Evaluation of Breast Cancer Patients with Genetic Risk in a University Hospital: Before and After the Implementation of a Heredofamilial Cancer Unit

The identification of patients at risk for breast cancer by genetic testing has proven to reduce breast cancer mortality. In 2010, due to a lack of systematization in hereditary cancer assistance in our center, we implemented a multidisciplinary Heredofamilial Cancer Unit (HFCU). We analyze if the HFCU improved the rates of referrals and preventive management of breast cancer patients with genetic risk. We retrospectively compared family history records, referrals of high-risk patients to genetic counseling, and detection and management of patients with BRCA1/2 mutations in two cohorts of breast cancer patients diagnosed before (first period: 2007–2010) and after the creation of the HFCU (second period: 2010–2013). In the first period, 893 patients were included, and 902 were included in the second. Due to the inability to establish their genetic risk, 142 patients (15.9%) vs. 70 (7.8%) were excluded from analysis (p?<?0.001). Among the evaluable patients, 194 (25.8%) vs. 223 (26.8%) fulfilled one or more risk criteria (p?=?0.65). Family history documentation in patient’s medical records (92.4 vs. 97.8%, p?<?0.001) and referral rate (26.3 vs. 52%, p?<?0.0001) significantly increased in the second period. Eight BRCA1/2 mutations were detected among patients referred in the first period and 17 among those referred to the HFCU. The rate of preventive surgeries in patients with BRCA mutations significantly increased in the second period (25 vs. 76.5%, p?=?0.03). In conclusion, there was a clear improvement in family history records, referrals, and preventive surgeries in breast cancer patients with genetic risk after the implementation of the HFCU.     

Assessing Psychiatric Symptoms in Youth Affected by HIV: Comparing a Brief Self-Administered Rating Scale with a Structured Diagnostic Interview

Brief psychiatric assessment tools are needed for evaluating children affected by HIV for emotional and behavioral problems. We compared a self-administered symptom rating scale (CASI-4R) to a semi-structured diagnostic interview (DICA-P) in 136 U.S. children affected by HIV. Agreement and performance measures for the two instruments were computed for attention deficit hyperactivity disorder, depression, anxiety, and disruptive behavior. Correlations and regression analyses were conducted to compare the two instruments, and to evaluate their associations with social, academic, and global function. Higher CASI-4R symptom severity scores were associated with DICA diagnoses (p?<?0.02 for all disorders). Agreement (κ) between DICA diagnoses and CASI-4R Clinical Cutoffs (which incorporated symptoms and impairment) was low to moderate (0.19–0.40 for all disorders). Thirty-two percent of cases with a DICA diagnosis were identified by the CASI-4R Clinical Cutoff (sensitivity), yet over 90% of DICA-negative cases were negative by the CASI-4R (specificity). Sensitivity was higher using CASI-4R Severity Score thresholds based on median scores compared to the DICA diagnoses. The presence and severity of psychiatric symptoms and impairment were associated with poorer academic, social, and global function. The CASI-4R symptom checklist can be used to inexpensively screen youth affected by HIV for emotional and behavioral problems, although it is important that there be appropriate mental health evaluation follow-up.     

Mother–child and metapelet–child touch behavior with three‐year‐old kibbutz children in two contexts

The frequency and function of self‐touch and of touching another was studied among 32 three‐year‐old kibbutz children, their mothers, and their metaplot [caretakers; singular: metapelet] in two contexts: coconstruction of a narrative with Duplo toys, and coconstruction of a narrative with an emotion‐evoking picture book without text. Self‐touch, mainly fidgeting, was more frequent for children during the task with the picture book and more frequent for adults during the task with the Duplo toys. Mothers and children touched each other more often than metaplot and children. Adults' touches of the children were perceived as either expressions of affection or as acts of grooming and were task‐related. The children's touching of the adults was mainly task‐related. It appears that self‐touch is for children and adults alike a mode of self‐regulation of mild stress and that touching the other has a wide range of functions, especially in intimate relationships. ©2003 Michigan Association for Infant Mental Health.     

THE IMPACT OF THE FEMINIST CRITIQUE ON TESTS, ASSESSMENT, AND ETHODOLOGY

In this article we discuss the implications of the feminist critique for methodologies related to tests and assessment. Several specific examples of the impact (or lack of impact) of feminist thinking on psychological, vocational, and educational tests are provided. From the point of view of a feminist critique, while the revision of the Strong–Campbell Interest Inventory appears to be a success, the 1990 revision of the Minnesota Multiphasic Personality Inventory (MMPI–2) is not. Feminists have inspired methodological improvements such as the use of meta–analysis to evaluate sex difference data and the ability to estimate sampling error to challenge the research on free-response and multiple-choice tests. Recognition of the need to involve women in the development of normative data, introduction of sensitivity reviews, and implementation of differential item functioning analyses have improved tests. However, although testing has improved from the feminist perspective, additional changes can be expected as feminists (female and male) become more involved as scholars and scientists.     

Hand preferences and hand ability in congenitally blind children

Congenitally blind and sighted blindfolded children between the ages of 6 and 14 years were tested for hand preference with performance tasks. There were no differences between the groups in direction or degree of hand preference. The degree of handedness increased with age and was essentially linear though the blind seemed to be somewhat less lateralized at the younger ages.

When the same groups were required to match three-dimensional bricks for height, depth, breadth, and volume, no hand advantages were found for either group. Both groups of children improved in their accuracy of spatial discriminations with age.

Further, the degree of lateralization on the handedness task did not relate to ability on the tactile task or to differences between the right and left hands on the tactile task. Thus, there is no effect of blindness on tactile matching ability nor is there an effect of the hand used in the task.     

From gains to losses: Age-related differences in decisions under risk in a non-monetary gambling task

Lifespan theory suggests a shift from a primary orientation towards attaining gains in young adulthood to preventing losses in older adulthood. The current research tested if this motivational shift is reflected in behavioural and emotional responses to risks in non-monetary gains and losses. Study 1 established in a sample of N = 168 younger (18–30 years) and older adults (65–79 years) that a non-monetary gambling task was experienced similarly by the age groups with respect to arousal and valence of the task, and the willingness to continue playing. In Study 2 (N = 83), differences between young (18–30 years) and older (64–85 years) adults’ risk-taking in this non-monetary gambling task with mixed gambles were tested while assessing physiological responses (event-related heart rate change) to gain and loss feedback. Behavioural – but not physiological – results confirm hypotheses derived from a lifespan motivational framework regarding age-differential effects of gains and losses.