Unpacking the Blockers: Understanding Perceptions and Social Constraints of Health Communication in Hereditary Breast Ovarian Cancer (HBOC) Susceptibility Families

Family communication is essential for accurate cancer risk assessment and counseling; family blockers play a role in this communication process. This qualitative analysis of social exchanges is an extension of earlier work characterizing those who are perceived by study participants as health information gatherers, disseminators, and blockers within families with Hereditary Breast and Ovarian Cancer (HBOC) susceptibility. Eighty-nine women, ages 23–56 years, enrolled in a Breast Imaging Study (BIS) and participated in a sub-study utilizing a social assessment tool known as the Colored Ecological Genetic Relational Map (CEGRM). Purposive sampling ensured that participants varied according to numbers of participating family members e.g., ranging from 1 to 6. Eighty-nine women from 42 families (1–8 relatives/family) participated. They collectively designated 65 blockers, both male and female. Situational factors, beliefs, attitudes and cultural traditions, privacy and protectiveness comprised perceived reasons for blocking intra-family health communications. Longitudinal data collected over 4 years showed families where blocking behavior was universally recognized and stable over time, as well as other families where blocking was less consistent. Self-blocking was observed among a significant minority of participating women. Blocking of health communications among family members with HBOC was variable, complex, and multifaceted. The reasons for blocking were heterogeneous; duration of the blocking appeared to depend on the reasons for blocking. Blocking often seemed to involve bi-directional feedback loops, in keeping with Lepore’s Social Constraints and Modulation Theory. Privacy and protectiveness predominated as explanations for long-term blocking.     

Brooding Rumination and Risk for Depressive Disorders in Children of Depressed Mothers

The goal of the current study was to examine the role of brooding rumination in children at risk for depression. We found that children of mothers with a history of major depression exhibited higher levels of brooding rumination than did children of mothers with no depression history. Examining potential mechanisms of this risk, we found no evidence for shared genetic influences (BDNF or 5-HTTLPR) or modeling of mothers’ rumination. However, we did find that children with a history of prior depressive disorders exhibited higher current levels of brooding rumination than children with no depression history. Importantly, children’s brooding predicted prospective onsets of new depressive episodes over a 20-month follow-up even when we statistically controlled for depressive symptom levels at the initial assessment, suggesting that the predictive effect of brooding rumination in children was not due simply to co-occurring depressive symptoms.     

Null Results in Assessing Survey Score Comparability: Illustrating Measurement Invariance Using Item Response Theory

In using organizational surveys for decision-making, it is essential to consider measurement equivalence/invariance (ME/I), which addresses the questions of whether score differences are attributable to differences in the latent variable we intend to measure, or attributable to confounding differences in measurement properties. Due to the tendency for null results to remain unpublished, most articles have focused on findings of, and reasons for violations of ME/I. On the other hand, little is available to practitioners and researchers concerning situations where ME/I can be expected to uphold. This is especially disconcerting due to the fact that the null is the desired result in such analyses, and allows for unfettered observed-score comparisons. This special issue presents a unique opportunity to provide such a discussion using real-world examples from an organizational culture survey. In doing so we hope to clear up confusion surrounding the concept of ME/I, when it can be expected, and how it relates to actual differences in scores. First, we review the basic tenets and past findings focusing on ME/I, and discuss the item response theory differential item functioning framework used here. Next, we show ME/I being upheld using organizational survey data wherein violations of ME/I would reasonably not be expected (i.e., the null hypothesis was predicted and supported), and simulate the consequences of ignoring ME/I. Finally, we suggest a set of conditions wherein ME/I is likely to be upheld.     

Student Healthcare Clinicians' Illness Narratives: Professional Identity Development and Relational Practice

ABSTRACT

In this qualitative, grounded theory study we examine how the intersection of self-reflection, illness narratives and perceived messages of professional identity inform care provided by medical, nursing, and medical family therapy students to patients and families. We discovered four common challenges students faced navigating personal experiences of illness and connecting to patients: 1) discrepancies between ideal and lived experiences, 2) challenges of healthcare work and culture, 3) navigating power and hierarchy, and 4) developing a shell of privacy. Discussion and implications include interdisciplinary training and collaboration and the unique role of medical family therapists in healthcare.     

Benefits Derived by College Students from Mentoring At-Risk Youth in a Service-Learning Course

Service learning is increasingly being used as a pedagogical strategy for promoting the development of civic-mindedness among university students. Despite the use of this strategy, little is known about the benefits derived from specific types of service-learning experiences. Additionally, few notable studies have examined the unique outcomes experienced by mentors of at-risk youth. Therefore, this study examines the civic-related benefits that college students derive from mentoring at-risk youth within a structured, service-learning course. A series of linear regression models were estimated to determine if there were significant post-intervention differences between the treatment and comparison condition for the variables of interest, after adjusting for key background factors and pre-intervention levels of all variables. The results indicated that, in comparison to college students who did not participate in the course (n = 258), college student in Campus Corps, a youth mentoring program, (n = 390) had significantly higher scores at post-intervention regarding mentors’ civic attitudes, community service self-efficacy, self-esteem, interpersonal and problem solving skills, political awareness, and civic action. Findings hold important implications for youth mentoring programs and future research.     

