Acceptability of,and Information Needs Regarding,Next-Generation Sequencing in People Tested for Hereditary Cancer: A Qualitative Study

Next generation sequencing (NGS) for patients at risk of hereditary cancer syndromes can also identify non-cancer related mutations, as well as variants of unknown significance. This study aimed to determine what benefits and shortcomings patients perceive in relation to NGS, as well as their interest and information preferences in regards to such testing. Eligible patients had previously received inconclusive results from clinical mutation testing for cancer susceptibility. Semi-structured telephone interviews were subjected to qualitative analysis guided by the approach developed by Miles and Huberman. The majority of the 19 participants reported they would be interested in panel/genomic testing. Advantages identified included that it would enable better preparation and allow implementation of individualized preventative strategies, with few disadvantages mentioned. Almost all participants said they would want all results, not just those related to their previous diagnosis. Participants felt that a face-to-face discussion supplemented by an information booklet would be the best way to convey information and achieve informed consent. All participants wanted their information stored and reviewed in accordance with new developments. Although the findings indicate strong interest among these individuals, it seems that the consent process, and the interpretation and communication of results will be areas that will require revision to meet the needs of patients.     

Reproductive Health CHOICES for Young Adults with Sickle Cell Disease or Trait: Randomized Controlled Trial Outcomes over Two Years

Interventions to assist reproductive health decision-making in populations affected by sickle cell disease (SCD) or trait (SCT) lack proven efficacy over time. Our aim was to compare effects of CHOICES, a Web-based multimedia education program on implementing informed reproductive plans, and usual care education (e-Book) on reproductive knowledge, intention, and behavior over 24 months. We randomized 234 participants with SCD (n?=?138) or SCT (n?=?96) (age 18–35 years, 35 % male, 94 % African American) to CHOICES and e-Book groups. Participants completed a sickle cell-specific reproductive measure before and four times after the intervention (6, 12, 18 and 24 months). Compared to the e-Book group the CHOICES group had significantly more improvement in knowledge over time (p?=?.004) but not intention (p?=?.18) or behavior (p?=?.69). At baseline, 114 (48.7 %) participants reported having partners who would not put the couple at risk for their children inheriting SCD. Of the 116 (49.6 %) at-risk participants, a higher poroportion of those who were in the CHOICES group chose partners that reduced their risk by the last visit than the e-Book group (p?=?.04). Study findings provide important insights for designing a national trial of the CHOICES intervention focusing on subjects whose partner status puts them at risk for having a child with SCD.     

Virtually Perfect: Image Retouching and Adolescent Body Image

Most studies of ideal-body media effects on body image focus on the extreme thinness of the models, not their idealness. In modern media, this idealness is often created or maximized via digital image editing. This experiment tested the effects of image editing outside the research-typical context of exclusive thinness. Original unretouched photographs were manipulated by a professional retoucher to produce unretouched and retouched image conditions. In a third condition (retouched-aware), the retouched images were explicitly labeled as retouched. Adolescents ( N = 393, average age 15.43) were randomly assigned to one of these conditions or a no-exposure control, and they completed a questionnaire following exposure. Objectified body consciousness increased and physical self-esteem decreased among male and female adolescents in the retouched-aware condition only. This boomerang effect of retouching awareness is explored in the discussion.     

Preferences Regarding Targeted Education and Risk Assessment in People with a Family History of Major Depressive Disorder

Genetic testing for susceptibility to major depressive disorder (MDD) is not available for clinical use at present. Given this, family history remains the best predictor for development of MDD, and family-history-based risk assessment and information about familial aspects of MDD may be useful to clients at increased risk for MDD attending for genetic counseling. This study uses a mixed-methods design to assess the information needs and preferences of people at increased familial risk for MDD. Telephone interviews were conducted with 23 individuals, who had at least one first-degree relative with MDD and were recruited through advertisements placed on depression education websites. The most preferred way to access depression information was via the internet (87 % of participants), although this preference may have been due to the internet-based recruitment method. The second most preferred dissemination strategy (56 %) was face-to-face delivery through a health professional, including genetic counselors. Individuals reported a need for information about etiology and development of MDD, reproductive decision-making, early detection of symptoms and risk-reducing strategies. Nearly all participants expressed an interest in risk assessment. The present study found evidence of a high level of interest for information targeted to people at increased familial risk for MDD. Genetic counselors are likely to be called upon increasingly to provide supportive counseling to assist clients at increased familial risk in interpreting and contextualizing such information once it becomes available.     

FROM PRIMARY MATERNAL PREOCCUPATION TO DEAD MOTHER*

Ferenczi (1929) writes about the unwelcome child who is not ushered into this world with care and grows up in the grip of the death instinct, with a depressive streak and a weakness in the capacity for life. Andre Green’s (1986) concept of the dead mother describes a similar phenomenon, by which the image of a loving mother is transformed into an inanimate, dead parent. The absent mother becomes the negative, which will then take up a central position in the child’s psyche. Winnicott (1956) describes a different maternal participation, and proposes that towards the end of her pregnancy the ordinary devoted mother develops a psychological condition which he calls primary maternal preoccupation, the main feature of which is the mother’s heightened attunement to her baby at the expense of all else. I suggest that there is a potent and clinically relevant connection among these concepts: a depressed or damaged mother can still provide temporary devotion before reverting back to a state of depressive absence and that, conversely, even the devoted mother will eventually recover from the state of primary maternal preoccupation and begin to tend to other matters, and the mother’s reclaiming herself can be traumatic for the child even under the best of circumstances. The connection among these concepts is illustrated with clinical material, including transference and countertransference implications, from the treatment of a young woman who grew up as an unwelcome child.     

The practice of speleology: What is its relationship with spatial abilities?

Cognitive Processing - Given the evidence of motor and exploring activities being related to spatial abilities on different scales, the present study considers the case of speleology, a peculiar...     

A new approach to assessing optimism: the development of a german version of the positive and negative expectancies questionnaire (paneq-g)

This study describes the construction and validation of a German version of the Positive and Negative Expectancies Scale, PANEQ-G, which is based on the original English version of the PANEQ. The German version showed the same factor structure as the original, comprising the three subscales of Negative Affectivity/Pessimism, Positive Affectivity/Optimism, and Fighting Spirit. The reliability data for the new scale were acceptable, and the factor structure was confirmed by means of a confirmatory factor analysis in an independent sample. As expected, concurrent validation uncovered substantial correlations of the three established scales. Negative Affectivity/Pessimism was related to Neuroticism and Positive Affectivity/Optimism was related to Extraversion. Fighting Spirit, the third scale, was related to Self-Efficacy and Conscientiousness. The PANEQ-G provides a reliable and valid instrument that can be used in conjunction with the original PANEQ for cross-cultural studies on Optimism and Pessimism. It also offers a new third component, Fighting Spirit, which can enrich research in this area.     

A client‐generated psychometric instrument: The development of ‘PSYCHLOPS’

PSYCHLOPS (Psychological Outcome Profiles) is a recently developed, client‐generated, psychometric instrument that can be used as an outcome measure. Based on a similar instrument developed primarily for use in physical illnesses (MYMOP — ‘Measure Your Medical Outcome Profile’), it seeks the client's perspective on their psychological distress. It asks them to describe and then score the problem that troubles them the most at the start of counselling. We describe the development of PSYCHLOPS, including the involvement of the Plain English Campaign and two national mental health organisations: the mental health charity and support group, Depression Alliance (DA) and Primary Care Mental Health Education (PRIMHE). We review the literature and suggest that PSYCHLOPS, by focusing on the problems of greatest priority to the client, might prove a sensitive measure of improvement after counselling.