Psychosocial impact of genetic testing in familial medullary-thyroid carcinoma: a multicentric pilot-evaluation.
BACKGROUND: Many crucial problems are associated with the diagnosis of inherited cancer susceptibility. One of the most important is related to the psychosocial consequences of the knowledge by the patients and their relatives of their own genetical status. Little data are available in the literature, mainly from studies including small numbers of selected and motivated patients. PATIENTS AND METHODS: From January till December 1997, we studied the psychometric and quality of life parameters of 77 subjects followed in two French specialized centers. These subjects had been treated for either sporadic or familial or were at risk for medullary thyroid carcinoma. All patients had previously attended genetic counselling with detection of germline Ret-mutations, were informed on their own genetic risk, had good short-term prognosis and performance status and did not receive recent cancer treatment. Each patient was invited to answer two questionnaires, the hospital anxiety and depression scale (HADS) and the subjective quality of life profile (SQLP). RESULTS: We report herein the descriptive results of this study (HADS and SQLP scores and distributions) and describe the individual clinical covariates that might explain the observed differences between subgroups of individuals. Although psychometric scores appeared similar in these subgroups, quality of life scores were lower in Ret-mutation carriers. Genetically-predisposed patients were less satisfied and expressed more expectations for favourable change in their quality of life. CONCLUSION: This finding suggests a high level of frustration and latent unsatisfaction related either to the management of the genetic information given by the clinicians and its psychosocial consequences or simply to the knowledge of the genetic risk of cancer. Further studies on the individual consequences of genetic testing, information delivery and when necessary psychotherapeutic interventions, are needed to insure the quality of presymptomatic genetic testing in this field of oncology. (+info)
Behavioral economics: reunifying psychology and economics.
"Behavioral economics" improves the realism of the psychological assumptions underlying economic theory, promising to reunify psychology and economics in the process. Reunification should lead to better predictions about economic behavior and better policy prescriptions. (+info)
Retrospective versus original information on physical and psychosocial exposure at work.
OBJECTIVES: Retrospective exposure assessments are often performed in epidemiologic studies. The presence of an eventual misclassification, both nondifferential and differential, is debated but can rarely be investigated. The aim of this study was to compare self-reported information on the same physical and psychosocial work exposures with 25 years' difference. METHODS: In 1969-1970 a survey of randomly chosen men and women in Stockholm county, concerning, among other things, work exposures, was undertaken. During 1993-1994, 280 subjects participated in a reexamination, regarding psychosocial and physical factors at work and musculoskeletal disorders. The questions were all formulated in the same way as in 1969-1970. RESULTS: When self-reported information on work exposures, collected with a 25-year interval, was compared, acceptable, although not high, agreement was found for 3 out of 4 physical factors and for 4 out of 10 physical environmental factors. Questions measuring psychosocial load had somewhat lower agreement. Current exposure status influenced the memory of past exposures. Study subjects who reported low-back disorders at the reexamination tended to show a better agreement in their assessments of retrospective exposures than those without current symptoms. When relative risks from original and retrospective data were calculated, hardly any influence on the estimates due to that differential misclassification could be found. For persons with and without neck or shoulder symptoms no apparent differences in assessments were found. CONCLUSIONS: Retrospective assessments of exposures at the workplace showed misclassifications to a certain degree. However, the influence of the misclassifications on the risk estimates was limited. (+info)
Psychosocial aspects of abortion. A review of issues and needed research.
The literature on psychosocial aspects of abortion is confusing. Individual publications must be interpreted in the context of cultural, religious, and legal constraints obtaining in a particular society at a given time, with due attention to the status and availability of alternatives to abortion that might be chosen by a woman with an "unwanted" pregnancy. A review of the literature shows that, where careful pre- and post-abortion assessments are made, the evidence is that psychological benefit commonly results, and serious adverse emotional sequelae are rare. The outcome of refused abortion seems less satisfactory, with regrets and distress frequently occurring. Research on the administration of abortion services suggests that counselling is often of value, that distress is frequently caused by delays in deciding upon and in carrying out abortions, and by unsympathetic attitudes of service providers. The phenomenon of repeated abortion seeking should be seen in the context of the availability and cost of contraception and sterilization. The place of sterilization with abortion requires careful study. A recommendation is made for observational descriptive research on populations of women with potentially unwanted pregnancies in different cultures, with comparisons of management systems and an evaluation of their impact on service users. (+info)
Organizing cancer genetics programs: the Swiss model.
