Genetic Counseling for Personal Genomic Testing: Optimizing Client Uptake of Post-Test Telephonic Counseling Services

The field of genetic counseling faces a broad challenge: many potential clients may not be aware of the value and benefit of genetic counseling services, and therefore may not utilize those services. Navigenics is a personal genomic testing company that provides telephonic genetic counseling services for multifactorial diseases and pharmacogenetics. When first offered in 2008, utilization of the Navigenics genetic counseling service was less than expected. To explore the basis for under-utilization and potential mechanisms for increasing uptake, Navigenics initiated a quality improvement study, in which three different methods of engaging clients in the uptake of genetic counseling services were assessed over the course of 1 year. Outcomes showed significant differences in uptake rates between methodologies (7.5%, 24.6%, and 60.1%), yielding an 8-fold increase in service utilization when post-test telephonic outreach to all clients was performed. Further, utilization spanned all risk levels based on client results, evidence that not only clients with high-risk results were motivated to engage in the genetic counseling service. This research indicates that implementing strategies to educate clients about genetic counseling can positively impact client engagement and utilization of available services.     

The Use of a Family History Risk Assessment Tool within a Community Health Care System: Views of Primary Care Providers

Primary care providers (PCPs) offered input regarding the incorporation of a family health history (FHH) risk assessment tool into a community health care system (CHCS). Sixteen PCPs participated in one of three focus groups. Perceived impediments included the lack of standard screening guidelines, effective screening tests, genetic counseling resources, and services for high-risk patients. The PCPs were concerned about their level of expertise, the cost of preventive health care, and genetic discrimination. They also were concerned about the use of a FHH tool by oncologists within the CHCS because of communication gaps between oncologists and PCPs, lack of clarity regarding follow-up and legal liability, and reimbursement issues. To integrate a FHH tool into a CHCS, PCPs will need consultation and referral services, evidence-based recommendations, and "just-in-time" educational resources. Oncologists who use the tool will need to develop a streamlined communication system with PCPs, establish clearly defined roles, and ensure patient follow-up.     

Impulse Control Disorders in Parkinson’s Disease: A Psychosocial Perspective

Parkinson's disease (PD) is a progressive neurodegenerative disease primarily characterised by motor symptoms. However, another feature of PD which is receiving increasing attention is the phenomenon of impulse control disorders (ICDs), such as pathological gambling. To date, research into ICDs in PD has centred on a biomedical model of cause, related to the effects of dopamine replacement therapy. However, there are several areas of discrepancy in the current biomedical account of ICDs in PD. In addition, we argue that social and psychological factors also need to be considered to achieve a more complete understanding of the phenomenon. We present a novel conceptual model which combines biomedical and psychosocial factors in the genesis of ICDs in PD and use the model to identify a number of potential treatment intervention points and to highlight important outstanding questions concerning the inter-relationship between psychosocial and biomedical factors in the genesis of ICDs in PD.     

Early Career Boot Camp: A Novel Mechanism for Enhancing Early Career Development for Psychologists in Academic Healthcare

The purpose of this article is to describe a pilot mentoring program for Early Career Psychologists (ECPs) working in Academic Health Centers (AHCs) and synthesize the lessons learned to contribute to future ECP and AHC career development training programs. The authors describe an early career development model, named the Early Career Boot Camp. This intensive experience was conducted as a workshop meant to build a supportive network and to provide mentorship and survival tools for working in AHCs. Four major components were addressed: professional effectiveness, clinical supervision, strategic career planning, and academic research. Nineteen attendees who were currently less than 5 years post completion of doctoral graduate programs in psychology participated in the program. The majority of boot camp components were rated as good to excellent, with no component receiving below average ratings. Of the components offered within the boot camp, mentoring and research activities were rated the strongest, followed by educational activities, challenges in AHCS, and promotion and tenure. The article describes the purpose, development, implementation, and assessment of the program in detail in an effort to provide an established outline for future organizations to utilize when mentoring ECPs.     

Construct validity of the Anxiety Sensitivity Index-3 in clinical samples

Using two clinical samples of patients, the presented studies examined the construct validity of the recently revised Anxiety Sensitivity Index-3 (ASI-3). Confirmatory factor analyses established a clear three-factor structure that corresponds to the postulated subdivision of the construct into correlated somatic, social, and cognitive components. Participants with different primary clinical diagnoses differed from each other on the ASI-3 subscales in theoretically meaningful ways. Specifically, the ASI-3 successfully discriminated patients with anxiety disorders from patients with nonanxiety disorders. Moreover, patients with panic disorder or agoraphobia manifested more somatic concerns than patients with other anxiety disorders and patients with nonanxiety disorders. Finally, correlations of the ASI-3 scales with other measures of clinical symptoms and negative affect substantiated convergent and discriminant validity. Substantial positive correlations were found between the ASI-3 Somatic Concerns and body vigilance, between Social Concerns and fear of negative evaluation and socially inhibited behavior, and between Cognitive Concerns and depression symptoms, anxiety, fear of negative evaluation, and subjective complaints. Moreover, Social Concerns correlated negatively with dominant and intrusive behavior. Results are discussed with respect to the contribution of the ASI-3 to the assessment of anxiety-related disorders.     

