Nursing and genetic health care

Advances in DNA technology are leading to major developments in nursing practice in clinical genetics, including the creation of new roles for nurses who care for people with genetic conditions. Application of genetic information and testing is moving genetics into the mainstream of health care. Therefore, it is anticipated that nurses in all areas of practice will become involved in the provision of information about genetic testing and assisting individuals and families in decision making and adjustment to new genetic information. This article provides an overview of the profession of nursing which may be useful to genetic counselors in the development of collaborative relationships between the two professions.     

A BRIEF COMPONENT ANALYSIS OF POTENTIAL TREATMENT PACKAGES IN AN OUTPATIENT CLINIC SETTING WITH YOUNG CHILDREN

The purpose of this study was to develop outpatient clinic assessments that allowed us to assess multiple treatment variables, produce relatively quick effects, and isolate active treatment components. Assessment began by evaluating a treatment package consisting of antecedent and consequence variables followed by a component analysis to determine the separate effects of the treatment variables. Three examples of the findings are presented.     

Concurrent processes: The affect-cognition relationship within the context of the “mere exposure” phenomenon

The affect-cognition relationship and Zajonc’s (1968) “mere exposure” hypothesis were examined in two studies that involved ratings of: (1) preference and familiarity for geometric forms previously scaled for complexity and (2) preference or height and familiarity for male yearbook pictures previously scaled for attractiveness or height. Two exceptions to his hypothesis were noted: simple geometric forms and unattractive faces showed satiation, and faces seen once before were rated more attractive than both novel faces and faces seen twice before. Moreover, mere exposure effects were noted with a nonaffective dimension (height). The major finding was that presentation frequency generally manifested independent relations to affect and rated familiarity, as well as to height and rated familiarity, therefore evoking a concurrent response process Eriksen, 1960).     

Effects of gender,target's gender,topic, and self-esteem on disclosure to best and midling friends

Two studies examining self-disclosure as a function of discloser's gender, target's gender, topic, class standing, and self-esteem are reported. In the first study, 172 college students were given a test containing items from a modified Jourard Self-Disclosure Questionnaire and the Culture-Free Self-Esteem Inventory, and asked to report disclosure to their best, nonromantic, same-and cross-sex friends; the second study was a replication of the first, but the 138 subjects were questioned about disclosure to midling-level friends. The expected effects were found—topic, target's gender, etc.—and self-esteem level and class standing were found to influence disclosure levels as well. The ² and correlations are reported, so that readers can see an estimate of the effects' magnitudes as well as their significance levels.     

Using logistic regression to estimate delay-discounting functions.

The monetary choice questionnaire (MCQ) and similar computer tasks ask preference questions in order to ascertain indifference, the perceived equivalence of immediate versus larger delayed rewards. Indifference data are then fitted with a hyperbolic function, summarizing the decline in perceived value with delay time. We present a fitting method that estimates the hyperbolic parameter k directly from survey responses. Binary preferences are modeled as a function of time (X2) and a transformed reward ratio (X1), yielding logistic regression coefficients beta 2 and beta 1. The hyperbolic parameter emerges as k = beta 2/beta 1, where the logistic predicted p = .5 (the definition of indifference). The MCQ was administered to 1,073 adolescents and was scored using both standard and logistic methods. The means for In(k) were similar (standard, -4.53; logistic, -4.51), and the results were highly correlated (rho = .973). Simulated MCQ data showed that k was unbiased, except where beta 1 > or = -1, indicating a vague survey response. Jackknife standard errors provided excellent coverage.     

How internet users find, evaluate, and use online health information: a cross-cultural review.

