If We Build It … Will They Come? – Establishing a Cancer Genetics Services Clinic for an Underserved Predominantly Latina Cohort

Background: Cancer genetic counseling and testing is a standard of care option for appropriate families and can identify individuals at increased risk prior to diagnosis, when prevention or detection strategies are most effective. Despite documented efficacy of cancer risk reduction in high-risk individuals, underserved and minority individuals have a disproportionate cancer burden and limited access to genetic counseling. Methods: A needs assessment survey documented gaps in knowledge and interest in prevention. Satellite clinics were established at two indigent healthcare systems. Cancer genetics CME lectures were conducted and referral guidelines disseminated to clinicians who referred patients for counseling. Results: An increase in clinician knowledge was demonstrated post-CME and reflected by quality referrals. Eighty-eight percent of patients kept their appointments. In the predominantly Latina⁶ (n=77) clinic population, 71.4% were affected with cancer, and 17 mutation positive families were identified. Preliminary data shows a positive impact on patients' motivation and behavior. The majority has expressed satisfaction and reduction in anxiety. Conclusions: This study demonstrates feasibility and acceptability of cancer genetics services in this population, suggesting the potential to reduce cancer morbidity in underserved, high-risk families.“Latino” is the most common census term for individuals of Spanish, Mexican, Central and South American, Cuban, or Puerto Rican descent, referring to ethnicity, and is generally considered a more ethnically/culturally based term for individuals of the aforementioned groups. As this cohort is female the feminine noun “Latina” is used     

Pilot programs in newborn screening

The term "pilot study" has been used over the years to describe the evaluation of the many elements involved in deciding whether a proposed condition should be added to a newborn screening (NBS) panel, and until recently, was unilaterally used to describe the evaluation of the assay to be used before the condition was officially adopted by a state for its newborn screening panel. Since Guthrie's introduction of screening for PKU, each time a new condition was added to the panel, the screening assay itself was validated through a population-based trial, in which the test was performed with de-identified samples to avoid association between the test result and the infant. This is considered by the laboratory as the "pilot phase" of adding a new condition. To advance the science of NBS, especially to accommodate new technologies that may provide new types of information (genetic versus physiological) for each new condition, pilot programs are essential. Involvement of the clinical community serves to improve these evaluations and provides the needed clinical validation of decisions made as a result of it. This paper describes the historical context of pilot programs in population-based NBS that utilize laboratory-based markers as indicators of concern; specifically, three applications that demonstrate different approaches to the use of pilots in adding conditions to a NBS panel are described.     

Constructions of Mexican American family grief after the death of a child: an exploratory study

Using a collective case study ethnographic approach, nine individuals comprising three Mexican American families were interviewed about their family bereavement experiences after the death of a child. All families were Catholic, had surviving siblings, and had had three or more years to grieve their loss when interviewed. The deceased children ranged in age from 3 to 14, and all experienced sudden, traumatic, nonsuicide deaths. To provide a broader, contextual picture of their grief experiences, four individuals who supported these family members after the loss were also interviewed. Unique grief experiences were identified, and eight common themes emerged, reflecting the ways in which family members maintained their bond to the deceased: dreams, storytelling, keepsakes, sense of presence, faith-based connections, proximity connections, ongoing rituals, and pictorial remembrances. The cultural implications of family bereavement are highlighted.     

Relations among mothers' expressivity, children's effortful control, and their problem behaviors: a four-year longitudinal study

Longitudinal relations between mothers' expressivity, children's effortful control, and their problem behaviors were examined when children (N = 181) were 6.5-10 years old (T2) and again 2 (T3) and 4 (T4) years later. Mothers reported on their expression of positive and negative dominant emotion. Mothers and teachers reported on children's effortful control and externalizing and internalizing problem behaviors. In structural equation models, variables exhibited consistency over time. Further, the relation between mothers' expressivity (positive minus negative dominant emotion) at T2 and children's externalizing problems at T4 was mediated by T3 effortful control. The same process of mediation was significant for teacher- but not mother-reported internalizing problems. The results provide one explanation for how emotion-related socializing behaviors influence children's problem behaviors.     

Working models of attachment and attribution processes in intimate relationships

Two studies examined the link between working models of attachment and social construal processes in romantic relationships. In Study 1, individuals high in attachment-related anxiety responded to hypothetical partner transgressions by endorsing relationship-threatening attributions, experiencing emotional distress, and endorsing behavioral intentions that were likely to result in conflict. These effects emerged after controlling for pessimistic explanatory style, depressed mood, and self-esteem. In addition, the association between anxiety and emotional distress was mediated by attributions and attachment-related needs. In Study 2, anxious individuals endorsed relationship-threatening attributions for their partner's transgressions but less so for their partner's positive behaviors, and these effects occurred primarily among those in unhappy relationships. In contrast, avoidant individuals endorsed pessimistic attributions for their partner's positive behavior but less so for their partner's transgressions, and these effects occurred regardless of their level of relationship satisfaction.     

Age differences in fluid intelligence: contributions of general slowing and frontal decline

The current study examined the contributions of general slowing and frontal decline to age differences in fluid intelligence. Participants aged 20-89 years completed Block Design, Matrix Reasoning, simple reaction time, choice reaction time, Wisconsin Card Sorting, and Tower of London tasks. Age-related declines in fluid intelligence, speed of processing, and frontal function were observed. Hierarchical regression analyses showed that the processing speed and frontal function measures accounted for significant variance in fluid intelligence performance, but there was also a residual effect of age after controlling for each variable individually as well as both variables. An additional analysis showed that the variance in fluid intelligence that was attributable to processing speed was not fully shared with the variance attributable to frontal function. These findings suggest that the age-related decline in fluid intelligence is due to general slowing and frontal decline, as well as other unidentified factors.