Participation in Breast Cancer Genetic Counseling: The Influence of Educational Level, Ethnic Background, and Risk Perception

Genetic counseling has been suggested as a means of providing information and support to women with a family history of breast cancer. Yet women who undergo cancer genetic counseling in the United States generally consist of only a subset of those at risk, namely well-educated, upper-middle class, European American and Jewish women. We report outcomes from a study that provided a unique opportunity to determine whether women of African American, European American, Native American, or Ashkenazi Jewish ancestry have varying interest in having cancer genetic counseling. The study offered a genetic counseling session to 97 women with a family history of breast cancer who were participating in a larger interview study designed to assess attitudes toward genetic testing for breast cancer. The study offered genetic counseling free of charge to all study participants with a family history of breast cancer, removing the potential barriers of cost, the need for a physician referral, and lack of awareness of genetic counseling. Fifty women out of the 97 women offered genetic counseling (52%) accepted the offer by completing a session. Those who accepted genetic counseling had a higher educational level, a higher perceived risk of breast cancer, and were more likely to expect a positive BRCA1 or BRCA2 genetic test if they were to undergo genetic testing. When controlling for education level, there was no correlation between the participants' ethnic background and acceptance of a genetic counseling session. Outreach efforts to minority populations may increase awareness of the availability of genetic counseling and may facilitate participation by such populations.     

Relationship Dynamics Between Aging Mothers and Caregiving Daughters: Filial Expectations and Responsibilities

Using qualitative analysis, this research examined filial responsibility and the relationship dynamics between aging mothers and their caregiving daughters. In-depth interviews with 11 mother–daughter pairs explored respondents' sense of filial responsibility, filial expectations, the congruence between mothers' and daughters' expectations, and strategies used to negotiate incongruent expectations. Employing grounded theory, seven categorical themes emerged describing the daughters' perceptions and experiences of providing care. Themes were later linked to the mothers' responses concerning filial responsibility and their experiences of receiving care. Three approaches to caregiving emerged: undifferentiated, dispassionate, and mutually balanced. Findings from the present study have important implications for practitioners working with older adults and their family caregivers.     

Residual Geriatric Depression Symptoms: A Place for Psychotherapy

Geriatric depression is a relatively commonly occurring mental disorder. A subpopulation of depressed older adults are those who have engaged in or completed pharmacotherapy, yet continue to experience depressive symptoms. We review the prevalence, psychosocial effects, and treatment of residual symptoms of depression in older adults. Data from previous studies conducted by our group are presented to support our contention that residual symptoms of geriatric depression are treatable through psychosocial means.     

Intellectual similarity of virtual twin pairs: Developmental trends

Virtual twins (VTs) are same-age unrelated siblings reared together from infancy who replicate twinship, but without the genetic relatedness. A 2005 report from the ongoing Fullerton Virtual Twin Study found an IQ intraclass correlation of .26 (p < .01, n = 113 pairs) and a within-pair difference of 13.22 IQ points. The average age of VTs in that study was 8.10 years (SD = 8.56, range: 4.01-54.84 years). An opportunity to retest members of 43 VT pairs, 1.70-8.96 years after their time 1 assessment, allowed additional analyses of genetic and environmental influences underlying general intellectual development. A decrease in the VT IQ correlation and an increase in the within-pair difference were indicated, consistent with increasing genetic and/or non-shared environmental influences and decreasing shared environmental influence on general intellectual development throughout childhood.     

Positive and negative characteristics of marital interaction and their association with marital satisfaction in middle-aged and older couples

The study examined age differences in positive (e.g., warm) and negative (e.g., hostile) characteristics of marital interactions between middle-aged and older couples and whether these characteristics were differentially associated with marital satisfaction by age. Spouses' perception of partners' positive and negative behavior during marital interaction was assessed in general and following disagreement and collaborative tasks. Trained observers coded spouses' positive and negative behavior during interactions. Older individuals reported higher marital satisfaction and perceived their spouse's behavior as less negative in general and more positive across all contexts than middle-aged individuals. Spouses' perceptions of their partners' positive and negative behavior independently predicted marital satisfaction for both age groups across contexts. Perceptions of partners' negative behavior in general and of both positive and negative behavior in the disagreement task were more closely associated with marital satisfaction for older spouses than for middle-aged spouses. Results point to the importance of positive and negative characteristics in marital functioning across age cohorts and indicate that such characteristics may be context dependent. Findings suggest that, in some contexts, both positive and negative characteristics are more salient for older adults.     

“Compliance” to “Concordance”: A Critical View

Advocates of “concordance” describe it as a new model of shared decision-making between physicians and patients based on a partnership of equals. “Concordance” is meant to make obsolete the notion of “compliance,” in which patients are seen as, ideally, following doctors’ orders. This essay offers a critical view of concordance, arguing that the literature itself on concordance, including materials at the web site of Medicines Partnership, the implementation arm in Great Britain of the concordance model, is full of contradiction; concordance, in fact, harbors an ideology of compliance. The essay suggests that an improvement in patient medication use will more likely come from a frank consideration of the relation of compliance issues and commercial ones, and that a key question across domains is, “how are patients/health agents/consumers persuaded to acquire certain drugs and take them as directed?”     

Relations of maternal socialization and toddlers' effortful control to children's adjustment and social competence

The authors examined the relations of maternal supportive parenting to effortful control and internalizing problems (i.e., separation distress, inhibition to novelty), externalizing problems, and social competence when toddlers were 18 months old (n = 256) and a year later (n = 230). Mothers completed the Coping With Toddlers' Negative Emotions Scale, and their sensitivity and warmth were observed. Toddlers' effortful control was measured with a delay task and adults' reports (Early Childhood Behavior Questionnaire). Toddlers' social functioning was assessed with the Infant/Toddler Social and Emotional Assessment. Within each age, children's regulation significantly mediated the relation between supportive parenting and low levels of externalizing problems and separation distress, and high social competence. When using stronger tests of mediation, controlling for stability over time, the authors found only partial evidence for mediation. The findings suggest these relations may be set at an early age.