A psychological predictor of elders' driving performance: social‐comparisons on the road

Older individuals often believe they can drive better than their contemporaries. This belief is an example of downward social‐comparisons; they can be self‐enhancing tools that lead to beneficial outcomes. As predicted, we found that drivers who engaged in downward social‐comparisons were significantly less likely to have adverse driving events over time, after controlling for relevant factors (p = .02). This effect was particularly strong among women, who tend to experience more negative driving stereotypes (p = .01). The study was based on 897 interviews of 117 elder drivers, aged 70–89 years, over 2 years. Our findings suggest that interventions to reduce adverse driving events among elders could benefit from including a psychological component.     

Postural Control Complexity and Fatigue in Minimally Affected Individuals with Multiple Sclerosis

This study investigated changes in postural control complexity in people with multiple sclerosis (PwMS) before and after a fatigue protocol. Thirteen minimally affected PwMS (1.53 ± 1.03- Expanded Disability Status Scale) and 12 non-MS controls. Postural test included quiet stance on a force platform under two visual conditions (saccades and fixation) before and after a fatigue protocol. Postural complexity was assessed through the multiscale entropy. A three-way ANOVA showed a main effect of fatigue in the medial-lateral direction (p <0.007), with fatigue protocol reducing postural complexity in both groups. No differences were found between groups or visual conditions. Minimally affected PwMS demonstrated similar postural complexity compared with non-MS controls under both visual tasks and showed similar decrements in postural complexity as a result of fatigue.     

Risk Reduction Behaviors and Provider Communication Following Genetic Counseling and BRCA1 Mutation Testing in an African American Kindred

Little is known about the impact of cancer genetic counseling and testing on health behaviors in racial and ethnic subgroups. This prospective observational study examined use of risk reduction strategies following BRCA1 counseling and testing. Participants were female members of an African American kindred who received genetic education, counseling and testing (n = 40) and completed a 1-year follow-up interview. Mutation carriers were more likely to opt for breast (100%, 7/7) and ovarian (25%; 1 of 4) cancer surveillance than prophylactic surgery. Following genetic counseling, 71% (5/7) of the BRCA1 carriers who opted for surveillance reported having a mammogram within the year following receipt of their genetic test results. Ovarian cancer screening among mutation carriers increased from 0% at baseline to 25% (one of four) at 1 year. Compared to noncarriers (23%, 7/30), carriers (70%, 7/10) were more likely to discuss their BRCA1 test results with their primary health care providers. Surveillance for breast cancer was preferred to prophylactic surgery and chemoprevention as a way to reduce risk for these cancers. Our data indicate that patient-provider communication about BRCA1 test results is suboptimal.     

Preschool Children’s Pretend and Physical Play and Sex of Play Partner: Connections to Peer Competence

This study was designed to examine associations between preschool childrens pretend and physical play with same-sex, other-sex, and mixed sex peers and childrens social competence with peers. Sixty predominately middle-class preschoolers (33 boys, 51 European-American) were observed on the playground at their school over a period of 4 months. Childrens same-sex, other-sex, and mixed-sex peer play was observed, and teachers and peers provided assessments of childrens social competence. Analyses revealed that children who engaged in more same-sex pretend play were better liked by peers and were viewed by teachers as being socially competent. In addition, girls who engaged in same-sex exercise play and boys who engaged in same-sex rough-and-tumble play were better liked by peers, whereas boys who engaged in rough-and-tumble play with other-sex peers were less liked by peers. The results suggest that child gender and gender of playmate are important factors in the association between pretend play and rough-and-tumble play and childrens social competence with peers.     

Living circumstances of children and adults with mental retardation or developmental disabilities in the United States, Canada, England and Wales, and Australia

The purpose of this article was to collate evidence to describe where people with mental retardation or developmental disabilities live in five developed countries: United States, Canada, England, Wales, and Australia. Family homes are important dwelling places for people with mental retardation. They are the home of the great majority of children with mental retardation and a considerable proportion of adults with mental retardation. The likelihood of placement outside the family home increases with adulthood and progressively as people age. Adults with mental retardation live in a wide variety of settings, with formal residential provision frequently dependent on the arrangements that the authorities responsible for providing service support have chosen to make. There has been a considerable move away from accommodating people in large segregated and geographically isolated institutions in the countries considered. However, the current range of accommodation includes much with a distinctively different character to the homes where other citizens live. Many people still live in larger groups than would be ordinarily found in typical homes and this may necessitate departure from the architectural norm. In all of the countries considered, there has been a recent trend towards small community settings, compatible with typical housing architecture. This appears furthest advanced in the U.S. but is discernible elsewhere. Availability of residential services at a national level varies between 100 and 155 places per 100,000 total population. Regional variation within countries is even greater. In no case is the national availability considered adequate to meet the demand arising from changing need or expectations. MRDD Research Reviews 7:115-121, 2001. (c) 2001 Wiley-Liss, Inc.