If We Build It … Will They Come? – Establishing a Cancer Genetics Services Clinic for an Underserved Predominantly Latina Cohort

Background: Cancer genetic counseling and testing is a standard of care option for appropriate families and can identify individuals at increased risk prior to diagnosis, when prevention or detection strategies are most effective. Despite documented efficacy of cancer risk reduction in high-risk individuals, underserved and minority individuals have a disproportionate cancer burden and limited access to genetic counseling. Methods: A needs assessment survey documented gaps in knowledge and interest in prevention. Satellite clinics were established at two indigent healthcare systems. Cancer genetics CME lectures were conducted and referral guidelines disseminated to clinicians who referred patients for counseling. Results: An increase in clinician knowledge was demonstrated post-CME and reflected by quality referrals. Eighty-eight percent of patients kept their appointments. In the predominantly Latina⁶ (n=77) clinic population, 71.4% were affected with cancer, and 17 mutation positive families were identified. Preliminary data shows a positive impact on patients' motivation and behavior. The majority has expressed satisfaction and reduction in anxiety. Conclusions: This study demonstrates feasibility and acceptability of cancer genetics services in this population, suggesting the potential to reduce cancer morbidity in underserved, high-risk families.“Latino” is the most common census term for individuals of Spanish, Mexican, Central and South American, Cuban, or Puerto Rican descent, referring to ethnicity, and is generally considered a more ethnically/culturally based term for individuals of the aforementioned groups. As this cohort is female the feminine noun “Latina” is used     

A Qualitative Study of Health Professionals' Views Regarding Provision of Information About Health-Protective Behaviors During Genetic Consultation for Breast Cancer

This study aimed to explore health professionals' views and practice regarding the provision of information about health-protective behaviors (e.g., exercise, alcohol consumption, diet) during genetic consultation for breast cancer. Ten genetic counselors participated in three focus groups, and seven medical specialists were interviewed in a focus group or individually. Data was analyzed using the constant comparative method. Findings suggested that health professionals held differing, often opposing, views about the value of health-protective behaviors for women at increased risk of breast cancer. The content and extent of information provided about health-protective behaviors varied widely, and participants expressed a need to form consensus regarding information provision both within and across clinics. The main barriers to providing information regarding health-protective behaviors included the lack of research evidence regarding the impact of these factors and higher priority of other information need to be provided in the limited consultation time. Participants generally did not consider it their role to promote health-protective behaviors, and were concerned about the psychological impact of providing information about behavioral risk factors during genetic consultations.     

A Survey of Patients’ Experiences with the Cancer Genetic Counseling Process: Recommendations for Cancer Genetics Programs

In order to promote ongoing quality improvement of not only the Penn State Cancer Genetics Program, but also other cancer risk assessment programs throughout the country, we developed, piloted and conducted a survey to explore patient expectations, experiences, and satisfaction with the cancer genetic counseling process. The comprehensive survey was mailed to 340 eligible patients, 156 (45.9%) of whom returned the completed survey within the allotted time. Responses to closed-ended questions were tallied and open-ended questions were content analyzed. Major findings show that: (1) Patients were seeking cancer-related information and support throughout the cancer risk assessment process and were interested in participating in available research studies; (2) The setting in which patients are seen for cancer risk assessment may pose potential emotional ramifications; (3) Misperceptions regarding insurance discrimination and lack of insurance coverage persist; (4) Patients view the genetic counselor as responsible for updating them about new discoveries. Specific recommendations for cancer genetics programs are included.     

“More on Respect for Embryos and Potentiality: Does Respect for Embryos Entail Respect for In Vitro Embryos?”

It is commonly assumed that persons who hold abortions to be generally impermissible must, for the same reasons, be opposed to embryonic stem cell research [ESR]. Yet a settled position against abortion does not necessarily direct one to reject that research. The difference in potentiality between the embryos used in ESR and embryos discussed in the abortion debate can make ESR acceptable even if one holds that abortion is impermissible. With regard to their potentiality, in vitro embryos are here argued to be more morally similar to clonable somatic cells than they are to in vivo embryos. This creates an important moral distinction between embryos in vivo and in vitro. Attempts to refute this moral distinction, raised in the recent debate in this journal between Alfonso Gómez-Lobo and Mary Mahowald, are also addressed.     

