the same meaning) are widely recognized as a major contributor to health disparities. The purpose of this study was to examine GC-patient communication in real time, to assess its effectiveness from the patient perspective, and then to pilot intervention strategies to improve the communication. We observed 64 English-, 35 Spanish- and 25 Chinese-speaking (n = 124) public hospital patients and 10 GCs in 170 GC appointments, and interviewed 49 patients who were offered testing using the audio recordings to stimulate recall and probe specific aspects of the communication. Data analyses were conducted using grounded theory methods and revealed a fundamental mismatch between the information provided by GCs and the information desired and meaningful to patients. Several components of the communication that contributed to this mismatch and often resulted in ineffective communication included: (1) too much information; (2) complex terminology and conceptually difficult presentation of information; (3) information perceived as not relevant by the patient; (4) unintentional inhibition of patient engagement and question-asking; (5) vague discussions of screening and prevention recommendations. Our findings indicate a need to transform the standard model of genetic counseling communication using evidence-based principles and strategies from other fields of Medicine. The high rates of limited health literacy in the US, increasing access of diverse populations to genetic services, and growing complexity of genetic information have created a perfect storm. If not directly addressed, this convergence is likely to exacerbate health disparities in the genomic age.     

Quality of Life in Patients with Recurrent Vasovagal or Unexplained Syncope: Influence of Sex, Syncope Type and Illness Representations

Health-related quality of life (QoL) is reduced in patients with recurrent vasovagal (VVS) or unexplained (US) syncope. Little is known regarding these patients’ QoL as pertains to their capacity to attain their life goals. Factors influencing QoL, such as sex, syncope type and illness representations have not been studied. Our objective is to examine the relationship between illness representations and QoL, as well as possible sex and syncope type differences. One hundred and four patients undergoing tilt-table testing (TTT) for recurrent syncope were interviewed one month before TTT, using questionnaires. Data were analysed using ANCOVAs, a-priori Helmert contrasts for illness representations, and regressions. Patients with US had a poor QoL compared to those with VVS [F(1, 91) = 10.46; p < 0.01], particularly in men (p < 0.01). Patients with higher perceived syncope severity showed an impoverished QoL relative to those with less severe perceptions [F(1, 91) = 5.47; p < 0.05]. A hierarchical regression revealed that illness representations mediate the impact of lifetime number of syncope on QoL. In conclusion, QoL is reduced in these patients, and is influenced by illness representations. Helping patients change their perceptions about their syncope may be an efficient way to promote QoL.     

Messianism and nationalism: Liberal optimism vs. orthodox anxiety

Confronting modernity, nineteenth century Jewish historians offered four different interpretations of the Jewish century that began in 1840: the liberal, the Orthodox, the nationalist, and the messianic. Exponents of the Wissenschaft school associated the year 5600 with the gospel of emancipation and the winds of cultural openness in western Europe; Orthodox historians viewed these change with suspicion and believed that the new century would usher in a period of twilight. Nationalist and the messianic interpreters saw the year 5600 as marking the start of the age of the redemption of Israel in its land: whether because the first buds of a Jewish national movement had appeared or because contemporary events were identified as heralds of the messianic redemption in the traditional sense. Unique was Rabbi Judah Alkalai, who sought to link traditional messianism with the liberal, optimistic interpretation of current events. He viewed progress, the Haskalah, and emancipation as positive signs of the messianic age and indicted traditionalists. Their rejectionist attitude toward modernity, he said, was delaying redemption. Today, narrowing differences between the traditionalist reaction to modernity and the religious nationalism have buried the memory of Alkalai's bold attempt.     

Do textual features affect credibility judgment? It all depends on who is the judge

This study examined the moderating role of absorption (a disposition associated with vivid imagination and rich mental experiences) in the process of interpersonal reality monitoring. Seventy five participants were assessed for absorption, and read a text describing an event that was either rich or poor in perceptual–emotional–contextual detail. They were asked to assess the credibility of the narrator; that is, the likelihood that he or she had actually experienced the event. For a text poor in detail, high‐absorption individuals believed the narrator more than low‐absorption individuals, whereas for a text rich in detail, no group differences appeared. The data seem to suggest that for high‐absorption individuals, credibility judgment depends on the degree to which the text can be assimilated into their own vivid imagination. Consideration of the judges' characteristics might therefore bring about a better understanding of the biases and errors involved in interpersonal reality monitoring. Copyright © 2008 John Wiley & Sons, Ltd.     

The role of attachment in influencing reactions to manipulated feedback from romantic partners

A study of 80 couples (mean age 24) examined the impact of attachment patterns on reactions to manipulated positive or negative feedback, ostensibly from partners. As expected, individuals high in attachment anxiety reported more negative mood and the least indifference to partner feedback. In addition, those high in attachment anxiety reported more negative reactions to negative feedback compared to those low in anxiety. Those high in attachment anxiety reported lower self‐competence after receiving negative feedback than those low in anxiety. Further, reactions to manipulated feedback mediated the relationship between attachment anxiety and self‐competence. Attachment models play a role in determining reactions to partner feedback and moderate how feedback is used to maintain self‐views. Copyright © 2006 John Wiley & Sons, Ltd.     

Family,gender, and attitudes toward retirement

The relationships between marital status, proximity of children, and attitudes toward retirement of 432 men and 373 women on the verge of retirement were studied. Three dimensions of attitudes were examined: attitudes toward losses associated with retirement, toward gains in entering retirement, and toward gains in leaving work. Women hold significantly more positive attitudes toward both types of gains; there are no gender differences concerning attitudes toward losses. The married of both sexes perceive more gains in entering retirement. Proximity of children is curvilinearly related to gain in entering retirement, especially among women. Attitudes toward losses and gains in leaving work are not associated with familial state. The meaning of work and the myth of the primacy of family for women are discussed.This paper draws on research supported by Grant Number 1 R01 AG 05206-01 from the National Institute on Aging.     

The contribution of external and internal features to the matching of unfamiliar faces

The relative efficacy of external and internal features in matching unfamiliar faces was studied in three experiments in which the subjects matched target and test faces differing in terms of external or internal features, or both. In Experiment 1 only full congruency between target and test faces was considered a match; in Experiments 2 and 3 faces sharing the same external and internal features were also considered to be matches. A total of 100 subjects matched 192 pairs of target and test faces in a same-different task. Reaction times and matching errors were recorded for analyses of variance. In all three experiments performance was best when either all features matched or all features mismatched, with mismatches having a slight edge. When matches of external and internal features with the target faces were inconsistent with each other, mismatches of external features led to faster responses in Experiments 1 and 2, and mismatches of internal features led to faster responses in Experiment 3. The results suggest that since faces are configurational stimuli, face matching is influenced by the non-relevant set of features; and that mismatches, especially of external features, influence face matching more than matches do.     

The effects of setting similarity on children's learning of the transverse patterning problem

A group of 15 fourth-graders were given training on the transverse patterning problem, a task consisting of three different geometric forms presented in pairs. Three other groups of 15 fourth-graders each received training on problems containing the same geometric forms, along with either one (color or size) or two (color and size) additional nonspatial dimensions varying among the settings comprising the different cue-cue patterns. Contrary to a prediction derived from Croll's (1967) extension of Spiker's (1963) theory of discrimination learning, none of the Ss solved the basic transverse patterning problem, nor was there any improvement in performance on this problem after 90 trials. Consistent with predictions derived from Spiker's theory, it was found that the addition of one nonspatial dimersion resulted in solution, and that the greater the number of nonspatial dimensions present, the better the learning.