Prenatal Testing for Adult-Onset Conditions: the Position of the National Society of Genetic Counselors

Advances in genetic testing and the availability of such testing in pregnancy allows prospective parents to test their future child for adult-onset conditions. This ability raises several complex ethical issues. Prospective parents have reproductive rights to obtain information about their fetus. This information may or may not alter pregnancy management. These rights can be in conflict with the rights of the future individual, who will be denied the right to elect or decline testing. This paper highlights the complexity of these issues, details discussions that went into the National Society of Genetic Counselors (NSGC) Public Policy Task Force’s development of the Prenatal testing for Adult-Onset Conditions position statement adopted in November 2014, and cites relevant literature on this topic through December 2015. Issues addressed include parental rights and autonomy, rights of the future child, the right not to know, possible adverse effects on childhood and the need for genetic counseling. This paper will serve as a reference to genetic counselors and healthcare professionals when faced with this situation in clinical practice.     

“Heartbreaking” Referrals,Professional “Disgrace”: The Impact of Medicare Ineligibility on the Counseling Profession

To better understand the impact of the Medicare mental health coverage gap, the authors analyzed survey data provided by 1,859 members of the American Counseling Association using a conventional qualitative content analysis. One overarching theme, direct impact of Medicare policy on the counseling profession, is presented, along with 3 thematic categories: emotional impact on providers, economic toll on providers, and negative influence on profession's credibility. Implications for the counseling profession are discussed.     

Homeless Adults’ Recovery Experiences in Housing First and Traditional Services Programs in Seven European Countries

Across Europe, as governments turn to housing-led strategies in attempts to reverse rising rates of homelessness, increasing numbers of Housing First (HF) programs are being implemented. As HF programs become more widespread, it is important to understand how service users experience them compared to the more prevalent traditional treatment-first approach to addressing long-term homelessness. Although there is a large body of research on service users’ experiences of Housing First compared to treatment-first in North American contexts, comparatively less is known about how these two categories of homeless services are experienced in the European context. In a correlational and cross-sectional study, part of a larger examination of homelessness in Europe, participants (n = 520) engaged with either HF (n = 245) or traditional services (TS; n = 275) programs in seven countries completed measures of their experiences of services (consumer choice, housing quality, and service satisfaction) and recovery (time in independent housing, psychiatric symptoms, and community integration). Across the seven countries, participants engaged with HF programs reported experiencing more consumer choice, better perceived housing quality, and more satisfaction with services than participants engaged in TS programs. Participants in HF programs also reported a greater proportion of time in independent accommodation, fewer psychiatric symptoms, and more community integration. Varying patterns of association between experiences of services and recovery outcomes were observed. Findings indicate HF consistently predicts greater recovery than TS across diverse sociopolitical and economic contexts. Implications of findings for configurations of homeless services and homeless services policy are discussed.     

Parent training for children with pervasive developmental disorders: a multi‐site feasibility trial

The primary purpose of this study was to evaluate the feasibility of a structured, manual‐based parent training (PT) program designed to reduce noncompliant behavior and enhance adaptive behavior in children with Pervasive Developmental Disorders (PDD) who were taking medication for irritability, tantrums, aggression, and self‐injury. Children (N = 17, mean age 7.7 ± 2.6 years) with PDD were enrolled in a 24‐week structured PT protocol. Parental attendance to sessions (93%), satisfaction with the program (92%), and adherence to PT assignments (80%) were excellent. The program was adequately implemented with a mean treatment integrity rate of 94%. Parent‐reported rates of noncompliance were reduced by 39%; irritability was reduced by 34%; and daily living skills were enhanced by 19%. Parenting stress was also reduced by 14%. However, these results must be interpreted with caution because the study did not include a control group. The study supports feasibility of the PT program, which will be used in an randomized clinical trials (RCT). Copyright © 2007 John Wiley & Sons, Ltd.     

Opinions of personality disorder experts regarding the DSM-IV personality disorders classification system

OBJECTIVE: To survey the opinions of personality disorder (PD) experts on possible revisions in the classification system for PDs in the DSM-V. METHOD: Four hundred members of two international associations, the Association for Research on Personality Disorders, and the International Society for the Study of Personality Disorders, were asked to take a 78-item web survey. RESULTS: Of the experts who completed the survey (N = 96), 74% felt that the DSM-IV's categorical system of PD diagnosis should be replaced. Eighty percent felt that PDs are better conceived of as personality dimensions or illness spectra, than as categories. The most frequently endorsed alternative system for PDs was a mixed system of categories and dimensions. Most experts preferred the PDs to remain on Axis II. Only 31.3% wanted the term, "Borderline Personality Disorder," retained in the DSM-V. CONCLUSIONS: A clear majority of the PD experts were dissatisfied with the current diagnostic system for PDs.     

Fear of Failure Biases Affective and Attentional Responses to Lexical and Pictorial Stimuli

The purpose of this investigation was to examine whether attentional biases would be noticed among individuals differing in levels of fear of failure (FF) as they viewed pictorial and lexical stimuli depicting various affective content. Indices of natural selective attention, namely, viewing time and self-reported affect, were assessed in 137 college students during free viewing picture and word presentation conditions. As hypothesized, FF was (a) negatively associated with self-reported dominance and valence for failure- and unpleasant-themed stimuli, and (b) positively associated with arousal ratings for unpleasant pictures. Although initially suppressed by neuroticism, partial correlation coefficients revealed a significant positive relationship between FF and viewing time for failure pictures. Results are discussed in the context of current theories of emotional reactivity and attentional biases pertaining to the nature of FF. Recommendations are provided for future research to elaborate the mechanisms involved in detrimental effects of FF.     

Normativeness and individualism

Five experiments were conducted with a twofold aim: firstly, examine the normativeness of some important features of Western individualism, and secondly, determine what aspect of social value serves as the anchor for their potential normativeness. Five key constituents of individualism were studied. A questionnaire composed of five sub‐questionnaires was used, each one referring to an ‘individualistic’ constituent and to its opposing ‘collectivistic’ referent. Two main paradigms in the judgment‐norm approach were implemented, one implying self‐presentation strategies and the other implying social judgments. Together, the results revealed that only three constituents of individualism can be considered normative—self‐sufficiency, individual anchoring, and internality—and that one of the constituents—the primacy of individual goals—is not normative at all, and may be even counter‐normative. The results pointed out an individualistic pattern that is much less homogeneous than often assumed. Copyright © 2004 John Wiley & Sons, Ltd.     

医患互动与新生儿先天性HCMV感染的诊疗

在新生儿先天性巨细胞病毒感染的诊疗中,乃至儿科疾病的防治中,应注重调节好医患矛盾的两方面。医患双方处理好知情同意,避免诊疗中的医疗纠纷,对于建立积极主动的、和谐信任的医患互动模式非常重要。这也体现了双方对新生命的最大的珍惜和尊重。