An Assessment of Genetic Counseling Services for Individuals with Multiple Sclerosis

Multiple sclerosis (MS) affects up to 1/500 Canadians. The University of British Columbia MS Clinic (UBC Clinic) is the only MS clinic in Canada (and likely internationally) that routinely offers genetic counseling to patients and their families. A typical session includes the collection of family history and demographic data, discussion of the inheritance of MS, interpretation of family-specific recurrence risks and psychosocial counseling. The aims of this study were to explore patients’: 1) expectations of the genetic counseling session; 2) understanding of the etiology of MS (both pre and post-session); and 3) post-session perceptions of genetic counseling. A two-part questionnaire to assess genetic counseling services was distributed before and after sessions to all consenting patients seen during the period October 1, 2008 to February 28, 2009 inclusive. Sixty-two completed questionnaires were analysed. Genetic counseling was found to significantly increase the number of individuals who were able to correctly identify the etiology of MS (p?<?0.001). Patient satisfaction with genetic counseling was high, with an average satisfaction score of 32.4/35 (92.6 %). Of those who provided comments (n?=?42/60) regarding the usefulness of the genetic counseling session, 95.2 % reported it useful (n?=?40/42). Findings suggest that genetic counseling is effective in increasing patients’ knowledge of the etiology of MS and is viewed by patients as a useful service. Based on the high level of positive feedback regarding genetic counseling by the study sample, this study suggests that the services provided by genetic counselors may be beneficial for patients with MS seen in other centers.     

Using Creative Techniques With Children Who Have Experienced Trauma

Verbal and emotional forms of expression can be difficult for young children who have experienced trauma. Creative methods and approaches such as puppets, sandtray, letter writing, and art are therapeutic mediums that provide an outlet for a young client’s story of trauma to be told. Children can use puppets to depersonalize and share feelings with a counselor that would provide insight into their coping strategies. Similarly, sandtray is another nonverbal approach that gives children the opportunity to externalize their feelings safely and can be easily used with extroverted and introverted clients. Letter writing and art can empower children and give them hope for the future. In summary, creative techniques can allow counselors to help explore stories of trauma with young clients.     

The Genetic Counselor in the Pediatric Arrhythmia Clinic: Review and Assessment of Services

There are minimal data on the impact of genetic counselors in subspecialty clinics, including the pediatric arrhythmia clinic. This study aimed to describe the clinical encounters of a genetic counselor integrated into a pediatric arrhythmia clinic. In the 20 months between July 2015 and February 2017, a total of 1914 scheduled patients were screened for indications relevant for assessment by a genetic counselor. Of these, the genetic counselor completed 276 patient encounters, seeing 14.4% of all patients in clinic. The most expected and common indications for genetic counselor involvement were related to suspicion for primary heritable arrhythmia conditions, though patients seen in this clinic display a wide range of cardiac problems and many additional indications for genetic evaluation were identified. Roughly 75% (211/276) of encounters were for personal history of confirmed/suspected heritable disease, including cardiac channelopathies, cardiomyopathies, ventricular arrhythmias, and congenital heart defects, and 25% (65/276) were for family history of disease, including long QT syndrome and sudden unexplained death. Overall, this study shows that about 1 in 7 patients seen in a pediatric arrhythmia clinic have indications that likely benefit from genetic counselor involvement and care. Similar service delivery models embedding genetic counselors in pediatric arrhythmia clinics should be encouraged, and this model could be emulated to increase patient access to genetic counseling services.     

Peer support critical elements and experiences in supporting the homeless: A qualitative study

Peer supporters are individuals with lived experience and are an integral part of health care systems, providing support to those affected by various phenomena such as homelessness and addictions. However, little is known about the critical elements that underpin peer support interventions. This qualitative study sought to understand the critical elements of intentional peer support with a homeless population, voiced by those who provide and/or receive this support. Twenty‐nine participants from 4 different homeless charities in England were interviewed about their experiences of providing/receiving peer support and what they felt were critical factors to its success. Participants defined peer support as an experience‐based relationship, built upon mutual understanding, empathy, and support. Thematic analysis was utilised to in developing 6 themes. Results identified peers' persistence in developing unique experience‐based relationships, providing social support, role modelling recovery, and peers' motivations were perceived as important factors involved in peer support. It was also found that peers described benefitting from helping, such as, undergoing transformative identity developments that helped them to escape homelessness. Through the retelling of their stories, they create meaning and restructure their autobiography, attributing experiences of homelessness as a catalyst for positive changes in their lives. Limitations and future research are discussed.     

