Predictors of Cancer Worry in Unaffected Women from High Risk Breast Cancer Families: Risk Perception is not the Primary Issue

Some women at increased familial risk of breast cancer experience elevated levels of cancer-specific worry, which can possibly act as a barrier to screening, and may be a significant factor in decisions regarding risk-reducing surgery. The aim of this study was to comprehensively examine predictors of cancer-specific worry in high risk women and to test a model which proposes that perceived breast cancer risk mediates the impact of other factors on worry. 1,437 unaffected women from high risk breast cancer families completed questionnaires and interviews. Path analysis was used to test the model of potential predictors of cancer worry, including familial, personal and psychological variables, mediated via perceived cancer risk. Levels of cancer-specific worry were generally low despite an average perceived risk of 50.3%. The goodness-of-fit of the proposed model was poor, explaining only 9% of the variance for perceived risk and 10% of the variance for cancer specific worry. An alternative model of a direct relationship between all of the predictor variables and cancer worry, explained 24% of the variation in cancer worry. General anxiety, perceived risk, the stressful impact of recent cancer related events, a relative risk greater than 10, being closer in age to the youngest breast cancer diagnosis in family, and knowledge of personal mutation status, all independently contributed to cancer worry. Addressing general affective responses, experiences of recent cancer related events, in addition to education about personal risk, should be considered in counselling women with elevated cancer worry. Risk perception appears to act independently of other factors in its formulation and impact on cancer worry. Further research on the way in which women come to perceive their risk is indicated. The kConFab Psychosocial Group are (in alphabetical order of institution): Brain and Mind Institute, University of Sydney, Australia (I Hickie) Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia (K-A Phillips) Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia (B Bennett, B Meiser, K Tucker) Department of Oncology, St Vincent’s Hospital, Melbourne, Australia (S-A MaLachlan) Department of Psychological Medicine, Royal North Shore Hospital, St Leonards, Australia (C Tennant); Medical Psychology Research Unit, University of Sydney, Australia (P Butow, M Price).     

Conceptualization and measurement of family outcomes associated with families of individuals with intellectual disabilities

The purpose of this review is to (a) document the current status of conceptualizing and measuring family outcomes related to having a member with an intellectual disability and (b) determine the extent to which family research focuses on internal family characteristics as contrasted to external family support. The reviewers collected 28 articles using the terms well-being, adaptation, family functioning, or family quality of life in the title. Results of our analyses are presented as a comparison between well-being, adaptation, and family functioning articles in one group and family quality of life articles in a second group. Both groups lacked explicit conceptual definitions, theory, and random/representative samples. The articles placed an undue emphasis on maternal participation, and tended to report a single family member score as representative of the whole family. Two major differences between the groups was a tendency for family quality of life studies to be grounded in conceptual frameworks and focus on new instrument development. Recommendations for future research directions are included.     

Re‐conceptualizing spirituality in the light of educating young children

What is meant by spirituality in relation to a young child? Palmer (2003 Palmer, P. J. 2003. “The heart of a teacher: identity and integrity”. In The Jossey‐Bass Reader on Teaching, Edited by: Lieberman, A. 3–25. San Francisco: Jossey‐Bass.  [Google Scholar]) asserted that spirituality is an elusive word with a variety of definitions—some compelling, some witty, some downright dangerous. The spirituality of a young child involves actively living by being connected to a natural source within the moral universe and affectively belonging with relationships that are interconnected within a child’s culture and community. Children’s spirituality is transformational by inspiring others and directive by facilitating and encouraging peers by connecting with others within a classroom community. This paper discusses a re‐conceptualization of children’s spirituality through autobiographical experiences and self‐reflection that embrace early childhood relationships and involve interconnected transformational and directive spiritual experiences. These spiritual experiences build trustful, moral, relational learning moments in an early childhood classroom with peers.     

Juvenile homicide in America: how can we stop the killing?

