Subjective and Objective Risks of Carrying a BRCA1/2 Mutation in Individuals of Ashkenazi Jewish Descent

This repeated measures study examines (1) the change in subjective risk of mutations pre- to postcounseling, (2) the accuracy of BRCAPRO estimates of mutations, and (3) the discrepancy between subjective risk and BRCAPRO estimates of mutations before and after genetic counseling. Ninety-nine Ashkenazi Jewish individuals pursued testing for BRCA1/2 mutations. Most had a personal cancer history (N = 51; family only: N = 48); and received uninformative negative results (N = 66; positives: N = 23; informative negative: N = 10). The coping strategy of defensive pessimism predicts that individuals will believe the worst case scenario to better cope with a potential negative outcome. Consistent with this, most felt they would have a mutation, if not mutations in both genes. The BRCAPRO model appeared to overestimate risk of having a mutation in this sample (p < .001). BRCAPRO overestimates notwithstanding, genetic counseling increased accuracy of subjective risk (p < .01). Individuals with a family-only cancer history had the least accurate estimates of risk (p < .05) and may need further intervention to either manage anxiety or improve knowledge.     

Are Some Psychotherapies Much More Effective Than Others?

In a previous paper we had reported on the examination of comparisons of 18 metaanalyses of active treatments with each other (Luborsky, Rosenthal, Diguer, et al., 2001). These metaanalyses gave a small and nonsignificant mean level of difference between types of treatments. The smallness of this correlation confirms Rosenzweig's (1936) expectation that because of the large overlap in effective ingredients of different psychotherapies, comparative studies of psychotherapies would show little difference. Such a comparison that includes psychoanalyses seems a long way off, but if outcomes of psychoanalyses are defined similarly to those in the other psychotherapies, the expected differences in outcomes may also be small.     

Stability of older adults' preferences for life-sustaining medical treatment.

The use of instructional advance directives assumes that preferences for life-sustaining medical treatment remain stable over time and across changes in life condition. A sample of 332 older adults recorded their preferences for 4 life-sustaining treatments in 9 illness scenarios. These preferences were elicited again 1 and 2 years after the original interview. Overall, preferences for life-sustaining treatment were moderately stable over time, but stability varied significantly across judgments. Preferences were most stable for illness scenarios that were most and least serious and for decisions to refuse treatment. Age, gender, education, and prior completion of an advance directive were all related to preference stability, and evidence indicated that declines in physical or psychological functioning resulted in decreased interest in life-sustaining treatment.     

Protecting Play: It’s a Matter of Life and Death

ABSTRACT

Play is a critical activity, as important to healthy life as sleep, water, and nutrition. Research shows that play promotes cognitive and socioemotional development, and that learning, problem-solving, self-regulation and pro-social skills all stem from playing. Yet play is valued less and less in our culture, with children as young as preschool age being placed in organized activities based on an understanding of enrichment that’s limited to academic achievement and performance. As families and as a society we are failing to provide a “good-enough facilitating environment” for our children to grow, to live, as we take time and space to play away from children and adolescents. Why are we doing this? I speculate that we are a culture who is preoccupied with guaranteeing safety and success because of our anxiety and denial of four fundamental and interrelated experiences: failure, loss, aggression, and death. With the use of clinical material, I illustrate how, in our attempt to guarantee safety and success, we have become unable to safely risk engaging (i.e., play) with, and fully experience, these vulnerabilities, and are in fact creating an unsafe psychic environment for our children, and how play can help us redress this emotional impoverishment.     

Social relationships and ambulatory blood pressure: structural and qualitative predictors of cardiovascular function during everyday social interactions.

Healthy normotensive men and women (N = 102) underwent a 3-day ambulatory blood pressure (BP) assessment in which a BP reading was taken 5 min into each social interaction. After each interaction, participants completed a diary that included structural categorization of the relationship and ratings of the quality of the relationship with the interaction partner. Random regression analyses revealed that interactions with family members and spouses were associated with lower ambulatory BP. Interactions with ambivalent network members (characterized by both positive and negative feelings) were associated with the highest ambulatory systolic BP, an effect that was independent of the familial effects on BP. Although there were psychological correlates associated with both structural and functional aspects of relationships, no evidence was found that these mediated the primary findings involving ambulatory BP. These data highlight the influence of both structural and qualitative aspects of relationships on ambulatory BP and possibly health.     

Models of competence in solving physics problems

We describe a set of two computer-implemented models that solve physics problems in ways characteristic of more and less competent human solvers. The main features accounting for different competences are differences in strategy for selecting physics principles, and differences in the degree of automation in the process of applying a single principle. The models provide a good account of the order in which principles are applied by human solvers working problems in kinematics and dynamics. They also are sufficiently flexible to allow easy extension to several related domains of physics problems.