A Mobile Colonoscopic Unit for Lynch Syndrome: Trends in Surveillance Uptake and Patient Experiences of Screening in a Developing Country

The Genetic and Endoscopic Surveillance Clinic is an annual outreach service offering accessible colonoscopic surveillance to known families with Lynch syndrome living in remote areas of the Western and Northern Cape Province of South Africa. Unfortunately attendance at this outreach clinic has been declining over several years and fewer than a quarter of participants, attending for surveillance, have been adherent with all their recommended screening appointments. Concerns exist for non-adherent individuals as screening can prevent colorectal cancer by removing the precancerous lesion or enabling the treatment of a malignancy at an early stage. This study explored the experience of surveillance from both the non-adherers’ and adherers’ perspectives and identified unique factors affecting attendance at the outreach clinic. Rates of compliance are calculated for 191 mutation-positive cases of Lynch syndrome, using strict attendance criteria, and compared to figures obtained from self-reported attendance. Non-compliance was under-reported and compliance was exaggerated when basing data on self-reported adherence to recommendations. Specific characteristics of the outreach clinic affecting compliance are identified and recommendations are made to facilitate improvements to the service. These improvements can result in increased compliance with screening regimens and ultimately reduce cancer-related mortality.     

Honeymoon,medical treatment or big business? An analysis of the meanings of the term “reproductive tourism” in German and Israeli public media discourses

Background/Introduction

Infertile couples that travel to another country for reproductive treatment do not refer to themselves as “reproductive tourists”. They might even be offended by this term. “Tourism” is a metaphor with hidden connotations. We will analyze these connotations in public media discourses on “reproductive tourism” in Israel and Germany. We chose to focus on these two countries since legal, ethical and religious restrictions give couples a similar motivation to travel for reproductive care, while the cultural backgrounds and conceptions of reproduction are different.

Results

Our research shows that the use of the metaphor “reproductive treatment” and its hidden messages depends on the writers’ intention and the target population. Although the phenomenon of patients travelling for reproductive treatment can fit into the definitions of tourism, the term emphasizes aspects that do not reflect patients’ reality. In both the German and the Israeli public media debate the term “reproductive tourism” is either used to criticize the economic aspects of the phenomenon or to attract patients as potential clients.

Conclusions

Ethicists should be cautious when borrowing metaphors like “reproductive tourism” from the public debate. Our findings support Penning’s suggestion to use instead an unloaded term like cross-border reproductive care to describe the phenomenon in a more neutral way and to make it explicit whenever criticism is necessary.

     

Vehicle Drivers and Fatal Accidents

ABSTRACT: This study attempts an exploratory study of the question, What happens to drivers of vehicles involved in accidents in which there is a fatality, whether or not the driver was at fault? The purpose of the investigation was to attempt to determine what, if any, crisis intervention is needed for such drivers. A total of 33 drivers participated who were involved in such an accident from 6 months to 11 years prior to the interviews. Major findings are (1) the range of time for drivers to resolve their crises seemed to be from a few hours to years after the accident, (2) the crises created many psychosocial and physical problems for these drivers, (3) the support of family, friends, and significant others was the most important variable for the drivers in crisis resolution, (4) condemnation hindered them most.     

Low-level lead exposure, executive functioning, and learning in early childhood.

The current paper presents evidence relating low-level lead exposure to impaired executive functioning in young children. Using the Shape School task, we assessed focused attention, attention switching, working memory, and the ability to inhibit automatic responses in a cohort of 170 children. Participants performed the Shape School task at both 48 and 54 months of age; the mean blood lead level was 6.49 microg/dl at 48 months. After controlling for a wide range of sociodemographic, prenatal, and perinatal variables, blood lead level was negatively associated with children's focused attention while performing the tasks, efficiency at naming colors, and inhibition of automatic responding. In addition, children with higher blood lead levels completed fewer phases of the task and knew fewer color and shape names. There was no association between blood lead and performance on the most difficult tasks, those requiring attention switching or the combination of inhibition and switching. Children's IQ scores were strongly associated with blood lead and Shape School performance, and when entered as a covariate, only color knowledge and the number of tasks completed remained significant. Results provide only weak support for impaired executive functioning, but the deficits in color knowledge may indicate a primary sensory deficit or difficulty with forming conditional associations, both implicating disruptions in dopamine system function.     