The Three Domains of Disgust Scale: factor structure, psychometric properties, and conceptual limitations

This investigation examined the measurement properties of the Three Domains of Disgust Scale (TDDS). Principal components analysis in Study 1 (n = 206) revealed three factors of Pathogen, Sexual, and Moral Disgust that demonstrated excellent reliability, including test-retest over 12 weeks. Confirmatory factor analyses in Study 2 (n = 406) supported the three factors. Supportive evidence for the validity of the Pathogen and Sexual Disgust subscales was found in Study 1 and Study 2 with strong associations with disgust/contamination and weak associations with negative affect. However, the validity of the Moral Disgust subscale was limited. Study 3 (n = 200) showed that the TDDS subscales differentially related to personality traits. Study 4 (n = 47) provided evidence for the validity of the TDDS subscales in relation to multiple indices of disgust/contamination aversion in a select sample. Study 5 (n = 70) further highlighted limitations of the Moral Disgust subscale given the lack of a theoretically consistent association with moral attitudes. Lastly, Study 6 (n = 178) showed that responses on the Moral Disgust scale were more intense when anger was the response option compared with when disgust was the response option. The implications of these findings for the assessment of disgust are discussed.     

Psychometric assessment of the Mindful Attention Awareness Scale (MAAS) among Chinese adolescents

The Mindful Attention Awareness Scale (MAAS) has the longest empirical track record as a valid measure of trait mindfulness. Most of what is understood about trait mindfulness comes from administering the MAAS to relatively homogenous samples of Caucasian adults. This study rigorously evaluates the psychometric properties of the MAAS among Chinese adolescents attending high school in Chengdu, China. Classrooms from 24 schools were randomly selected to participate in the study. Three waves of longitudinal data (N = 5,287 students) were analyzed. MAAS construct, nomological, and incremental validity were evaluated as well as its measurement invariance across gender using latent factor analyses. Participants' mean age was 16.2 years (SD = 0.7), and 51% were male. The 15-item MAAS had adequate fit to the one-dimensional factor structure at Wave 1, and this factor structure was replicated at Wave 2. A 6-item short scale of the MAAS fit well to the data at Wave 3. The MAAS maintained reliability (Cronbach's α = .89-.93; test-restest r = .35-.52), convergent/discriminant validity, and explained additional variance in mental health measures beyond other psychosocial constructs. Both the 15- and 6-item MAAS scales displayed at least partial factorial invariance across gender. The findings suggest that the MAAS is a sound measure of trait mindfulness among Chinese adolescents. To reduce respondent burden, the MAAS 6-item short-scale provides an option to measure trait mindfulness.     

MMPI-2-RF characteristics of custody evaluation litigants

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is a 338-item objective self-report measure drawn from the 567 items of the MMPI-2. Although there is a substantial MMPI-2 literature regarding child custody litigants, there has been only one previously published study using MMPI-2-RF data in this population that focused on Validity scales L-r and K-r. The current study evaluated the MMPI-2-RF results of 344 child custody litigants and showed substantial consistency between T-score elevations typically found on MMPI-2 Validity scales L and K, and comparable elevations for MMPI-2-RF validity scales L-r and K-r. Mean T-scores well within normal limits characterized results for clinical scales on both instruments. The RC scale intercorrelation patterns, and alpha coefficient values found for MMPI-2-RF scales in a custody population, were also found to be very similar to those reported for other populations. Directions for future research are presented.     

Eye movements of second language learners when reading spaced and unspaced Chinese text

The effect of spacing in relation to word segmentation was examined for four groups of non-native Chinese speakers (American, Korean, Japanese, and Thai) who were learning Chinese as second language. Chinese sentences with four types of spacing information were used: unspaced text, word-spaced text, character-spaced text, and nonword-spaced text. Also, participants' native languages were different in terms of their basic characteristics: English and Korean are spaced, whereas the other two are unspaced; Japanese is character based whereas the other three are alphabetic. Thus, we assessed whether any spacing effects were modulated by native language characteristics. Eye movement measures showed least disruption to reading for word-spaced text and longer reading times for unspaced than character-spaced text, with nonword-spaced text yielding the most disruption. These effects were uninfluenced by native language (though reading times differed between groups as a result of Chinese reading experience). Demarcation of word boundaries through spacing reduces non-native readers' uncertainty about the characters that constitute a word, thereby speeding lexical identification, and in turn, reading. More generally, the results indicate that words have psychological reality for those who are learning to read Chinese as a second language, and that segmentation of text into words is more beneficial to successful comprehension than is separating individual Chinese characters with spaces.