Genetic Testing of Children for Predisposition to Mood Disorders: Anticipating the Clinical Issues

Large-scale sequencing information may provide a basis for genetic tests for predisposition to common disorders. In this study, participants in the Coriell Personalized Medicine Collaborative (N?=?53) with a personal and/or family history of Major Depressive Disorder or Bipolar Disorder were interviewed based on the Health Belief Model around hypothetical intention to test one’s children for probability of developing a mood disorder. Most participants (87 %) were interested in a hypothetical test for children that had high (“90 %”) positive predictive value, while 51 % of participants remained interested in a modestly predictive test (“20 %”). Interest was driven by beliefs about effects of test results on parenting behaviors and on discrimination. Most participants favored testing before adolescence (64 %), and were reluctant to share results with asymptomatic children before adulthood. Participants anticipated both positive and negative effects of testing on parental treatment and on children’s self-esteem. Further investigation will determine whether these findings will generalize to other complex disorders for which early intervention is possible but not clearly demonstrated to improve outcomes. More information is also needed about the effects of childhood genetic testing and sharing of results on parent–child relationships, and about the role of the child in the decision-making process.     

Demographic and Experiential Correlates of Public Attitudes Towards Cell-Free Fetal DNA Screening

This study seeks to inform clinical application of cell-free fetal DNA (cffDNA) screening as a novel method for prenatal trisomy detection by investigating public attitudes towards this technology and demographic and experiential characteristics related to these attitudes. Two versions of a 25-item survey assessing interest in cffDNA and existing first-trimester combined screening for either trisomy 13 and 18 or trisomy 21 were distributed among 3,164 members of the United States public. Logistic regression was performed to determine variables predictive of interest in screening options. Approximately 47 % of respondents expressed an interest in cffDNA screening for trisomy 13, 18, and 21, with a majority interested in cffDNA screening as a stand-alone technique. A significantly greater percent would consider termination of pregnancy following a diagnosis of trisomy 13 or 18 (52 %) over one of trisomy 21 (44 %). Willingness to consider abortion of an affected pregnancy was the strongest correlate to interest in both cffDNA and first-trimester combined screening, although markedly more respondents expressed an interest in some form of screening (69 % and 71 %, respectively) than would consider termination. Greater educational attainment, higher income, and insurance coverage predicted interest in cffDNA screening; stronger religious identification also corresponded to decreased interest. Prior experience with disability and genetic testing was associated with increased interest in cffDNA screening. Several of these factors, in addition to advanced age and Asian race, were, in turn, predictive of respondents’ increased willingness to consider post-diagnosis termination of pregnancy. In conclusion, divergent attitudes towards cffDNA screening—and prenatal options more generally – appear correlated with individual socioeconomic and religious backgrounds and experiences with disability and genetic testing. Clinical implementation and counseling for novel prenatal technologies should take these diverse stakeholder values into consideration.     

Evolutionary policy contexts and policies in preparation for the twenty‐first century

The importance of preparing now for the next century is emphasized. The author's field and Kondratiev theories as a basis for long‐range policymaking over periods of dynamic, recon‐figurational change are briefly reviewed, and a number of assumptions relevant to this kind of policymaking are provided.. Equilibrium and nonequilibrium structures and thinking are contrasted. Limitations to control associated with limits to knowledge and knowability are discussed. The possibility is considered that continuation of present policies and practices may accelerate movement along a trajectory to nowhere. Problem solutions are considered within the context of what is meant by a civilized society, and some 15 characteristics of a civilized society are proposed. The theoretical basis for preparation for the Twenty‐First Century is advanced. Deficiencies in the present dominant politicoeconomic theories of Western Capitalistic Democracy and Marxism are discussed, and the need for a new set of “founding fathers” is proposed. The importance of developing and implementing a replacement theory of similar magnitude to present theories is emphasized, and the nature of this theory is briefly sketched. Some recommendations for guided paradigm change are offered.     

True and false memory in the absence of perceptual identification

Two experiments are reported in which, after attempting to identify a briefly flashed, masked test word, participants were asked to rate the likelihood that it had been presented in an earlier study list. Even when people were unable to identify such items, they demonstrated an ability to discriminate between those that were studied and those that were not studied; ratings given to studied items were significantly higher than ratings given to nonstudied items. This effect does not appear to be a data‐driven phenomenon. In Experiment 1 it was found when the presentation modality was changed from study to test. In Experiment 2 false memory for unidentified items that were related to studied items was shown.     

Predicting behavioral outcomes with two psychological assessment methods in an outpatient pain management program

Abstract

In research with pain patients, the determination of psychological variables that can predict physiological gains would be helpful for practitioners doing assessments on pain patients. The present study used the Millon Behavioral Health Inventory (MBHI) and the Minnesota Multiphasic Personality Inventory (MMPI) to assess whether gains in time sitting, time standing, number of stairs climbed, time on a treadmill, treadmill speed, grip strength in both hands, and a composite score of these variables could be successfully predicted for patients at a 20-day outpatient multidisciplinary pain rehabilitation program. Discriminant analyses demonstrated that both the MBHI and the MMPI were successful in this prediction. Advantages for using the two instruments singly and together in assessment procedures and suggestions for future research are made.     

Trauma history as a resilience factor for patients recovering from total knee replacement surgery

Research concerning the impact of trauma history on individuals' ability to cope with subsequent events is mixed. While many studies find that trauma history increases vulnerability for conditions such as post-traumatic stress disorder and chronic pain, others reveal that there are benefits associated with moderate levels of stress (e.g. development of coping skills).

Objective: The present study investigated whether the experience of prior traumatic stressors would serve as a risk or resilience factor based on physical and emotional outcomes among patients recovering from total knee replacement surgery (TKR).

Design: 110 patients undergoing unilateral, TKR completed surveys before surgery, as well as one and three months following the procedure.

Results: Contrary to hypotheses, patients who reported more prior traumas experienced less severe pain and functional limitations at one- (β = ?.259, p = .006) and three-month follow-up assessments (β = ?.187, p = .04). A similar pattern emerged when specific types of traumas (e.g. interpersonal) were examined in relation to physical recovery. Further, patients’ trauma history was negatively related to symptoms of post-traumatic stress three-months following surgery (e.g. Avoidance: β = ?.200, p = .037).

Conclusion: Trauma history represents a source of resilience, rather than vulnerability, within the context of arthroplastic surgery.     

‘I quit’ versus ‘I’m sorry I used’: A preliminary investigation of variations in narrative ending and transportation

A narrative experience can partly depend on how a narrative ends or concludes. This study examined prevention effects of personal drug use narratives varying by type of ending and gender of protagonist. Additionally, the role of transportation in the persuasion process, particularly the association between transportation and cocaine use intentions, both directly and indirectly, through the mediation of anti-drug and pro-drug expectancies was assessed. A total of 500 undergraduate students at a large northern university in the UK participated in the experiment which was a 2?×?2?×?2 mixed design with ending (progressive vs. regressive) and gender of protagonist (male vs. female) as within-participants factors and participant gender (male vs. female) as between-participants factors. The results demonstrated significant main effects for ending, gender of protagonist in the narrative and participant gender, but no interaction effects. Finally, greater transportation was associated with stronger anti-cocaine expectancies, which were further associated with lower cocaine use intentions. Important theoretical and empirical implications are discussed.