Operationalizing the Reciprocal Engagement Model of Genetic Counseling Practice: a Framework for the Scalable Delivery of Genomic Counseling and Testing

With the advent of widespread genomic testing for diagnostic indications and disease risk assessment, there is increased need to optimize genetic counseling services to support the scalable delivery of precision medicine. Here, we describe how we operationalized the reciprocal engagement model of genetic counseling practice to develop a framework of counseling components and strategies for the delivery of genomic results. This framework was constructed based upon qualitative research with patients receiving genomic counseling following online receipt of potentially actionable complex disease and pharmacogenomics reports. Consultation with a transdisciplinary group of investigators, including practicing genetic counselors, was sought to ensure broad scope and applicability of these strategies for use with any large-scale genomic testing effort. We preserve the provision of pre-test education and informed consent as established in Mendelian/single-gene disease genetic counseling practice. Following receipt of genomic results, patients are afforded the opportunity to tailor the counseling agenda by selecting the specific test results they wish to discuss, specifying questions for discussion, and indicating their preference for counseling modality. The genetic counselor uses these patient preferences to set the genomic counseling session and to personalize result communication and risk reduction recommendations. Tailored visual aids and result summary reports divide areas of risk (genetic variant, family history, lifestyle) for each disease to facilitate discussion of multiple disease risks. Post-counseling, session summary reports are actively routed to both the patient and their physician team to encourage review and follow-up. Given the breadth of genomic information potentially resulting from genomic testing, this framework is put forth as a starting point to meet the need for scalable genetic counseling services in the delivery of precision medicine.     

Social Support. Physiological Processes, and Health

Social relationships serve important functions in people's everyday lives. Epidemiological research indicates that supportive relationships may also significantly protect individuals from various causes of mortality, including cardiovascular disease. An important issue is how social support influences such long-term health outcomes. In this article, we review evidence indicating that social support may influence mortality via changes in the cardiovascular, endocrine, and immune systems. These data suggest that it may be worthwhile to incorporate social-support interventions in the prevention and treatment of physical health problems.     

Bulimic symptoms and body image dissatisfaction in college women: more affected by climate or race?

The authors examined bulimic symptoms and body image dissatisfaction (BID) in a sample of college women. No differences were found in comparisons of bulimic symptoms or BID between Southern and Northern White women, and both groups reported similar levels of awareness and internalization of sociocultural aesthetic standards of appearance. Southeastern Black women reported (a) significantly lower levels of bulimic symptoms in comparison with White women from the North and (b) lower levels of BID in comparison with White women from both Southern and Northern regions. Further, Southeastern Black women were significantly less likely to be aware of and endorse mainstream standards of appearance in comparison with both groups of White women. Findings support the hypothesis that having a positive body image and less susceptibility to mainstream aesthetic standards of appearance may reduce the risk of eating disorder pathology in Black women.     

Aging and cardiovascular reactivity to stress: longitudinal evidence for changes in stress reactivity

Although age differences in cardiovascular function are well documented, little research has provided longitudinal evidence for age-related changes in cardiovascular reactivity to stress. In this study, the authors report such data from a follow-up of their prior work (B. N. Uchino, D. Uno, J. Holt-Lunstad, & J. B. Flinders, 1999) with participants between the ages of 30 to 70 (n=108, mean follow-up=10 months, range=7 to 16 months). Results revealed longitudinal evidence for an age-related increase in systolic blood-pressure reactivity and parasympathetic withdrawal to acute stress. The implications of these findings are discussed in light of the increased cardiovascular disease risk with age, as well as the links between aging, emotions, and physiology.     

Guest referees for 17(4)

Background and objectives: Although intimate partner violence (IPV) has demonstrated strong associations with anxiety and posttraumatic stress, these constructs have rarely been examined simultaneously in IPV research. Gaps in knowledge remain as to their differential associations to substance use problems among IPV-victimized women. Design: A sample of 143 community women self-reported on their current IPV victimization, mental health and substance use problems. Method: Hierarchical entry multiple regressions were used to test for the direct and indirect effects of psychological, physical, and sexual IPV to alcohol and drug problems through anxiety and posttraumatic stress. Results: Higher anxiety symptom severity and higher physical IPV severity were associated with greater alcohol and drug problems. Higher posttraumatic stress symptom severity was associated with greater alcohol and drug problems. Mediation analyses indicated (i) significant indirect pathways of IPV types to alcohol problems through posttraumatic stress symptom severity controlling for anxiety symptom severity and (ii) significant indirect pathways of IPV types to drug problems through anxiety symptom severity controlling for posttraumatic stress symptom severity. Conclusions: In examining the indirect pathways of psychological, physical, and sexual IPV to substance use problems this study highlights that anxiety and posttraumatic stress symptom severity have unique effects on alcohol and drug problems among IPV-victimized women.     

