Willingness to test for BRCA1/2 in High Risk Women: Influenced by Risk Perception and Family Experience, rather than by Objective or Subjective Numeracy?

Genetic testing for breast and ovarian cancer can help target prevention programs, and possibly reduce morbidity and mortality. A positive result of BRCA1/2 is a substantial risk factor for breast and ovarian cancer, and its detection often leads to risk reduction interventions such as increased screening, prophylactic mastectomy and oophorectomy. We examined predictors of the decision to undergo cancer related genetic testing: perceived risk, family risk of breast or ovarian cancer, and numeracy as predictors of the decision to test among women at high risk of breast cancer. Stepwise regression analysis of survey responses from 459 women registered in the Cancer Genetics Network revealed greater likelihood to test for women with more family history, higher perceived risk of mutation, or Ashkenazi descent. Neither subjective nor objective numeracy was associated with the decision to test, although we replicated an earlier finding that subjective numeracy predicted willingness to pay for testing. Findings underscore the need for genetic counselling that disentangles risk perception from objective information to promote better decision-making in the context of genetic testing. Highlighting these factors is crucial for public health campaigns, as well as to clinic-based testing and direct-to-consumer testing. (PsycINFO Database Record (c) 2016 APA, all rights reserved

Conceptual versus perceptual priming in incomplete picture identification

金沢大学文学部This paper examined conceptual versus perceptual priming in identification of incomplete pictures by using a short-term priming paradigm, in which information that may be useful in identifying a fragmented target is presented just prior to the target\u27s presentation. The target was a picture that slowly and continuously became complete and the participants were required to press a key as soon as they knew what it was. Each target was preceded by a visual prime. The nature of this prime varied from very conceptual (e.g., the name of the picture\u27s category) to very perceptual (e.g., a similar-shaped pictorial prime from a different category). Primes also included those that combined perceptual and conceptual information (e.g., names or images of the target picture). Across three experiments, conceptual primes were effective while the purely perceptual primes were not. Accordingly, we conclude that pictures in this type of task are identified primarily by conceptual processing, with perceptual processing contributing relatively little. © 2005 Springer Science+Business Media, Inc

Subjective but not objective numeracy influences willingness to pay for BRCA1/2 genetic testing

A positive test result for BRCA1/2 gene mutation is a substantial risk factor for breast and ovarian cancer. However, testing is not always covered by insurance, even for high risk women. Variables affecting willingness to pay (WTP) have implications for clinic-based and direct-to-consumer testing. The relative impact of objective and subjective numeracy on WTP, in the context of worry, perceived risk (of having the mutation and developing breast cancer) and family history, was examined in 299 high-risk women, not previously tested for BRCA1/2. Objective and subjective numeracy correlated positively with one another, yet only subjective numeracy correlated (positively) with WTP. This could not be explained by educational level or worry. In line with the numeracy result, other objective factors including family history, age, and Ashkenazi descent were not correlated with WTP. Perceived risk of having a mutation was also correlated with WTP, though perceived risk of developing breast cancer was not, perhaps because it lacks direct connection with testing. Thus, subjective confidence in the ability to interpret test results and perceived risk of a positive test result are more important drivers in paying for BRCA1/2 testing than factors more objective and/or further removed from the testing itself (e.g., perceived risk of developing cancer, family history). Findings underscore the need for genetic counselling that makes probabilistic information accessible and intelligible, so as to build confidence and promote accurate perception of mutation risk and ultimately better decision-making

Charting the internal landscape: Affect associated with thoughts about major life domains explains life satisfaction

Studies of happiness have examined the impact of demographics, personality and emotions accompanying daily activities on life satisfaction. We suggest that how people feel while contemplating aspects of their lives, including their weight, children and future prospects, is a promising yet uncharted territory within the internal landscape of life satisfaction. In a sample of 811 American women, we assessed women’s feelings when thinking about major life domains and frequency of thoughts about each domain. Regression and dominance analyses showed that emotional valence of thoughts about major life domains was an important predictor of current and prior life satisfaction, surpassing, in descending order, demographics, participants’ feelings during recent activities, and their neuroticism and extraversion scores. Domains thought about more frequently were often associated with greater emotional valence. These results suggest that life satisfaction may be improved by modifying emotional valence and frequency of thoughts about life domains. Moreover, these thoughts appear to be an important and relatively stable component of well-being worthy of further study

Cognitive impairment, fatigue and depression in multiple sclerosis: Is there a difference between benign and non-benign MS?

INTRODUCTION Multiple Sclerosis (MS) is a chronic inflammatory and degenerative disease of the central nervous system (CNS). The severity of disability in people with MS (PwMS) is generally measured with the Expanded Disability Status Scale (EDSS). A variant of MS known as 'benign MS' (BMS) has been defined as an EDSS score of 3 or lower, combined with a disease duration of 10 years or longer; however, there is disagreement in the field about whether BMS really exists. Given that the EDSS does not capture cognitive issues, communication dysfunction, fatigue, depression, or anxiety properly, its ability to accurately represent disability in all PwMS, including BMS, remains questionable. METHODS In this study, 141 persons with BMS (PwBMS) were included, consisting of 115 females (82%) and 26 males (18%) with a mean age of 50.8 (±8.68). A computerized test battery (NeuroTrax®) was used to assess cognition, covering seven cognitive domains (memory, executive function, visual-spatial processing, verbal function, attention, information processing, and motor skills). Fatigue was measured using the Fatigue Severity Scale (FSS). The Beck Depression Inventory (BDI) was used to assess symptoms of depression. Cognitive impairment was defined for this study as when someone has a score lower than 85 in at least two subdomains of the cognitive test battery. Rates of impairment were compared to 158 persons with non-benign MS (PwNBMS; with a disease duration of 10 years and longer and an EDSS score higher than 3) and 487 PwMS with a disease duration of fewer than 10 years. RESULTS Cognitive impairment was found in 38% of PwBMS and in 66% of PwNBMS (p<0.001). In PwBMS, the lowest rate of impairment was found in the verbal function domain (18%) and the highest rate of impairment in the domain of information processing (32%). Fatigue and depression were found in 78% and 55% of all PwBMS, with no difference in these rates between PwBMS and PwNBMS (p = 0.787 and p = 0.316 resp.) CONCLUSION: Cognitive impairment, fatigue and depression are common among people with an EDSS-based definition of benign MS. These aspects should be incorporated into a new and better definition of truly benign MS

