The utilization of genetic counselors within a newborn screening program

Genetic counselors have participated in the Michigan Newborn Screening Program on a contractual basis since 1988. Their role includes newborn screening education and training, newborn nursery site visits, and monitoring newborn screening in hospitals. Their impact has been to improve the quality of newborn screening services by reducing errors and increasing completion of data fields on newborn screening cards, improving hospital nursery cooperation and problem solving, and enhancing health department response to specific problems.     

A brief neuropsychological screening battery to detect brain damage in a psychiatric population

Seventy-five patients admitted to the psychiatric unit of a general hospital were administered a brief neuropsychological screening battery. Discharge diagnoses obtained from the medical records revealed that 20% had brainbased pathology. A discriminant function analysis resulted in a five-variable model (Symbol-Digit Modalities Test, educational level, Psychiatric-Organic subscale of the MMPI, and Shipley Vocabulary and Abstraction scores) which correctly classified 84% of the subjects, with 87% correct identification of the brain-damaged group. A jackknife cross-validation procedure resulted in comparable hit rates.     

The comparison problem for approximating epistemic ideals

Some epistemologists think that the Bayesian ideals matter because we can approximate them. That is, our attitudes can be more or less close to the ones of our ideal Bayesian counterpart. In this paper, I raise a worry for this justification of epistemic ideals. The worry is this: In order to correctly compare agents to their ideal counterparts, we need to imagine idealized agents who have the same relevant information, knowledge, or evidence. However, there are cases in which one's ideal counterpart cannot have one's information, knowledge, or evidence. In these situations, agents cannot compare themselves to their ideal counterpart.     

A survey of reimbursement for cystic fibrosis carrier testing

To assess the current status of reimbursement for cystic fibrosis (CF) carrier testing, we surveyed individuals tested in the Mid-Atlantic region. Results show that CF testing was covered by insurance in part or in full for greater than 50% of respondents. The test was nearly always covered when performed during pregnancy because of a positive family history, but it was also covered for more than 50% of pregnant respondents with a negative family history. There were no significant differences in coverage by type of insurance. Many respondents needed to supply additional information about the testing to their insurance company before a coverage decision could be made. Before population-based CF screening programs are initiated, more data are needed on insurance reimbursement for testing, especially when performed pre-conceptually.     

The Development of the Toddler Behavior Screening Inventory

The purpose of the present study was to develop the Toddler Behavior Screening Inventory (TBSI) for rapidly assessing maternal reports of toddler behavior problems. The TBSI is a 40-item measure intended for use by pediatricians, psychologists, and other child-care professionals. A group of mothers (n = 312) rated the initial 93-item TBSI in terms of behavior frequency and parental perception of the behavior as problematic. Following item elimination, 40 items were retained due to being both frequent and problematic at all toddler age levels. Data were obtained with a new sample of mothers (n = 581) and showed the TBSI to possess good reliability and validity.     

Counseling and screening for cystic fibrosis in patients with congenital bilateral absence of the vas deferens: Patient perceptions

Congenital bilateral absence of the vas deferens (CBAVD) occurs in approximately 1.3% of infertile males and is thought to be, in most cases, a primarily genital form of cystic fibrosis (CF). Fourteen males with CBAVD considering microsurgical sperm aspiration from the epididymis (MESA) and in vitro fertilization were seen for genetic counseling and screening for CF. To retrospectively evaluate these patients' perceptions of the counseling and screening information, we conducted structured telephone interviews to assess their recall of information about CF and its impact on their health concerns and reproductive plans. We found that, as the health implications of CF are abstract and not as important to patients as the diagnosis of CBAVD itself, patients tend to view their CF status primarily in terms of their reproductive potential. Retrospective analysis afforded us an opportunity to identify the psychosocial issues of most concern to this unique patient population.     

Pre-screening education in multiple marker screening programs: The effect on patient anxiety and knowledge

Previous studies have shown that unexplained deviations in maternal serum multiple marker screening (MMS) generate considerable anxiety during the remainder of pregnancy. While the role of education in decreasing anxiety is documented, to date there has been no prospective evaluation of which educational practices might minimize this emotional stress. In a pilot study, we prospectively examined the effects on anxiety and knowledge by providing information about MMS (1) by genetic counselor, (2) by pamphlet, and (3) by primary physician. Women randomized to one of these three modalities were administered the Spielberger State- Trait Anxiety Inventory [STAI] and knowledge questionnaires at their initial obstetrics visit, at their second visit after educational intervention and 1–2 weeks after MMS results were provided to patients. Education resulted in an increase in knowledge and post-education knowledge was different between educational modalities. Anxiety declined in patients educated through genetic counseling or a pamphlet.     

The effects of expected future interaction and prior group support on the conformity process

Previous results indicate that people conform more to group judgments when they have received unanimous group support for their opinions than when they have received no support. The present study tested the hypothesis that these differences would be attenuated when future interaction with the group members was anticipated. The 70 male subjects were tested in a Crutchfield-type conformity situation, where prior group support (100 vs 0%) and anticipation of future interaction (alone vs group) were manipulated. Predictions were based on an examination of conformity incentives that considered normative and informational sources of social influence, as well as Hollander's model of idiosyncracy credit. Consistent with predictions, conformity in the 0% prior support condition was greater when subjects anticipated future group interaction than when they did not, whereas the reverse was true in the 100% prior support condition. In addition, conformity was correlated negatively with both confidence in task ability and feelings of group acceptance when future interaction with the group was anticipated. These data suggest that when future group activity is expected, the tendency to reciprocate past treatment from the group is reduced.     

Choosing what to choose from: Preference for inclusion over exclusion when constructing consideration sets from large choice sets

Decision making is a two‐stage process, consisting of, first, consideration set construction and then final choice. Decision makers can form a consideration set from a choice set using one of two strategies: including the options they wish to further consider or excluding those they do not wish to further consider. The authors propose that decision makers have a relative preference for an inclusion (vs. exclusion) strategy when choosing from large choice sets and that this preference is driven primarily by a lay belief that inclusion requires less effort than exclusion, particularly in large choice sets. Study 1 demonstrates that decision makers prefer using an inclusion (vs. exclusion) strategy when faced with large choice sets. Study 2 replicates the effect of choice set size on preference for consideration set construction strategy and demonstrates that the belief that exclusion is more effortful mediates the relative preference for inclusion in large choice sets. Studies 3 and 4 further support the importance of perceived effort, demonstrating a greater preference for inclusion in large choice sets when decision makers are primed to think about effort (vs. accuracy; Study 3) and when the choice set is perceived as requiring more effort because of more information being presented about each alternative (vs. more alternatives in the choice set; Study 4). Finally, Study 5 manipulates consideration set construction strategy, showing that using inclusion (vs. exclusion) in large choice sets leads to smaller consideration sets, greater confidence in the decision process, and a higher quality consideration set.