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.     

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.     

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.     

The Mindbrain and Dreams: An Exploration of Dreaming,Thinking, and Artistic Creation,by Mark J. Blechner,Routledge, Abingdon and New York, 2018, 343 pp.

The American Journal of Psychoanalysis -     

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.