Validity of a novel computerized cognitive battery for mild cognitive impairment

BACKGROUND: The NeuroTrax Mindstreams computerized cognitive assessment system was designed for widespread clinical and research use in detecting mild cognitive impairment (MCI). However, the capability of Mindstreams tests to discriminate elderly with MCI from those who are cognitively healthy has yet to be evaluated. Moreover, the comparability between these tests and traditional neuropsychological tests in detecting MCI has not been examined. METHODS: A 2-center study was designed to assess discriminant validity of tests in the Mindstreams Mild Impairment Battery. Participants were 30 individuals diagnosed with MCI, 29 with mild Alzheimer's disease (AD), and 39 healthy elderly. Testing was with the Mindstreams battery and traditional neuropsychological tests. Receiver operating characteristic (ROC) analysis was used to examine the ability of Mindstreams and traditional measures to discriminate those with MCI from cognitively healthy elderly. Between-group comparisons were made (Mann-Whitney U test) between MCI and healthy elderly and between MCI and mild AD groups. RESULTS: Mindstreams outcome parameters across multiple cognitive domains significantly discriminated among MCI and healthy elderly with considerable effect sizes (p < 0.05). Measures of memory, executive function, visual spatial skills, and verbal fluency discriminated best, and discriminability was at least comparable to that of traditional neuropsychological tests in these domains. CONCLUSIONS: Mindstreams tests are effective in detecting MCI, providing a comprehensive profile of cognitive function. Further, the enhanced precision and ease of use of these computerized tests make the NeuroTrax system a valuable clinical tool in the identification of elderly at high risk for dementia

Invasive Prenatal Diagnostic Testing Recommendations are Influenced by Maternal Age, Statistical Misconception and Perceived Liability

Funding policy and medico-legal climate are part of physicians’ reality and might permeate clinical decisions. This study evaluates the influence of maternal age and government funding on obstetrician/gynecologist recommendation for invasive prenatal testing (i.e. amniocentesis) for Down syndrome (DS), and its association with the physician’s assessment of the risk of liability for medical malpractice unless they recommend amniocentesis. Israeli physicians (N = 171) completed a questionnaire and provided amniocentesis recommendations for women at 18 weeks gestation with normal preliminary screening results, identical except aged 28 and 37. Amniocentesis recommendations were reversed for the younger (‘yes’ regardless of testing results: 6.4%; ‘no’ regardless of testing results: 31.6%) versus older woman (‘yes’ regardless of testing results: 40.9%; ‘no’ regardless of testing results: 7.0%; χ2 = 71.55, p < .01). About half of the physicians endorsed different recommendations per scenario; of these, 65.6% recommended amniocentesis regardless of testing results for the 37-year-old woman. Physicians routinely performing amniocentesis and those advocating for amniocentesis for all women ≥ age 35 were approximately twice as likely to vary their recommendations per scenario. Physicians who perceived risk of liability for malpractice as large were nearly one-and-a-half times more likely to vary recommendations. The results indicate physicians’ recommendations are influenced by maternal age, though age is already incorporated in prenatal DS risk evaluations. The physician’s assessment of the risk that they will be sued unless they recommend amniocentesis may contribute to this spurious influence

Structural correlates of memory performance with diffusion tensor imaging

Aging is associated with a variety of structural and pathological brain changes. Memory, or the ability to store and retrieve information, declines significantly during aging. In order to characterize the brain micro-structural correlates of memory performance, 52 healthy subjects, age 25–82 years, completed a computerized non-verbal memory test and were scanned using magnetic resonance diffusion tensor imaging. Partial correlation was conducted between DTI parameters and memory performance (accuracy and reaction time (RT) for different learning stages) controlling for age. A similar correlation pattern was found for apparent diffusion coefficient (ADC), FA, and radial and axial diffusivities, but correlations between ADC and memory performance were the most informative and are therefore reported here. While ADC was correlated with accuracy mainly in temporal and frontal cortical regions, it was correlated with RT in temporal and frontal white matter pathways, including the inferior longitudinal fasciculus and uncinate fasciculus. The task was repeated four times, performance in the first repetition was correlated with ADC in frontal white matter and in the fourth repetition with ADC in temporal gray matter structures mainly the parahippocapus and in the middle temporal gyrus. The localization of the correlations of ADC with the different task parameters is in line with previous studies. Thus, inter-subject variability in memory performance and tissue morphology, as expressed by diffusion tensor magnetic resonance imaging, can be used to relate tissue microstructures with cognitive performance, and to provide information to corroborate other functional localization techniques