Assessment of the Content and Process of Genetic Counseling: A Critical Review of Empirical Studies

This article reviews studies that assessed the process and content of genetic counseling communication. A systematic search of the literature was undertaken of studies that audio- or videotaped genetic counseling sessions conducted by genetics health care providers and subjected them to communication analyses. A total of 18 studies (published in 34 articles) were identified that met the eligibility criteria. Studies show that providers speak more than clients, that a large proportion of communication is biomedical rather than psychosocial and that the teaching model of genetic counseling is widely implemented. Higher levels of counselor facilitation of understanding and empathic responses, lower levels of verbal dominance (ratio of counselor to client talk) and the provision of a summary letter of the consultation are associated with more positive client outcomes. Findings from these studies should be used as an evidence base for teaching and continuing education of genetic counseling providers.     

Priority setting in health care: on the relation between reasonable choices on the micro-level and the macro-level

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework.     

Variable pay as a risky choice: Determinants of the relative attractiveness of incentive plans

This paper presents an experimental investigation of risk preferences in the context of compensation. In five studies, participants indicated their preference between a job offering a fixed salary and one having a lower certain component but the potential to earn a higher amount contingent on performance. Results demonstrate that people are not generally risk averse in this context, as found in earlier research, but rather that risk preferences depend on the nature of the variable pay plan. In particular, in both between- and within-subjects designs, variable pay was preferred more often when incentives were based on individual rather than collective (team or organizational) performance, and participants were more optimistic about the likelihood of receiving incentives as individuals. The effects of individual differences such as self-efficacy and preference for group work were contingent on the format of the variable pay plan. Implications for designing compensation plans and employee recruitment and retention are discussed.     

Race,Class, and Gender: A Constellation of Positionalities With Implications for Counseling

Race, class, and gender are social, political, economic, and cultural constructs that describe the positionalities of people. How these constructs are defined depends on the status occupied by individuals and the individual, institutional, and societal status of the individuals who have the power to construct hierarchies. The authors examine the intersection of race, class, and gender and the dimensions of oppression and discrimination in counseling. Historical and contemporary dimensions of racism, misogyny, and classism are presented. La Raza, clase social, y el género son construcciones sociales, políticas, económicas, y culturales que describen las posicionalidades de la gente. La definición de éstas construcciones depende de la posición social ocupada por los individuos e instituciones que tienen el poder de construir estas jerarquías. Los autores examinan el cruce de la raza, la clase, y el género y las dimensiones de la opresión y la discriminación en la consejería. Las dimensiones históricas y contemporáneas del racismo, la misoginia, y el clasismo se presentan.     

Semantic and subword priming during binocular suppression

In general, stimuli that are familiar and recognizable have an advantage of predominance during binocular rivalry. Recent research has demonstrated that familiar and recognizable stimuli such as upright faces and words in a native language could break interocular suppression faster than their matched controls. In this study, a visible word prime was presented binocularly then replaced by a high-contrast dynamic noise pattern presented to one eye and either a semantically related or unrelated word was introduced to the other eye. We measured how long it took for target words to break from suppression. To investigate word-parts priming, a second experiment also included word pairs that had overlapping subword fragments. Results from both experiments consistently show that semantically related words and words that shared subword fragments were faster to gain dominance compared to unrelated words, suggesting that words, even when interocularly suppressed and invisible, can benefit from semantic and subword priming.     

a test of holland's theory of vocational personalities and work environments

This study investigated the validity of J. L. Holland's (1997) theory of vocational personalities and work environments. The sample consisted of 241 randomly selected members of the National Association of School Psychologists, each of whom completed a demographic data form, the Self‐Directed Search‐Revised (SDS‐R; J. L. Holland, 1994) and a modified short form of the Minnesota Satisfaction Questionnaire (D. J. Weiss, R. V. Dawis, G. W. England, & L. H. Lofquist, 1967). Only limited support was found for major constructs associated with Holland's theory, although the study found several significant relationships between 3‐letter SDS‐R codes and desired role function as would be predicted by Holland's theory.     

Children of Incarcerated Mothers

We review the literature on children whose mothers are incarcerated in jails or prisons. These children typically experience a great many risk factors besides their mothers' incarceration, including poverty, drug and alcohol problems in their families, community violence, and multiple changes in caregivers. Children's lives are greatly disrupted when mothers are arrested, and most children show emotional and behavioral problems. The impact this has depends on the age of the child, the alternate caregiving arrangements, and the course of the mother's incarceration. Children of incarcerated mothers experience internalizing (fear, withdrawal, depression, emotional disturbance) and externalizing (anger, fighting, stealing, substance abuse) problems, as well as heightened rates of school failure and eventual criminal activity and incarceration. Research in this area is scarce and often of poor quality. A research agenda which is guided by a transactional, ecological, and developmental model, and which examines children's well-being over the course of the mothers' incarceration is suggested.     

The role of causal attributions in competitive situations

Previous data have shown that successful women are judged to have masculine characteristics [J. A. Doyle (1989), The Male Experience(2nd ed.), Dubuque, IA: Wm. C. Brown; D. L. Gill (1986), Psychological Dynamics of Sport,Champaign, IL: Human Kinetics; D. J. Murphy (1988), “Sport and Gender,” in W. M. Leonard II (Ed.), A Sociological Perspective of Sport(3rd ed.), New York: Macmillan; P. Willis (1994), “Women in Sport in Ideology,” in S. Birrell and C. L. Cole (Eds.), Women, Sport, and Culture,Champaign, IL: Human Kinetics]. Two experiments were conducted to test two different explanations for this effect, the appraisal and attribution hypotheses. In Experiment 1, male participants who lost to a female confederate on a masculine-relevant task rated her as having more masculine and fewer feminine characteristics than when the task was described as feminine-relevant. However, heart rate and blood pressure data failed to support the appraisal hypothesis that these reactions were due to the stress of losing to the female, or defensiveness. The alternative hypothesis that these ratings were due to standard attributional processes was more consistent with the data. Consequently, this hypothesis was tested in Experiment 2 using an attributional paradigm. Consistent with Experiment 1, the attribution hypothesis fared better than did the appraisal hypothesis.     

Active and passive distraction using a head-mounted display helmet: effects on cold pressor pain in children.

OBJECTIVE: The current study tested the effectiveness of interactive versus passive distraction that was delivered via a virtual reality type head-mounted display helmet for children experiencing cold pressor pain. DESIGN: Forty children, aged 5 to 13 years, underwent 1 or 2 baseline cold pressor trials followed by interactive distraction and passive distraction trials in counterbalanced order. MAIN OUTCOME MEASURES: Pain threshold and pain tolerance. RESULTS: Children who experienced either passive or interactive distraction demonstrated significant improvements in both pain tolerance and pain threshold relative to their baseline scores. In contrast, children who underwent a second cold pressor trial without distraction showed no significant improvements in pain tolerance or threshold. CONCLUSION: Although both distraction conditions were effective, the interactive distraction condition was significantly more effective. Implications for the treatment of children's distress during painful medical procedures are discussed.