Results of an Intervention for Individuals and Families with <Emphasis Type="Italic">BRCA</Emphasis> Mutations: A Model for Providing Medical Updates and Psychosocial Support Following Genetic Testing

Providing medical management updates and long-term support to families with hereditary cancer syndromes in rural areas is a challenge. To address this, we designed a one-day retreat for BRCA1/2 carriers in our region. The retreat included educational updates about medical management, genetic privacy and discrimination, and addressed psychological and family issues. Evaluations completed at the conclusion of the retreat were overwhelmingly positive with requests for a similar event in the future. The impact of this retreat on a variety of health behaviors was assessed. Eligible participants completed questionnaires before and 6 months after the retreat. Questionnaires focused on lifestyle, cancer screening and prevention practices, psychological history and distress, decision-making regarding genetic testing, and family communication issues. For individuals who completed both the pre and post retreat questionnaires, one-half made lifestyle changes and nearly two-thirds increased cancer screening, initiated chemoprevention, completed or planned to complete preventative surgery in the future. We conclude that this type of forum provides a valuable opportunity for BRCA carriers and their families to receive updated medical information, share personal experiences, provide and receive support, as well as change health behaviors.     

Clinical Characterization and Risk Profile of Individuals Seeking Genetic Counseling for Hereditary Breast Cancer in Brazil

Hereditary breast cancer (HBC) accounts for 5–10% of breast cancer cases and it significantly increases the lifetime risk of cancer. Our objective was to evaluate the sociodemographic variables, family history of cancer, breast cancer (BC) screening practices and the risk profile of cancer affected or asymptomatic at-risk women that undergo genetic counseling for hereditary breast cancer in public Brazilian cancer genetics services. Estimated lifetime risk of BC was calculated for asymptomatic women using the Gail and Claus models. The majority of women showed a moderate lifetime risk of developing BC, with an average risk of 19.7% and 19.9% by the Gail and Claus models, respectively. The average prior probability of carrying a BRCA1/2 gene mutation was 16.7% and overall only 32% fulfilled criteria for a hereditary breast cancer syndrome as assessed by family history. We conclude that a significant number of individuals at high-risk for HBC syndromes may not have access to the benefits of cancer genetic counseling in these centers. Contributing factors may include insufficient training of healthcare professionals, disinformation of cancer patients; difficult access to genetic testing and/or resistance in seeking such services. The identification and understanding of these barriers is essential to develop specific strategies to effectively achieve cancer risk reduction in this and other countries were clinical cancer genetics is not yet fully established.     

Living with Multiple Endocrine Neoplasia Type 1: Decent Care-Insufficient Medical and Genetic Information A Qualitative Study of MEN 1 Patients in a Swedish Hospital

This qualitative study explores how 29 Swedish patients with Multiple Endocrine Neoplasia type 1 (MEN1) experience living with the condition, appraisal of the clinical follow-up program, and surveys their future expectations. The aim of this study is to build knowledge about this patient group in order to provide optimal care. The participants describe physical, psychological, and social limitations in their daily activities and how these limitations influence quality of life. Our findings indicate that a majority of patients have adjusted to their situation, describing themselves as being healthy despite physical symptoms and treatment. The participants received decent care in the clinical follow-up program, - however, greater effort should be put into patient information. These patients might benefit from genetic counseling. Health professionals involved should recognize their potential impact and influence on a patient’s ability to adjust to these circumstances. Antonovsky`s Sense of Coherence theory is used to discuss these findings.     

The Influence of Cancer-related Distress and Sense of Coherence on Anxiety and Depression in Patients with Hereditary Cancer

This study examines the association between Sense of Coherence and anxiety and depression amongst patients at risk of hereditary cancer receiving genetic counseling. When writing this article, 144 patients referred for genetic counseling due to a suspicion of hereditary cancer in the family were recruited for this multicentered longitudinal study on the psychosocial aspects of genetic counseling in Norway. A total of 96 (66%) patients responded to the follow-up survey distributed 6 months after genetic counseling. This survey included the Sense of Coherence-29 Scale, Impact of Event Scale, and Hospital Anxiety and Depression Scale. Multiple regression analyses were applied. Our results show association between cancer-related distress and symptoms of anxiety and depression. Sense of Coherence is significantly associated with both anxiety and depression. The hypothesis of Sense of Coherence buffering cancer-related distress and the possible impact of these findings for genetic counseling are discussed.     