Juvenile homicide remains a serious problem in the U.S., despite recent decreases in the juvenile arresr rate for murder. Reflecting on her clinical experiences evaluating 90 adolescent murderers, the author identifies 15 factors that appear to have contributed to the escalation in juvenile homicide beginning in the mid-198os. These factors can be grouped into five categories: situational factors (child abuse and neglect, and the absence of positive male role models), societal influences (the crisis in leadership and lack of heroes, and witnessing violence), resource availability (access to guns, involvement in alcohol and drugs, and poverty and lack of resources), personality characteristics (low self-esteem, the inability to deal with strong feelings, boredom, poor judgement, and prejuduce and hatred), and their cumulative effects (little or nothing to lose and the biological connection). Strategies to reduce juvenile violence are addressing using parents, schools, communities, government leaders, the media and individuals. ©1997 John Wiley & Sons, Ltd.     

RELATIONSHIP VIOLENCE AMONG ADOLESCENT MOTHERS: FREQUENCY, DYADIC NATURE, AND IMPLICATIONS FOR RELATIONSHIP DISSOLUTION AND MENTAL HEALTH

This article examines whether the frequency, dyadic nature, and potential implications of relationship violence differ in parenting ( n = 163) and nulliparous (i.e., never given birth; n = 165) adolescent females from low-income, urban communities. We found the frequency and dyadic nature of violence did not differ between parental status groups. Over half of the adolescents in both groups reported relationship violence in the past year, with female-enacted violence more common than male-enacted violence. However, significant group differences emerged in the relationship between violence and subsequent relationship dissolution and mental health. Higher levels of female-enacted violence predicted relationship dissolution among nulliparous adolescents but predicted increases in depression in parenting adolescents. Findings highlight the need for violence prevention programs tailored specifically to the developmental and contextual needs of adolescent mothers.     

The influence of infant irritability on maternal sensitivity in a sample of very premature infants

The relationship between maternal sensitivity and infant irritability was investigated in a short‐term longitudinal study of 29 very preterm infants. Infant irritability was assessed at term with the Brazelton NBAS, the Mother and Baby Scales (MABS) and the Crying Pattern Questionnaire (CPQ). Maternal sensitivity was assessed by nurses' ratings in the neonatal care unit and at three months during mother–infant interaction observation. Cross‐lagged panel analysis indicated that neonatal irritability did not influence sensitivity at 3 months nor did maternal sensitivity in the newborn period lead to reduced irritability at 3 months. Both irritability and maternal sensitivity showed moderate stability over time (r = 0.55 and r = 0.60, respectively). It is concluded that in early infancy maternal sensitivity shows little influence on infant irritability in very preterm infants. Copyright © 2003 John Wiley & Sons, Ltd.     

Cognitive change 5 years after coronary artery bypass surgery.

A longitudinal study of cognitive function after coronary artery bypass surgery examined 107 participants using 11 tests, preoperatively and at 6 days, 8 weeks, and 5 years after surgery. The overall neuropsychological (NP) change score declined at 6 days, showed some recovery at 8 weeks, and declined again at 5 years. The number of microemboli recorded during surgery, postoperative short-term cognitive change, and degree of recovery at 8 weeks were identified as predictors of change in NP score to 5 years. This suggests that even over a 5-year period, operative damage is detectable. Patients' vulnerability to short-term deterioration and resilience or ability to recover over a few weeks from operative cerebral insult are important processes of unknown mechanisms.     

What the family brings: gathering evidence for strengths-based work

Families attending child and adolescent mental health (CAMH) services are often assumed to have problems in key areas such as communication, belonging/acceptance and problem-solving. Family therapy is often directed towards addressing these difficulties. With increasing emphasis in family therapy and human services fields over the last decade on identifying and building from strengths, a different starting point has been advocated. This paper describes a large survey of the self-reported pre-therapy functioning of children and families using a public CAMH service (n=416). Before commencing family therapy parents identified family strengths across a range of key areas, despite the burden of caring for children with moderate to severe mental health problems. This evidence supports theoretical and clinical work that advocates a strengths perspective, and highlights how resilience framed in family (and social) rather than individual terms enables a greater appreciation of how strengths may be harnessed in therapeutic work.