Development and Pilot Testing of a Decision Aid for Genomic Research Participants Notified of Clinically Actionable Research Findings for Cancer Risk

Germline genomic testing is increasingly used in research to identify genetic causes of disease, including cancer. However, there is evidence that individuals who are notified of clinically actionable research findings have difficulty making informed decisions regarding uptake of genetic counseling for these findings. This study aimed to produce and pilot test a decision aid to assist participants in genomic research studies who are notified of clinically actionable research findings to make informed choices regarding uptake of genetic counseling. Development was guided by published literature, the International Patient Decision Aid Standards, and the expertise of a steering committee of clinicians, researchers, and consumers. Decision aid acceptability was assessed by self-report questionnaire. All 19 participants stated that the decision aid was easy to read, clearly presented, increased their understanding of the implications of taking up research findings, and would be helpful in decision-making. While low to moderate levels of distress/worry were reported after reading the booklet, a majority of participants also reported feeling reassured. All participants would recommend the booklet to others considering uptake of clinically actionable research findings. Results indicate the decision aid is acceptable to the target audience, with potential as a useful decision support tool for genomic research participants.     

HIV prevention with persons with mental health problems

The HIV seroprevalence rate among persons with mental health problems (PMHP) is substantially higher than that of the general population in the United States. This study examines the efficacy over 12 months of an HIV prevention program with 99 individuals attending outpatient mental health clinics who were randomly assigned to receive either: (a) a seven-session, small-group intervention of Project LIGHT (Living in Good Health Together); or (b) a one-session video intervention. Regression analyses of data from 87% of the sample interviewed at 1-year follow-up revealed that intervention group membership was associated with significantly fewer sexual risk acts. A significant intervention effect for condom use was found for 72% of the sample who were African American, but not for Latino or Caucasian participants. Results from this study suggest that HIV risk reduction groups such as Project LIGHT may have utility in public mental health care settings.     

Infant-mother attachment classification: risk and protection in relation to changing maternal caregiving quality

The relations between early infant-mother attachment and children's social competence and behavior problems during the preschool and early school-age period were examined in more than 1,000 children under conditions of decreasing, stable, and increasing maternal parenting quality. Infants' Strange Situation attachment classifications predicted mothers' reports of children's social competence and teachers' reports of externalizing and internalizing behaviors from preschool age through 1st grade. These relations appeared to be mediated by parenting quality; main effects of attachment classification disappeared when effects of parenting quality were controlled. Interactions were also observed. For example, when parenting quality improved over time, teachers rated children with insecure infant-mother attachments lower on externalizing behaviors; when parenting quality decreased, teachers rated insecure children higher on externalizing behaviors. In contrast, children classified as securely attached in infancy did not appear to be affected by declining or improving parenting quality.     

Child-care effect sizes for the NICHD Study of Early Child Care and Youth Development

This report summarizes findings from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development as effect sizes for exclusive maternal care and--for children in child care--type, quality, and quantity of care. Children (n = 1,261) were recruited at birth and assessed at 15, 24, 36, and 54 months. Exclusive maternal care did not predict child outcomes, but multiple features of child-care experience were modestly to moderately predictive. Higher quality child care was related to advanced cognitive, language, and preacademic outcomes at every age and better socioemotional and peer outcomes at some ages. More child-care hours predicted more behavior problems and conflict, according to care providers. More center-care time was related to higher cognitive and language scores and more problem and fewer prosocial behaviors, according to care providers. Child-care effect sizes are discussed from 3 perspectives: (a) absolute effect sizes, reflecting established guidelines; (b) relative effect sizes, comparing child-care and parenting effects; and (c) possible individual and collective implications for the large numbers of children experiencing child care.     

Frontolimbic neural circuitry at 6 months predicts individual differences in joint attention at 9 months

Elucidating the neural basis of joint attention in infancy promises to yield important insights into the development of language and social cognition, and directly informs developmental models of autism. We describe a new method for evaluating responding to joint attention performance in infancy that highlights the 9‐ to 10‐month period as a time interval of maximal individual differences. We then demonstrate that fractional anisotropy in the right uncinate fasciculus, a white matter fiber bundle connecting the amygdala to the ventral‐medial prefrontal cortex and anterior temporal pole, measured in 6‐month‐olds predicts individual differences in responding to joint attention at 9 months of age. The white matter microstructure of the right uncinate was not related to receptive language ability at 9 months. These findings suggest that the development of core nonverbal social communication skills in infancy is largely supported by preceding developments within right lateralized frontotemporal brain systems.     

The self-help clearinghouse concept: An evaluation of one program and its implications for policy and practice

Many clearinghouses have been organized within the last decade to promote mutual aid and to provide referral information about self-help groups to potential members. Few of the assumptions that underpin the operation of these programs have been evaluated, however. This paper presents an evaluation of the Self-Help Information Service, a clearinghouse integrated with a generic information and referral service. The results were generally positive with respect to operator and consumer satisfaction, community responsiveness, and the system's capacity to undertake numerous service and research functions. They also pointed up several changes that might be made to improve the system's impact. It is concluded that a new practice specialty might be developed within a clearinghouse context, and that the clearinghouse concept might serve as one cornerstone of a funding policy that supports the self-help approach.