Pirh2在分化型甲状腺癌中的表达及意义

探讨Pirh2、P53在分化型甲状腺癌(DTC)中的表达及其意义.随机选取湖南省人民医院乳腺甲状腺外科2006.6～2011.6间DTC64例,应用免疫组化法检测癌组织中的Pirh2、P53的表达.并以结节性甲状腺肿等良性甲状腺疾病病例作为对照,分析Pirh2、P53对DTC的可能作用.Pirh2、P53分别在64例DTC中阳性表达为68.8％ (44/64)、28.1％(18/64),而在36例甲状腺良性疾病中阳性表达为25％(9/36)、16.7％(6/36).Pirh2在DTC与良性肿瘤间的表达存在差异显著性(P＜0.001).P53在两者间的表达无差异显著性(P＞0.05).Pirh2表达与P53的表达具有正相关性(r=0.316、P＜0.05).Pirh2在DTC中呈较高表达,而在良性甲状腺疾病中表达率低,Pirh2可能与P53共同调节DTC的发生发展.     

大剂量抗坏血酸静脉滴注治疗恶性肿瘤的进展

尽管30年前鲍林与卡梅伦曾经用静脉注射+口服大剂量维生素C(10克/天)治疗肿瘤患者,并验证抗坏血酸的抗癌功效,但梅约医疗中心的口服双盲试验否定了他们的结论.沉寂30年后,鲍林的继承者瑞欧丹通过不懈的努力用科学实验和医疗实践证明,通过静脉滴注大剂量抗坏血酸,令其在血浆达到一定浓度,可以杀死多种癌细胞,从而作为化疗药物可以有效治疗恶性肿瘤.30年来的临床实践现已总结为“瑞欧丹规程”.近年来,他们的成就受到美国主流医学和媒体的高度重视.与一般化疗药物相比,该法的好处是基本没有副作用,延长生存期,提高存活质量(QOF).这是一项重大科学发现和成就.该疗法的确立意义重大,将推动癌的治疗及预防,乃至其他疾病如冠心病、感染性疾病及炎症的治疗及预防,提高人类健康水平.     

人乳头瘤病毒疫苗带来的伦理问题

人乳头瘤病毒疫苗的问世使宫颈癌的预防进入崭新的时代,自其问世以来便饱受伦理争议.通过分析目前全球医学文献中比较重视和争议的伦理问题,如Gardasil与Cervarix哪种更为有效,能否在发展中国家顺利推广,应当“强制接种”还是“自愿接种”,男性是否应常规接种等.基于伦理学的基本原则,提出正确的宣教是解决的经由之路.     

情绪作为道德判断的“催化剂”：道德判断中的评价倾向与特异性效应

在不同领域的道德判断中,情绪可能起着“催化剂”的作用。一种特定情绪对应一种核心评价;一种情绪只影响某一道德领域的判断,不同情绪的影响是特异性的;进化心理学和具身认知对道德判断中存在的评价倾向和特异性效应进行了解释。未来研究需要探索评价倾向与特异性效应的内在心理机制。以及进一步探讨文化等第三变量对不同情绪与特定领域道德判断的影响。     

混合模式调查下的测量不变性：跨文化视角

混合模式调查收集数据的有效性需以模式间测量等同为前提.以往调查模式间的测量等同研究尚未考虑文化因素的影响.本研究通过两个自我创新能力评价量表,基于中美两国数据,运用多组确认性因子分析法考察了将由网络调查和纸笔调查构成的混合调查模式应用于自我能力和行为评估时的测量等同问题.结果在美国的样本中发现创新能力评价量表在两种调查模式下具有测量不变性,而在中国的样本中只发现强因子测量不变性,提示混合模式调查下测量不等同的出现是调查模式和文化因素共同导致的结果.我们认为,集体主义文化扩大与强化了纸笔调查和网络调查之间的匿名感知差异,进而受访者可能在网络调查中呈现出“满意决策”作答行为或在线下的调查中呈现出“社会称许性作答行为”,从而增加了出现测量不等同的可能性.