Conceptions of identity: the challenge of sexual fluidity to Christian notions of marriage

ABSTRACT

In this paper, I consider the concept of identity as foundational to the heteronormative constructions of marriage manifesting in Christian interpretations of the institution. In an attempt to destabilize what I consider the congealing function of identity, I examine current research on sexuality fluidity emerging from Lisa Diamond’s work. I argue that the evidence of sexual fluidity in women challenges stable identity markers characteristic of marriage conceived of within the male–female binary. Sexual fluidity, thus, ultimately disrupts heteronormative claims of Christian marriage.     

Seven‐year‐olds’ aggressive choices in a computer game can be predicted in infancy

Concerns about the relationship between computer games and children's aggression have been expressed for decades, but it is not yet clear whether the content of such games evokes aggression or a prior history of aggression promotes children's interest in aggressive games. Two hundred and sixty‐six 7‐year‐old children from a nationally representative longitudinal sample in the UK played a novel computer game (CAMGAME) in which the child's avatar encountered a series of social challenges that might evoke aggressive, prosocial or neutral behaviour. Aggressive choices during the game were predicted by well‐known risk factors for aggressive conduct problems and the children's own early angry aggressiveness as infants. These findings suggest that children who are predisposed to aggression bring those tendencies to virtual as well as real environments.     

Are there age differences in attention to emotional images following a sad mood induction? Evidence from a free-viewing eye-tracking paradigm

Two experiments examined age differences in the effect of a sad mood induction (MI) on attention to emotional images. Younger and older adults viewed sets of four images while their eye gaze was tracked throughout an 8-s presentation. Images were viewed before and after a sad MI to assess the effect of a sad mood on attention to positive and negative scenes. Younger and older adults exhibited positively biased attention after the sad MI, significantly increasing their attention to positive images, with no evidence of an age difference in either experiment. A test of participants’ recognition memory for the images indicated that the sad MI reduced memory accuracy for sad images for younger and older adults. The results suggest that heightened attention to positive images following a sad MI reflects an affect regulation strategy related to mood repair. The implications for theories of the positivity effect are discussed.     

Traveling Without a Destination? A Dialogical Analysis of Professional Identity Construction Among Australian Double Degree Psychology Students

This paper presents findings from a study of Australian double degree psychology students’ construction of professional identity. Dialogical self theory was used as a framework to conceptualize professional identity construction and to identify the I-positions, the voices of others, and the relationships between these voices within the self. Results revealed that conflicting voices were heard within the self, creating tensions in students’ professional identification. Moreover, it seems that when trying to navigate their study journeys, students rely on several, sometimes unintentional, value orientations to assist them in moving forward from these struggles. Findings are considered in the context of further developing dialogical self theory and the enhancement of curricula that focus on multiprofessional and interdisciplinary learning and teaching.     

Working memory deficits in boys with attention deficit/hyperactivity disorder (ADHD): An examination of orthographic coding and episodic buffer processes

The episodic buffer component of working memory was examined in children with attention deficit/hyperactivity disorder (ADHD) and typically developing peers (TD). Thirty-two children (ADHD = 16, TD = 16) completed three versions of a phonological working memory task that varied with regard to stimulus presentation modality (auditory, visual, or dual auditory and visual), as well as a visuospatial task. Children with ADHD experienced the largest magnitude working memory deficits when phonological stimuli were presented via a unimodal, auditory format. Their performance improved during visual and dual modality conditions but remained significantly below the performance of children in the TD group. In contrast, the TD group did not exhibit performance differences between the auditory- and visual-phonological conditions but recalled significantly more stimuli during the dual-phonological condition. Furthermore, relative to TD children, children with ADHD recalled disproportionately fewer phonological stimuli as set sizes increased, regardless of presentation modality. Finally, an examination of working memory components indicated that the largest magnitude between-group difference was associated with the central executive. Collectively, these findings suggest that ADHD-related working memory deficits reflect a combination of impaired central executive and phonological storage/rehearsal processes, as well as an impaired ability to benefit from bound multimodal information processed by the episodic buffer.