Development of a Communication Aid to Facilitate Risk Communication in Consultations with Unaffected Women from High Risk Breast Cancer Families: A Pilot Study

The literature on risk perception in women from high-risk breast cancer families reveals persistent over-estimation of risk, even after counseling. In this study, a communication aid was designed to facilitate discussion of risk between clinical geneticists and genetic counselors and women from this high-risk population. Method: Stage 1. The aid was developed by an expert panel of clinical geneticists, genetic counselors, psychologists, an epidemiologist, an oncologist, linguists and a consumer. It was guided by the international literature on risk communication and a large multi-centre Australian study of risk communication. The 13 page full-color communication aid used varying formats of words, numbers, graphs and pie-charts to address (a) the woman’s subjective risk; (b) the population risk of breast cancer; c) the risk of inherited breast cancer; (d) the cumulative risk for women with BRCA1 and BRCA2 mutations; (e) family risk factors; (f) the woman’s suitability for genetic testing; (h) screening and management recommendations, and (i) a re-assessment of the woman’s subjective risk. Stage 2: A before–after pilot study of 38 women who were unaffected with breast cancer and were attending four Australian familial cancer clinics was undertaken. Baseline and follow-up questionnaires were completed by 27 women. Outcomes were compared to those observed in 107 similar women undergoing genetic counseling without the communication aid in 2001. Results: The risk communication aid appears to be beneficial; breast cancer genetics knowledge improved in some areas and importantly, risk perceptions improved in the cohort receiving the communication aid. Psychological measures showed no difference in anxiety or depression between the group receiving the communication aid and the comparison cohort. Women and clinicians were very positive about the usefulness of the communication aid as an adjunct to the genetic counseling consultation.     

Ethics, biotechnology, and global health: the development of vaccines in transgenic plants

As compared with conventional vaccine production systems, plant-made vaccines (PMVs) are said to enjoy a range of advantages including cost of production and ease of storage for distribution in developing countries. In this article, we introduce the science of PMV production, and address ethical issues associated with development and clinical testing of PMVs within three interrelated domains: PMVs as transgenic plants; PMVs as clinical research materials; and PMVs as agents of global health. We present three conclusions: first, while many of the ethical issues raised by PMVs are familiar, PMVs add a new dimension to old issues, and raise some novel issues for ethicists and policy-makers; secondly, it is premature to promise broad applicability of PMVs across the developing world without having demonstrated their feasibility; thirdly, in particular, proponents of PMVs as a solution to global health problems must, as a condition of the ethical conduct of their research, define the commercial feasibility of PMVs for distribution in the developing world.     

Predictors of suicidal ideation among "at risk" cocaine-using African American women

The focus of this study was to identify factors that differentiate women drug abusers who had experienced suicidal ideation from those who did not. Face-to-face interviews were conducted with 221 cocaine-using women in Atlanta, GA, 88 (39.8%) of whom reported thinking about committing suicide at least once during the 90 days prior to interview and 133 (60.2%) of whom did not. Multivariate logistic regression was used to identify predictors of suicidal ideation, and post hoc goodness-of-fit tests were conducted to assess the robustness of final models derived. Model 1 excluded all psychosocial functioning measures and Model 2 included these items. Both models showed that suicidal ideation was more common among women who were unemployed, had been abused sexually, engaged in sexual relations to cope with stresses, or had less helpful relatives. In addition, Model 1 revealed a heightened risk for women experiencing financial problems and those who had a previous mental health diagnosis, whereas Model 2 showed an elevated risk among women who experienced anxiety and those who had lower levels of self-esteem. These findings suggest the need for prevention and intervention programs that target at-risk women, and for such programs to include an emphasis on suicidal ideation in addition to focusing on risk factors that are addressed more commonly.     

Notes on Diversity and Working Together Across Cultures on Traumatization and Forgiveness: Siblings by Choice

The article addresses problems of severe collective traumatization by wars and discrimination not only for victims and perpetrators but also for the generations of children, nephews, and grandchildren. Two historical processes are exemplified in biographical experiences, slavery and oppression of African-American families, and the effects of Nazi ideology and World War II on German and Czech population. Aspects of forgiveness and healing are presented and discussed. One model of dissolving collective animosity and denial is explored in the intentional cooperation of caregivers and trainers in pastoral care and counseling from different cultures and religious traditions: siblings in struggle, siblings by choice.     

The influence of gender,social roles,and facial appearance on perceived emotionality

One of the most pervasive gender stereotypes in Western culture concerns expectations regarding men's and women's emotionality. Whereas men are expected to be anger prone, women are expected to smile more. At the same time, men are generally perceived as more facially dominant and facially dominant individuals are expected to show more anger. That is, both facial appearance and social role expectations would lead observers to expect men to show more anger. The present research had the goal to disentangle the unique contribution of these two factors. As it is impossible in our society to fully untangle the influence of these factors since they are highly confounded, we created an alien society where these factors could be unconfounded. In this alien world, Deluvia, child rearing is exclusively assumed by a third gender, the caregiver, whereas men and women share the same social roles. The facial appearance of the Deluvians was varied along the dominance continuum. The results showed that facially dominant Deluvians, regardless of gender, were expected to show more anger, disgust, and contempt and less happiness, fear, sadness, and surprise. Also, the nurturing caregivers were expected to show less anger, contempt, and disgust as well as more fear, sadness, and surprise, regardless of facial appearance. No effect of gender per se on perceived emotionality was found. Copyright © 2009 John Wiley & Sons, Ltd.     

Examining the Dynamics of the Implicit and the Explicit Self-Concept in Social Anxiety: Changes in the Implicit Association Test–Anxiety and the Social Phobia Anxiety Inventory Following Treatment

Data from the first two childhood memories was used to distinguish 15 delinquents from 18 nondelinquent controls. Subjects were male, middle class, 15-17 years of age, and equated for verbal IQ. All delinquents were property offenders. A coding system, devised from the memories of the delinquents and nondelinquents, successfully identified 80% of the delinquents and 100% of the nondelinquents. These prediction rates exceeded those from three clinicians experienced in working with a comparable delinquent population The coding system was then discussed in terms of the axioms and presuppositions which are suggested by the memories of the delinquent sample.     

Collecting Informed Consent with Juvenile Justice Populations: Issues and Implications for Research

Researchers must provide participants with opportunities to make informed decisions about whether to participate in research studies. Investigators conducting research with youth in the juvenile justice system face unique ethical, legal, and practical challenges to obtaining informed consent. Juvenile justice researchers must navigate multiple legal and ethical standards for collecting informed consent, take into account youths’ dual vulnerabilities as children and prisoners, and overcome practical limitations to obtaining parental/guardian permission. Given the challenges and complexity of obtaining standard informed consent of youth in juvenile justice facilities, this paper provides suggestions for overcoming obstacles to recruiting these youth for research participation. It offers guidance for fostering the enrollment of juvenile justice youth in research studies using procedures that comply with ethical and legal standards for research with this dually vulnerable population. Copyright © 2013 John Wiley & Sons, Ltd.