Genetic Cancer Risk Assessment and Counseling: Recommendations of the National Society of Genetic Counselors

These cancer genetic counseling recommendations describe the medical, psychosocial, and ethical ramifications of identifying at-risk individuals through cancer risk assessment with or without genetic testing. They were developed by members of the Practice Issues Subcommittee of the National Society of Genetic Counselors Cancer Genetic Counseling Special Interest Group. The information contained in this document is derived from extensive review of the current literature on cancer genetic risk assessment and counseling as well as the personal expertise of genetic counselors specializing in cancer genetics. The recommendations are intended to provide information about the process of genetic counseling and risk assessment for hereditary cancer disorders rather than specific information about individual syndromes. Key components include the intake (medical and family histories), psychosocial assessment (assessment of risk perception), cancer risk assessment (determination and communication of risk), molecular testing for hereditary cancer syndromes (regulations, informed consent, and counseling process), and follow-up considerations. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider's professional judgment based on the clinical circumstances of a client.     

Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples

In order to examine the concurrent and criterion validity of the questionnaire version of the Eating Disorders Examination (EDE-Q), self-report and interview formats were administered to a community sample of women aged 18-45 (n = 208). Correlations between EDE-Q and EDE subscales ranged from 0.68 for Eating Concern to 0.78 for Shape Concern. Scores on the EDE-Q were significantly higher than those of the EDE for all subscales, with the mean difference ranging from 0.25 for Restraint to 0.85 for Shape Concern. Frequency of both objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) was significantly correlated between measures. Chance-corrected agreement between EDE-Q and EDE ratings of the presence of OBEs was fair, while that for SBEs was poor. Receiver operating characteristic (ROC) analysis, based on a sample of 13 cases, indicated that a score of 2.3 on the global scale of the EDE-Q in conjunction with the occurrence of any OBEs and/or use of exercise as a means of weight control, yielded optimal validity coefficients (sensitivity = 0.83, specificity = 0.96, positive predictive value = 0.56). A stepwise discriminant function analysis yielded eight EDE-Q items which best distinguished cases from non-cases, including frequency of OBEs, use of exercise as a means of weight control, use of self-induced vomiting, use of laxatives and guilt about eating. The EDE-Q has good concurrent validity and acceptable criterion validity. The measure appears well-suited to use in prospective epidemiological studies.     

Semantic context influences memory for verbs more than memory for nouns

Three experiments revealed that memory for verbs is more dependent on semantic context than is memory for nouns. The participants in Experiment 1 were asked to remember either nouns or verbs from intransitive sentences. A recognition test included verbatim sentences, sentences with an old noun and a new verb, sentences with an old verb and a new noun, and entirely new sentences. Memory for verbs was significantly better when the verb was presented with the same noun at encoding and at retrieval. This contextual effect was much smaller for nouns. Experiments 2 and 3 replicated this effect and provided evidence that context effects reflect facilitation from bringing to mind the same meaning of a verb at encoding and at retrieval. Memory for verbs may be more dependent on semantic context because the meanings of verbs are more variable across semantic contexts than are the meanings of nouns.     

A meta-analytic review of prospective memory and aging

A meta-analysis of prospective memory (PM) studies revealed that in laboratory settings younger participants outperform older participants on tests of both time- and event-based PM (rs=-.39 and -.34, respectively). Event-based PM tasks that impose higher levels of controlled strategic demand are associated with significantly larger age effects than event-based PM tasks that are supported by relatively more automatic processes (rs=-.40 vs. -.14, respectively). However, contrary to the prevailing view in the literature, retrospective memory as measured by free recall is associated with significantly greater age-related decline (r=-.52) than PM, and older participants perform substantially better than their younger counterparts in naturalistic PM studies (rs=.35 and.52 for event- and time-based PM, respectively).     

Too proud to let go: narcissistic entitlement as a barrier to forgiveness

Narcissistic entitlement impedes forgiveness in ways not captured by other robust predictors (e.g., offense severity, apology, relationship closeness, religiosity, Big Five personality factors), as demonstrated in 6 studies. Narcissistic entitlement involves expectations of special treatment and preoccupation with defending one's rights. In Study 1, entitlement predicted less forgiveness and greater insistence on repayment for a past offense. Complementary results emerged from Study 2, which used hypothetical transgressions, and Study 3, which assessed broad forgiveness dispositions. Study 4 examined associations with the Big Five, and Study 5 extended the findings to a laboratory context. Study 6 demonstrated that entitlement predicted diminished increases in forgiveness over time. Taken together, these results suggest that narcissistic entitlement is a robust, distinct predictor of unforgiveness.     