PURPOSE: Inherited predisposition to cancer is a complex issue, and risk assessment, counseling, and management are multidisciplinary tasks. An infrastructure is needed through which clinical services may be delivered and research activities conducted. METHODS: The Swiss Institute for Applied Cancer Research (SIAK) Network for Cancer Predisposition Testing and Counseling was established in 1999. The goals of the Network are to set common standards for clinical services, to coordinate research activities, to address psychosocial and ethical issues concerning genetic counseling and testing, and to translate the knowledge gained into medical practice. RESULTS: An algorithm for genetic testing and counseling of the families studied by the SIAK Network centers has been established in a consensual process. Eight regional centers currently operate according to this algorithm. Furthermore, a proposal has been submitted for the setup of a Swiss databank for the characterization of BRCA1 and BRCA2 mutation patterns and the identification of potentially unique mutations in probands who seek genetic counseling and testing at the respective centers of the SIAK Network. CONCLUSION: Our coordinated effort will ensure state-of-the-art genetic testing and counseling services in Switzerland and will allow us to acquire knowledge for appropriate risk assessment and surveillance/prevention strategies for individuals with an inherited cancer predisposition. (+info)
Psychological antecedents to conception among abortion seekers.
At a university hospital, 642 women seeking induced abortion for an unwanted pregnancy were surveyed before the procedure regarding their perception of what psychological and behavioral factors, if any, played a role in their becoming pregnant: 35 percent said they had had intercourse during what they believed was a "safe period"; 33 percent believed that they had experienced a contraceptive failure; 29 percent indicated fear of side effects influenced their use of a contraceptive method; 27 percent and 21 percent, respectively, indicated that they had thought pregnancy "couldn't happen to me" or had "put the thought of pregnancy out of my mind." The women's responses indicated that a number of additional attitudes, beliefs, and behaviors were also important and that for any individual woman at least three or four factors had often combined in a dynamic sequence to greatly increase her risk of pregnancy. The implications of the findings for educational and counseling programs are discussed. (+info)
Dyslipidemia and an unfavorable fatty acid profile predict left ventricular hypertrophy 20 years later.
BACKGROUND: -Left ventricular hypertrophy (LVH) is a common risk factor for cardiovascular mortality. Causes other than hypertension have not previously been investigated longitudinally. The aim of the present study was to determine hemodynamic, metabolic, and psychosocial predictors at 50 years of age for the prevalence of echocardiographic LVH and geometric subtypes at age 70 by use of a large sample of men from the general population followed up for 20 years. Methods and Results-In 1970 to 1973, all men born from 1920 to 1924 and residing in Uppsala County, Sweden, were invited to participate in a health survey aimed at identifying risk factors for cardiovascular disease. At a reinvestigation 20 years later, echocardiographic left ventricular mass index was determined in 475 subjects. A 1-SD increase in body mass index, systolic or diastolic blood pressure, fasting LDL/HDL cholesterol, serum triglycerides, or the serum cholesterol ester proportion of several saturated fatty acids or oleic acid at age 50 significantly increased the odds of having LVH at age 70 by 27% to 41%, whereas an increase in linoleic acid proportion was protective. Almost all metabolic predictors were independent of ischemic heart disease, valvular disease, and use of antihypertensive medication at age 70. CONCLUSIONS: -Dyslipidemia and indices of a low dietary intake of linoleic acid and high intake of saturated and monounsaturated fats, as well as hypertension and obesity, at age 50 predicted the prevalence of LVH 20 years later in this prospective longitudinal cohort study, thereby suggesting that lipids may be important in the origin of LVH. (+info)
Psychosocial dysfunction in tuberculosis patients.
Tuberculosis continues to be a major health problem in India. It carries social stigma and results in adverse psychological sequelae. In the present study, 50 patients suffering from tuberculosis were examined. There was higher degree of neuroticism and the patients with tuberculosis showed marked to severe psychosocial dysfunctioning in personal, familial, vocational, social and cognitive areas. (+info)