Genetic Counseling as a Tool for Type 2 Diabetes Prevention: A Genetic Counseling Framework for Common Polygenetic Disorders

Advances in genetic epidemiology have increased understanding of common, polygenic preventable diseases such as type 2 diabetes. As genetic risk testing based on this knowledge moves into clinical practice, we propose that genetic counselors will need to expand their roles and adapt traditional counseling techniques for this new patient set. In this paper, we present a genetic counseling intervention developed for a clinical trial [Genetic Counseling/Lifestyle Change for Diabetes Prevention, ClinicalTrials.gov identifier: NCT01034319] designed to motivate behavioral changes for diabetes prevention. Seventy-two phenotypically high-risk participants received counseling that included their diabetes genetic risk score, general education about diabetes risk factors, and encouragement to participate in a diabetes prevention program. Using two validated genetic counseling scales, participants reported favorable perceived control and satisfaction with the counseling session. Our intervention represents one model for applying traditional genetic counseling principles to risk testing for polygenetic, preventable diseases, such as type 2 diabetes.     

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.     

Utilizing Benchmarking to Study the Effectiveness of Parent–Child Interaction Therapy Implemented in a Community Setting

Benchmarking is a program evaluation approach that can be used to study whether the outcomes of parents/children who participate in an evidence-based program in the community approximate the outcomes found in randomized trials. This paper presents a case illustration using benchmarking methodology to examine a community implementation of Parent–Child Interaction Therapy (CI-PCIT) utilized as a child maltreatment prevention effort. Data were collected from 83 parent–child dyads. Change scores were compared to treatment and control effect sizes aggregated from the PCIT literature. Pre-post results indicated significant positive changes in child behavior for CI-PCIT completers. Benchmarking analyses revealed that parents who completed CI-PCIT reported significantly greater positive child outcomes than the aggregate control group benchmark, and significantly less than observed in the treatment benchmark. A summary of decision points and implications for utilizing this methodology in the child maltreatment field are postulated.     

Associations Between Multiple Types of Stress and Disordered Eating Among Girls and Boys in Middle School

Stress is common during adolescence, yet no known studies have linked particular types of stress (performance, relationship, education, financial, and family) with disordered eating among adolescents in middle school. The present study investigated sex differences in types of stress and how multiple types of stress were associated with girls’ and boys’ body dissatisfaction, dieting behaviors, and bulimic symptoms. We found that girls reported higher levels of stress than boys and that different associations between stress and disordered eating existed for girls and boys. We also examined a path model for both sexes such that stress first led to body dissatisfaction, which then led to dieting and finally bulimic symptoms. Our model was supported for girls with performance, relationship, and family stress driving the process. For boys, all five types of stress were associated with body dissatisfaction, which was linked with dieting; however, the relation between dieting and bulimic symptoms was not significant. Future research and therapy should focus on the unique experiences of each sex in order to gain a better understanding of the processes involved in coping with stress and promoting healthy development.     

Understanding violence: Does psychoanalytic thinking matter?

A coherent psychoanalytic theory of violence has been hindered by the very few psychoanalysts who have actually worked with violent patients, by political allegiance to certain psychoanalytic schools of thought, a naïve belief that all violence is typically not intentional, but rather a problem of impulse control, and the lack of understanding of recent neurobiological findings concerning aggression. Although intensive psychoanalytic treatment is usually not appropriate for violent individuals, the authors assert that a comprehensive understanding of violent behavior from a psychoanalytic perspective is of relevance for all mental health practitioners interested in the nature of human aggression. Actual violence is informed by bodily enactments and regressions to primitive subjective states; the effects of trauma on representation and symbolic functioning; the demarcation between affective and predatory violence; and understanding how all of our mental processes, including cognitions, wishes, memories, unconscious phantasies, ego-defenses, and object relations, are originally rooted in the body. The authors review the historical psychoanalytic literature on violence and critique contemporary psychoanalytic theorizing regarding the etiology of violent behavior in the light of some neurobiological research findings. They conclude with treatment recommendations for those clinicians whose patients have been violent toward others.     

Cross-modal recognition of human individuals in domestic horses (Equus caballus)

This study has shown that domestic horses are capable of cross-modal recognition of familiar humans. It was demonstrated that horses are able to discriminate between the voices of a familiar and an unfamiliar human without seeing or smelling them at the same moment. Conversely, they were able to discriminate the same persons when only exposed to their visual and olfactory cues, without being stimulated by their voices. A cross-modal expectancy violation setup was employed; subjects were exposed both to trials with incongruent auditory and visual/olfactory identity cues and trials with congruent cues. It was found that subjects responded more quickly, longer and more often in incongruent trials, exhibiting heightened interest in unmatched cues of identity. This suggests that the equine brain is able to integrate multisensory identity cues from a familiar human into a person representation that allows the brain, when deprived of one or two senses, to maintain recognition of this person.     

The internal adaptation processes of professional boxers during the Showtime Super Six Boxing Classic: A qualitative thematic analysis

ObjectivesThe Super Six World Boxing Classic was conceived by Showtime Sports to feature the best six professional boxers in the super middleweight division (168 pounds) throughout a modified round robin tournament. The objective was to explore the adaptation and mal-adaptation processes of the tournament's original six tournament participants over time.DesignMedia data in the form of documentary episodes (n = 12 episodes, ～30 min each from the foregoing source were transcribed verbatim. Data included athletes' responses prior to their first bout and as each progressed or was eliminated. Boxers' post-bout explanations were also included.MethodThe original six contestants (mean age = 28.8 years at tournament start) from the tournament, with a record of 157 wins and 4 losses, were included within the project. Data were analyzed via thematic analysis (see Braun & Clarke, 2006).ResultsThe following themes were identified: (a) pre-conditions: moving into the tournament (subthemes: positive anticipation, uncertainty), (b) outcomes: moving through the tournament (subthemes: tournament progression, tournament regressions), and (c) consequences: moving out of the tournament (sub-themes: responses of the defeated, the king's adaptation).ConclusionsThis study highlights the adaptation processes of the six tournament contestants, demonstrating how one athlete adapted successfully and became champion through personal focus. The remaining athletes lost at least once, with pre-bout adaptation processes suggesting performance regression. These findings add to the adaptation literature, further contextualizing how adaptation meanings change and unfold over time.     

Effective Psychotherapy With Low-income Clients: The Importance of Attending to Social Class

The purpose of this article is to explore some of the issues associated with conducting psychotherapy with low-income clients. Throughout the article, we draw from our specific clinical experiences working with low-income Latina mothers in a depression prevention program. The themes that we address regarding class and psychotherapy are in the areas of assessment of social class, integration of class issues into the therapy process, and managing differences in social class between therapists and clients. As we discuss these themes, we provide concrete recommendations in order to advance awareness and effectiveness in working with economically disadvantaged populations.     

Effects of text messaged self-monitoring on class attendance and punctuality of at-risk college student athletes

This study examined the effects of text messaging class arrival to an academic counselor on the attendance and punctuality of 4 college student athletes. Each participant had a history of class tardiness and was considered to be at risk for academic failure. Class attendance and punctuality improved for all participants.