Accuracy of blood glucose estimation by children with diabetes: an investigation of repeated practice with growth curve modeling

This study used growth curve modeling to explore whether practicing the task of estimating blood glucose levels would increase accuracy in children with type 1 diabetes. It was predicted that accuracy would improve with practice and that younger, anxious, poorly adjusted children would improve most. 43 attendees at a diabetes summer camp participated. Their mean age was 13.4 yr. (SD = 1.6). All were Euro-American, and 22 were girls. Change in accuracy was best represented by a quadratic function, and this model fit the data well. Overall, participants' accuracy improved initially and then deteriorated. Results indicate that older children were more likely to improve and then deteriorate. Younger children were more likely to improve and sustain those improvements. Results indicate that practicing the task of estimating is not an effective way to increase accuracy and may be contra-indicated. These results can help guide research and clinical use of glucose estimation in children.     

Central inhibition ability modulates attention-induced motion blindness

Impaired motion perception can be induced in normal observers in a rapid serial visual presentation task. Essential for this effect is the presence of motion distractors prior to the motion target, and we proposed that this attention-induced motion blindness results from high-level inhibition produced by the distractors. To investigate this, we compared the extent of the attention-induced motion blindness effect with performance on central inhibition tasks: Stroop colour naming and negative priming. A negative correlation between Stroop interference and motion performance reflected that low Stroop scores, indicative of strong inhibition ability, was associated with more severe impairments in motion perception. This association could not be explained by individual differences in fluid intelligence, task switching or response speed. Negative priming was not specifically associated with attention-induced motion blindness. The results confirm that attention can modulate motion perception and suggest that the processes involved may be shared with high-level cognitive abilities.     

Pathways to violence in the children of mothers who were depressed postpartum

The impact of postnatal depression on a child's risk for violent behavior was evaluated in an urban British community sample (N=122 families). Mothers were interviewed during pregnancy, at 3 months postpartum, and when the child was 1, 4, and 11 years of age. Mothers, teachers, and children reported on violent symptoms at age 11. Structural equation modeling revealed that the child's violence was predicted by the mother's postnatal depression even when her depression during pregnancy, her later history of depression, and family characteristics were taken into account. Violence was associated with symptoms of attention-deficit/hyperactivity disorder and problems with anger management. Children were most violent if mothers had been depressed at 3 months and at least once thereafter.     

Pragmatic versus form-based accounts of referential contrast: evidence for effects of informativity expectations

Characterizing the relationship between form-based linguistic knowledge and representation of context has long been of importance in the study of on-line language processing. Recent experimental research has shown evidence of very rapid effects of referential context in resolving local indeterminacies on-line. However, there has been no consensus regarding the nature of these context effects. The current paper summarizes recent work covering a range of phenomena for which referential contrast has been shown to influence on-line processing, including prenominal and postnominal modification, focus operators, and intonational focus. The results of the body of work suggest that referential context effects are not limited to situations in which the linguistic form of the utterance directly specifies the point of contact with context. Rather, context effects of a pragmatic, Gricean nature appear to be possible, suggesting the relationship between linguistic form and context in rapid on-line processing can be of a very indirect nature.     

Affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts

The purpose of this study was to examine affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts. Forty-seven adolescents with a history of multiple suicide attempts (MA) were compared to 74 single suicide attempters (SA) on psychiatric diagnosis, depressive symptoms, affect regulation, self-mutilation, alcohol use, and hopelessness. Results revealed that the MA group was more likely to be diagnosed with a mood disorder, and reported more severe depressive symptoms and anger, in comparison to the SA group. Behaviorally, the MA group had higher rates of disruptive behavior disorders and higher levels of affect dysregulation and serious self-mutilation than the SA group. Further, greater levels of hopelessness were reported by the MA than the SA group. After controlling for a mood disorder diagnosis, only differences in anger, affect dysregulation, and serious self-mutilation remained significant. Overall, results suggest that treatment with adolescent suicide attempters might specifically target anger and affect dysregulation to reduce risk for future suicidal behavior.