Maternal defense: breast feeding increases aggression by reducing stress

Mothers in numerous species exhibit heightened aggression in defense of their young. This shift typically coincides with the duration of lactation in nonhuman mammals, which suggests that human mothers may display similarly accentuated aggressiveness while breast feeding. Here we report the first behavioral evidence for heightened aggression in lactating humans. Breast-feeding mothers inflicted louder and longer punitive sound bursts on unduly aggressive confederates than did formula-feeding mothers or women who had never been pregnant. Maternal aggression in other mammals is thought to be facilitated by the buffering effect of lactation on stress responses. Consistent with the animal literature, our results showed that while lactating women were aggressing, they exhibited lower systolic blood pressure than did formula-feeding or never-pregnant women while they were aggressing. Mediation analyses indicated that reduced arousal during lactation may disinhibit female aggression. Together, our results highlight the contributions of breast feeding to both protecting infants and buffering maternal stress.     

The role of common motor responses in stimulus categorization by preschool children

The purpose of this study was to assess the role of common motor responses as the "speaker" behavior on stimulus class formation, and the emergence of functional classes. Experiment 1 examined whether training one motor response to a set of three stimuli and a second motor response to another set of three stimuli would result in correct category-sort responses for 5 typically developing preschool children. Three of the children passed the categorization tests. Experiment 2 examined whether the classes formed in Experiment 1 were functional classes, and whether participants who did not pass categorization tests in Experiment 1 would do so following common vocal tact training. The 2 participants who failed categorization tests in Experiment 1 passed these tests in Experiment 2, although none of the participants passed the tests for functional classes. The results of the current study did not unequivocally support the naming hypothesis. Future research should therefore evaluate other possible sources of control that aid in stimulus categorization.     

Dyslexia,authorial identity,and approaches to learning and writing: A mixed methods study

Background. Dyslexia may lead to difficulties with academic writing as well as reading. The authorial identity approach aims to help students improve their academic writing and avoid unintentional plagiarism, and could help to understand dyslexic students’ approaches to writing. Aims. (1) To compare dyslexic and non‐dyslexic students’ authorial identity and approaches to learning and writing; (2) to compare correlations between approaches to writing and approaches to learning among dyslexic and non‐dyslexic students; (3) to explore dyslexic students’ understandings of authorship and beliefs about dyslexia, writing and plagiarism. Sample. Dyslexic (n= 31) and non‐dyslexic (n= 31) university students. Method. Questionnaire measures of self‐rated confidence in writing, understanding of authorship, knowledge to avoid plagiarism, and top‐down, bottom‐up and pragmatic approaches to writing (Student Authorship Questionnaire; SAQ), and deep, surface and strategic approaches to learning (Approaches and Study Skills Inventory for Students; ASSIST), plus qualitative interviews with dyslexic students with high and low SAQ scores. Results. Dyslexic students scored lower for confidence in writing, understanding authorship, and strategic approaches to learning, and higher for surface approaches to learning. Correlations among SAQ and ASSIST scores were larger and more frequently significant among non‐dyslexic students. Self‐rated knowledge to avoid plagiarism was associated with a top‐down approach to writing among dyslexic students and with a bottom‐up approach to writing among non‐dyslexic students. All the dyslexic students interviewed described how dyslexia made writing more difficult and reduced their confidence in academic writing, but they had varying views about whether dyslexia increased the risk of plagiarism. Conclusions. Dyslexic students have less strong authorial identities, and less congruent approaches to learning and writing. Knowledge to avoid plagiarism may be more salient for dyslexic students, who may benefit from specific interventions to increase confidence in writing and understanding of authorship. Further research could investigate how dyslexic students develop approaches to academic writing, and how that could be affected by perceived knowledge to avoid plagiarism.     

Social Relationships and Mortality

Social relationships benefit not only mental health but also physical health. This review addresses the following questions: (1) What is the overall magnitude of the effect of social relationships on risk for premature death? (2) How generalized is the effect and are there factors known to influence this association? (3) What are the likely pathways by which social relationships influence longevity? The article concludes by discussing the implications of these findings for potential interventions aimed at reducing risk for mortality.