Enhanced counseling for women undergoing BRCA1/2 testing : impact on subsequent decision making about risk reduction behaviours

The authors evaluated the impact of an enhanced counseling intervention, designed to promote well informed decision making for follow-up risk reduction options for ovarian cancer, among high-risk women undergoing BRCA1/2 testing (N = 77). Following standard genetic counseling, participants received either an enhanced counseling session—designed to help participants anticipate their reactions to possible test outcomes and plan for postresult consequences—or a general health information control session. One week after disclosure of test results, women in the enhanced counseling group experienced a greater reduction in avoidant ideation, suggesting more complete processing of risk feedback. At the 6-month follow-up, intervention respondents reported seeking out more information about prophylactic oophorectomy and were more likely to have actually undergone preventive surgery. The results indicate that the use of enhanced counseling can play an important role in decision making about risk reduction behaviours following BRCA1/2 testing.14 page(s

Using GRADE methodology for the development of public health guidelines for the prevention and treatment of HIV and other STIs among men who have sex with men and transgender people

<p>Abstract</p> <p>Background</p> <p>The World Health Organization (WHO) Department of HIV/AIDS led the development of public health guidelines for delivering an evidence-based, essential package of interventions for the prevention and treatment of HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender people in the health sector in low- and middle-income countries. The objective of this paper is to review the methodological challenges faced and solutions applied during the development of the guidelines.</p> <p>Methods</p> <p>The development of the guidelines followed the WHO guideline development process, which utilizes the GRADE approach. We identified, categorized and labeled the challenges identified in the guidelines development process and described the solutions through an interactive process of in-person and electronic communication.</p> <p>Results</p> <p>We describe how we dealt with the following challenges: (1) heterogeneous and complex interventions; (2) paucity of trial data; (3) selecting outcomes of interest; (4) using indirect evidence; (5) integrating values and preferences; (6) considering resource use; (7) addressing social and legal barriers; (8) wording of recommendations; and (9) developing global guidelines.</p> <p>Conclusion</p> <p>We were able to successfully apply the GRADE approach for developing recommendations for public health interventions. Applying the general principles of the approach while carefully considering specific challenges can enhance both the process and the outcome of guideline development.</p

Whose Risk in Philadelphia? Proximity to Unequally Hazardous Industrial Facilities

Few researchers have investigated who lives near the worst polluting facilities. In this study, we test for disparate impact from hazardous industrial and infrastructure facilities on racial/ethnic minorities, the disadvantaged, the working class, and manufacturing workers in the nine-county Philadelphia MSA. Copyright (c) 2007 Southwestern Social Science Association.