The Internet has become a favored source to find health information. Worldwide, about 4.5% of all Internet searches are for health-related information. However, research has found that the quality of online health information is mixed, which raises serious concerns about the impact of this information. This paper reviews relevant research to understand how health information on the Internet is retrieved, evaluated, and used. Most users of online health information are looking for information about specific health conditions because they or someone they know was diagnosed with a medical condition. They typically use general search engines to find online health information and enter short phrases, often misspelled. They seldom go beyond the first page of a search. Both their search and evaluation skills are limited although they are concerned about the quality of online health information. They avoid sites with overt commercialism, but often do not pay attention to indicators of credibility. Online health information is used to fill an information void which can enhance coping and self efficacy, affects health-related decisions and behavior of users and their friends and family, and is often discussed with health care providers. There are cross-cultural differences in the types of sites used as well as how online information is used. Based on the research reviewed in this paper, three major recommendations are suggested. Professionals should recommend sites. Professionals should promote more effective search and evaluation techniques. Professionals should be involved in developing and promoting uniform standards for health and mental health sites.     

Behavioral predictors of changes in social relatedness and liking school in elementary school

Normative trends and behavioral predictors for three dimensions of social relatedness were examined in a 6-month longitudinal study of 383 students in Grades 3, 4 and 5. Student reports of social relatedness (teacher supportiveness, school supportiveness, loneliness) and liking school indicated that students in each of the grades felt less positive about the school environment and liked school less in the Spring compared to the Fall. Girls reported higher levels of teacher supportiveness and school supportiveness. Reports of school supportiveness were lower among students at higher grade levels. Teacher-rated aggression predicted declines in students' perceptions of teacher supportiveness, increases in their sense of loneliness, and decreases in reports of liking school across the school year. Teacher-rated closeness predicted the maintenance of student perceptions of high levels of relatedness. Peer social preference predicted increases in loneliness. A path model indicated that the association between aggressive behavior and liking school was mediated by the association between aggressive behavior and perceptions of teacher supportiveness.     

Treating Depression Among Adolescent Perinatal Women With a Dialectical Behavior Therapy–Informed Skills Group

Depression is a prevalent and impairing problem affecting both women and offspring during the perinatal (pregnancy and the postpartum) period. Despite this, few studies have examined treatments for perinatal adolescents with depressive symptoms. The present study examined the feasibility and preliminary outcomes of a dialectical behavioral therapy (DBT) informed skills group among depressed adolescent perinatal women (N = 25) recruited from both a public health parent education program and an adolescent obstetric clinic. A brief composite case example is included to illustrate how DBT skills were taught, practiced, and applied. Findings suggest the intervention was credible, acceptable, and associated with improvement in depression. Challenges with feasibility of enrolling and retaining adolescent perinatal women were evident, as approximately half of the enrolled participants did not complete the study. This study provides preliminary evidence that a DBT-informed skills group may be a promising intervention for depressed adolescent perinatal women and points to important directions for clinical practice and research, including treatment engagement and retention.     

DNA Testing for Family Reunification in Canada: Points to Consider

Countries have adopted different laws, policies, and practices that allow immigration officers to request in certain cases DNA tests to confirm biological relationships in the context of family reunification. In Canada, Citizenship and Immigration Canada has adopted a policy of suggesting DNA testing only as a last resort in cases where no documentary evidence has been submitted or where the evidence provided is deemed unsatisfactory. However, in practice, there have been concerns on the increasing use of DNA tests in family reunification processes of nationals from certain regions including Africa, Asia, and Latin America. Moreover, the Immigration and Refugee Protection Regulations (IRPR) presents a biological definition of family as a determinant of parenthood in the context of family reunification that is inconsistent with the psychosocial definition used in provincial family laws. Although there are cases that can justify the request for DNA tests, there are also significant social, legal, and ethical issues, including discrimination and unfair practices, raised by this increasing use of genetic information in immigration. This policy brief identifies points to consider for policymakers regarding the use of DNA testing in Canadian family reunification procedures. These include (1) the need to refine the policy of “using DNA testing as a last resort” and its implementation, (2) the need to modify the definition of “dependent child” under the IRPR to reflect the intrinsic reality of psychosocial family ties, and (3) the importance of conducting more research on the use of DNA testing in other immigration contexts.