Work and Family Conflict: An Often Overlooked Issue in Couple and Family Therapy

Despite the systemic interaction, family-based journals, as well as intake and assessment forms most frequently used by couple and family therapists (CFTs), have given a limited amount of attention to the issue of work and family conflict. Moreover, a review of the literature indicated that many CFTs perceive themselves as inadequately prepared to assist couples and families with work and family conflict. Addressing this apparent limitation, the present study identified various work stressors that contributed to family conflict (WFC), and the family stressors that contributed to work conflict (FWC). Results revealed significant predictors of WFC and FWC. Implications for CFTs and recommendations for changes in academic training and supervision are provided. The authors would like to thank Dr. Gary Bischof, Associate Professor of Counselor Education and Marriage and Family Therapy program Director at Western Michigan University, for editorial comments made on a previous version of this paper.     

Distress and help-seeking as a function of person-environment fit and self-efficacy: A causal model

Self-efficacy, indicators of distress (state anxiety and frequency of physical symptoms), help-seeking (visits to the campus health center, an outside physician, and a counselor), and two measures of person-environment (P-E) fit were assessed on 152 college students and examined in a LISREL model. The two P-E fit measures were perceived discrepancy, the profile difference score between how each student would like their residence floor and how each viewed it as being, and actual discrepancy, the profile difference score between how each would like the floor to be and the mean rating for how floor residents viewed the floor. It was found that self-efficacy and perceived discrepancy had independent and moderate effects on distress but not on help-seeking, whereas actual discrepancy was found to have a strong effect on help-seeking and no direct effect on distress. Help-seeking was found to have a strong negative effect on distress.     

Sexual Violence Victimization and Associations with Health in a Community Sample of African American Women

Limited information exists on the relationship between sexual violence victimization and health among African American women. Using data from a community sample of African American women, we examine the association between current health and lifetime experiences of sexual violence. In-person interviews were completed in 2010. Among interviewees, 53.7% of women reported rape victimization and 44.8% reported sexual coercion in their lifetime. Victims of rape or sexual coercion were significantly more likely to report depression and posttraumatic stress disorder during their lifetime. Among victims whose first unwanted sexual experience was rape or sexual coercion, perpetrators were mostly acquaintances and intimate partners, and over one third were injured and needed services. More attention is needed on the health needs of African American women and their association to victimization status.     

ASSESSMENT AND TRAINING OF CLINICAL INTERVIEWING SKILLS: ANALOGUE ANALYSIS AND FIELD REPLICATION

Two studies were conducted to assess and train clinical interviewing skills. In Experiment 1, eight university practicum students (“therapists”) and either role played or volunteer “clients” were audiotaped during simulated interviews. Following the collection of baseline data on both therapist and client responses, training was provided by way of written materials, classroom instruction and practice, and quizzes. Results of a multiple baseline design across subjects showed improvements in therapists' interviewing skills and subsequent increases in client responding. Experiment 2 replicated and extended the research to a hospital outpatient clinic, in which therapists interviewed the parents of children with behavior problems. In addition, four months following the completion of Experiment 2, follow-up data collected during a maintenance condition showed continued high levels of therapist and client behavior. Finally, a panel of expert peers indicated that each response category was judged highly relevant to the behavioral assessment process.     

BEHAVIORAL COMMUNITY INTERVENTION TO REDUCE THE RISK OF SKIN CANCER

Peer leader modeling, posted feedback, posted goals, and a commitment raffle were used at two swimming pools to increase behaviors associated with skin cancer prevention. During the intervention condition, pool lifeguards modeled the protective behaviors by wearing sunglasses, t-shirts, and hats, using zinc oxide and sunscreen, and staying in the shade. Children and adolescents (1 to 16 years old) increased their use of two or more protective behaviors from a baseline mean of 6.5% to 26.9% during the intervention. Adults (older than 16 years) increased their protective behaviors from a baseline mean of 22% to 37.95% during the intervention. The lifeguards increased their use of all the protective behaviors from a baseline mean of 16.7% to 63.5% during intervention. Ways to improve and expand this intervention are discussed.