Attitudes and Practices Among Internists Concerning Genetic Testing

Many questions remain concerning whether, when, and how physicians order genetic tests, and what factors are involved in their decisions. We surveyed 220 internists from two academic medical centers about their utilization of genetic testing. Rates of genetic utilizations varied widely by disease. Respondents were most likely to have ordered tests for Factor V Leiden (16.8 %), followed by Breast/Ovarian Cancer (15.0 %). In the past 6 months, 65 % had counseled patients on genetic issues, 44 % had ordered genetic tests, 38.5 % had referred patients to a genetic counselor or geneticist, and 27.5 % had received ads from commercial labs for genetic testing. Only 4.5 % had tried to hide or disguise genetic information, and <2 % have had patients report genetic discrimination. Only 53.4 % knew of a geneticist/genetic counselor to whom to refer patients. Most rated their knowledge as very/somewhat poor concerning genetics (73.7 %) and guidelines for genetic testing (87.1 %). Most felt needs for more training on when to order tests (79 %), and how to counsel patients (82 %), interpret results (77.3 %), and maintain privacy (80.6 %). Physicians were more likely to have ordered a genetic test if patients inquired about genetic testing (p?<?.001), and if physicians had a geneticist/genetic counselor to whom to refer patients (p?<?.002), had referred patients to a geneticist/genetic counselor in the past 6 months, had more comfort counseling patients about testing (p?<?.019), counseled patients about genetics, larger practices (p?<?.032), fewer African-American patients (p?<?.027), and patients who had reported genetic discrimination (p?<?.044). In a multiple logistic regression, ordering a genetic test was associated with patients inquiring about testing, having referred patients to a geneticist/genetic counselor and knowing how to order tests. These data suggest that physicians recognize their knowledge deficits, and are interested in training. These findings have important implications for future medical practice, research, and education.     

Prospective Prediction of College Adjustment Using Self- and Informant-Rated Personality Traits

Summary: While the Activity Preference Questionnaire (APQ) appears to provide unusually pure and subtle measures of anxiety proneness, its forced choice format involves several drawbacks. Data are presented which suggest that a rating format can be used which avoids the disadvantages of the forced choice format but incorporates its advantages.     

Self-Concept and Sociometric Outcomes: A Comparison of Only Children and Sibling Children From Urban and Rural Areas in the People's Republic of China

We investigated differences in self-concept between 360 only children and 555 sibling children in the sixth grade of three urban schools and three rural schools in the People's Republic of China. Peer perceptions and teacher perceptions were also collected using sociometric measures. Self-concept was determined by the Self-Perception Profile for Children (Harter, 1985). Comparisons of sibling children and only children showed no differences on self-concept; however, urban residents had higher self-concept scores than children from rural areas, and boys scored higher than girls. No significant interaction effects between sibling status, gender, and residence were found.     

The Effects of Magnitude-Based Differential Reinforcement on the Skill Acquisition of Children with Autism

A common recommendation for teaching skills to children with autism is to apply differential reinforcement by reserving high-quality reinforcement for unprompted responses (Sundberg and Partington in Teaching language to children with autism or other developmental disabilities, Behavior Analysts Inc., Pleasant Hill, 1998). Earlier research focuses primarily on schedules or quality of reinforcement, rather than magnitude of reinforcement, when evaluating the use of differential reinforcement in practice. The utility of magnitude-based differential reinforcement may be dependent upon evidence that a learner responds differentially to large and small amounts of reinforcement such that he or she selects the large amount of reinforcement over the small amount of reinforcement and engages in more responses that produce the relatively larger magnitude reinforcement. Three individuals with autism participated in a treatment comparison of differential reinforcement. The manipulation of magnitude of differential reinforcement in a skill acquisition program did not have an appreciable effect on the rate of acquisition for any of the three participants.     

Clarifying Heterogeneity of Daytime and Nighttime Symptoms of Posttraumatic Stress in Combat Veterans With Insomnia

Daytime and nighttime symptoms of posttraumatic stress disorder (PTSD) are common among combat veterans and military service members. However, there is a great deal of heterogeneity in how symptoms are expressed. Clarifying the heterogeneity of daytime and nighttime PTSD symptoms through exploratory clustering may generate hypotheses regarding ways to optimally match evidence-based treatments to PTSD symptom profiles. We used mixture modeling to reveal clusters based on 6 daytime and nighttime symptoms of 154 combat veterans with insomnia and varying levels of PTSD symptoms. Three clusters with increasing symptom severity were identified (n1 = 50, n2 = 70, n3 = 34). These results suggest that, among veterans with insomnia, PTSD symptoms tend to exist on a continuum of severity, rather than as a categorical PTSD diagnosis. Hypotheses regarding possible targeted treatment strategies for veterans within each identified cluster, as well as ways to generalize these methods to other groups within the military, are discussed.