School‐based integrated and segregated interventions to reduce aggression

The goal of the study was to assess two types of school‐based interventions—a class intervention (integrated) and a small group counseling (segregated) intervention for highly aggressive children—and to determine which is more efficacious in reducing individual and classroom aggression, lessening internalizing and externalizing behavior, and increasing positive classroom relationships. The study, conducted in Israel, included 904 children from 13 schools. In each school, one age level was selected and divided randomly into three experimental conditions: psychoeducational class intervention, small group counseling, and control. In all classrooms, the highly aggressive children were identified a priori (n=166). Analyses were conducted separately for the aggressive children and their nonaggressive classmates, in a nested procedure (mixed models). Results showed similar positive outcomes on all variables in both treatment groups, and higher compared with the control group. The discussion focuses on the strengths of each type of intervention. Aggr. Behav. 35:342–356, 2009. © 2009 Wiley‐Liss, Inc.     

病理性使用互联网的界定与测量

病理性使用互联网（Pathological Internet Use,PIU）是人在互联网使用过程中出现的一种新型心理疾病。很多研究者认为互联网使用过度或不当是病理性使用互联网的主要原因。该文对病理性使用互联网已有研究的概念的界定与测量问题进行了分析与整合,讨论了在中国社会文化背景下如何界定与测量病理性使用互联网。     

焦点解决短期心理咨询原理与技术述评

焦点解决短期心理咨询是近年来形成并在世界范围内迅速崛起的一个短期咨询学派,它是一种以正向目标解决导向的咨询模式。该文介绍了焦点解决短期心理咨询模式的起源背景及此模式的基本原理与技术,并对其作了简要评价。     

Qualitative Cancer Genetic Counseling Research, Part II: Findings from a Exploratory Ethnographic Study in a Cancer Clinic

This is a report of the preliminary findings of a brief exploratory ethnographic study in a cancer diagnosis and treatment clinic. The main research purpose was to explore the meaning of cancer and cancer treatment to patients themselves and to their relatives and close friends. The methods are described in detail in a paper focusing on the experiences of being a novice ethnographer (Peters et al. (2001) J Genet Counsel 10(2):133–150.). The preliminary results of this exploratory fieldwork indicate that the experience of attending a cancer treatment clinic for evaluation and/or treatment is a complex social, emotional as well as medical process for patients and families. Themes with relevance to genetic counselors that emerged from this early observation period included ideas about causes of cancer, the complex nature of families and kinship, coping and support, use of food, and healing. These initial findings have implications for genetic counseling practice and hopefully will stimulate more qualitative social and behavioral research in cancer genetic counseling.     

非严重遗传病产前诊断及PGT的伦理思考

随着近年基因诊断技术的飞速发展,出现了要求通过产前诊断或胚胎植入前遗传学检测（preimplantation genetic testing,PGT）技术阻断某些非严重遗传病在家族中传递的新需求。从非严重遗传病定义,目前产前诊断及PGT技术发展现状、适应证及各自本身存在的伦理问题,遗传咨询原则等进行阐述,并以白化病和成人多囊肾为例,讨论遗传咨询医师应该如何根据国情、现行法律以及伦理原则对这类患者进行知情同意并实现医患共同决策。呼吁国家组织专家探讨共识,明确相关规定,遵循相关医学伦理学原则。     

对心理咨询中价值干预问题的理性思考

对价值问题的处理是心理咨询中的重要哲学命题。人本主义心理学所遵循的“价值中立”原则,是心理咨询中回避价值干预的根源所在。通过对心理咨询理论的整体审视,提出不能简单地把价值中立原则拓展到整个心理咨询之中,不能忽视心理咨询的教育功能和社会责任,纯粹的“价值中立”是无法实现的。