Uptake of BRCA1 Genetic Testing in Adult Sisters and Daughters of Known Mutation Carriers in Norway

This study was undertaken to examine transmission of information to first-degree relatives of BRCA1 mutation carriers and uptake of genetic testing. The intention was to consider revision of current legislation related to privacy if information on life-saving health care was not disseminated to at-risk family members. The Norwegian Radium Hospital provides clinical genetics services for families at high risk for hereditary breast and ovarian cancer. Together with major hospitals nationwide we provide medical surveillance. Nearly all expenses are covered by the National Health insurance. Because of the high number of families with founder mutations in BRCA1, we are in a unique position to gather information about these groups. Within a consecutive series, we identified 75 BRCA1 mutation carriers and registered information transmission and uptake of genetic testing 6 months or more after the index mutation carriers had been informed about their mutation status. These 75 BRCA1 mutation carriers had 172 living first-degree relatives, aged 18 years or older (84 females, 88 males). Forty-four out of 54 (81.5%) of females over 30 had opted for genetic testing. The testing rate among all relatives was 43%. At any age, 63% of the females underwent genetic testing compared with 24% of the males (p<0.05). The overwhelming majority of adult females at risk opted for genetic testing. Males with daughters more frequently than males without daughters asked for testing. The findings give neither reason to reconsider legislation on privacy, nor for us to consider more aggressive methods of contacting relatives.     

Suicide after suicide attempt in severe depression: a long-term follow-up

The temporal relation between completed suicide and first-ever suicide attempt was investigated in 58 future suicides with a primary severe depression/melancholia. The median survival after a first attempted suicide was 6.7 years. Male patients with initial ratings of psychomotor retardation lived significantly longer after their initial attempt than those who were not retarded. They also had more depressive episodes compared to other male suicides and retarded controls. Thus a slow suicidal process in the men with a severe depression and psychomotor retardation is proposed. Severity, repetition, and method of suicide attempt did not decrease the survival time.     

The effect of social network intervention for women with rheumatoid arthritis

A partially-controlled intervention study was performed. Female patients with rheumatoid arthritis (RA) were allocated to three groups: the network intervention group (n = 104), the attention control group (n = 85), and the no-treatment control group (n = 75). The network intervention consisted of an assessment session and a network meeting. Patients were assessed at baseline and approximately 10 and 18 months after the intervention. The network intervention group reported an increase in network size. Daily emotional support increased for the intervention patients compared with patients in the attention control group. The degree of social dysfunction was reduced for patients in the intervention group compared to patients in the no-treatment control group. Furthermore, for single patients, the intervention significantly increased the social network size and improved both social functioning, and perceived overall health, compared to both control groups. The results suggest that the social needs of single patients should be given special attention in clinical settings.     

The assessment of fitness to drive after a stroke: the Nordic Stroke Driver Screening Assessment

The British Stroke Driver Screening Assessment (SDSA) is a set of four simple cognitive tests to evaluate driving fitness in stroke patients. To evaluate its usefulness in a Scandinavian context, we adapted the tests and assessed a group of 97 stroke patients from Sweden and Norway, using a driving test as the criterion. When results were calculated according to the original method, based on a discriminant function, less than 70% of the participants were correctly classified. To improve the predictive potential, a new discriminant analysis was performed, using the scores of a subsample of 49 patients, and validated on the remaining 48 participants. In total, 78% of the patients were correctly classified, but specificity was superior to sensitivity. We conclude that the Nordic version of the SDSA is a useful instrument, provided that test scores are interpreted in a balanced manner, taking into account the possibility of compensatory traffic behavior.     

Proactive sensitizing effects of acute stress on acoustic startle responses and experimentally induced colitis in rats: relationship to corticosterone

In humans, some individuals develop a syndrome after trauma (post-traumatic stress disorder, PTSD) characterized by increased startle responses and lower than normal cortisol secretion. We explored a rat model using the acoustic startle response (ASR) as a behavioral indicator of the effect of a short series of shocks. Because gastrointestinal disorders have been associated with prior stress, we also studied the rats' vulnerability to a chemically-induced colitis. After initial blood sampling, 12 rats were exposed to ten 1 mA 5 s foot-shocks while 12 rats served as controls. Nineteen days later the rats were tested for ASR. Thirty trials (10 trials at each of 95, 105, and 115 dB, pseudo-randomized) were given. After exposure for 6 days to dextran sulphate sodium in their drinking water, the rats were killed and the colons examined for erosions. Shocked rats showed greater startle responses and more colonic erosion than unshocked rats, but the shock effects were significant only for animals with low initial plasma corticosterone levels. Shocked rats also showed higher levels of granulocyte marker protein (GMP) in their faeces. These results suggest that low corticosterone secretion may represent a marker for vulnerability to long term effects of shocks as indicated by increased startle responses and colonic pathology.     

Self-perceived clinical competence,gender and workplace setting predict burnout among psychotherapists

Work-related stress, or burnout, is elevated among healthcare staff but the specific risk factors for psychotherapists are not clear, which makes it difficult to design interventions to target this population. Therefore, the aim of this study was to investigate a set of background variables and work-related risk factors for burnout among psychotherapists. Potential protective factors such as level of education, number of years in the profession and access to clinical supervision were investigated. Symptoms of burnout were measured with the Copenhagen Burnout Inventory, and data were collected from 327 psychotherapists. In this group, 62% reported moderate or high levels of burnout symptoms, with significantly higher levels of personal- and work-related burnout than client-related burnout. Being female, having low self-perceived competence and working in the public sector were associated with higher levels of burnout. Other factors, such as age, work experience, level of education or having clinical supervision, were not associated with burnout after controlling for gender, perceived competence and workplace setting. These results confirm previous research that underlines the importance of perceived competence and control over one's work environment, and that women are at higher risk of burnout, possibly because of factors outside of work. The importance of perceived competence as a protective factor suggests that methods that increase therapeutic competence may play an important role in countering work-related stress. In conclusion, there may be a need to continue to develop and integrate specific burnout prevention interventions for psychotherapists.     

The Sacred Bed: Sex Guilt Mediates Religiosity and Satisfaction for Unmarried People

The relationship between religion and sexual satisfaction has long been debated. Oftentimes, previous research on the relationship between these two constructs has been directly contradictory. The current study sought to provide more detail, or perhaps clarify the way that religiosity may relate to sexual satisfaction. Past studies have shown that high religiosity is connected to lower sexual activity, lower desires, and more conservative values. Thus, the current study examined sexual guilt, resulting from sensitivity to internalized religious beliefs and teachings, as a potential mediator between the two constructs. Participants completed an online questionnaire that included measures of religious identification and internalization, sexual satisfaction, and sex guilt. Results suggest that sex guilt mediates the relationship between religiosity and sexual satisfaction for unmarried individuals, but not for married individuals. We suggest calling this finding the sacred bed phenomenon because the difference between the models for married and unmarried samples may be due to a belief in the sacred marital bed.