Communicating genetic information: a difficult challenge for future pediatricians

<p>Abstract</p> <p>Background</p> <p>The role of the pediatrician as genetic counselor is ideal because pediatricians have medical knowledge and experience with genetic disorders (e.g. Down syndrome). Moreover, pediatricians can provide comprehensive care in a medical home to patients with genetic disorders. However, changes in the curriculum of the pediatric resident are necessary to address the future challenges of effectively communicating genetic information to patients. The objective of this study was to explore these challenges and make recommendations for training to adequately prepare pediatricians for their future role as genetic counselors.</p> <p>Methods</p> <p>Three reviewers independently searched PubMed, OVID, and Medline databases to identify articles describing the challenges of communicating genetic information to patients, published from 1960 to December 2005. After the publications were identified and reviewed, four major areas of interest were identified in order to categorize the findings.</p> <p>Results</p> <p>Twenty-five publications were identified during the literature search. From the review, the following categories were selected to organize the findings: (1) Inherent difficulties of communicating and comprehending genetic information; (2) Comprehension of genetic information by pediatricians; (3) Genetics training in residency programs; and (4) The effect of genetic information on the future role of pediatricians and potential legal implications.</p> <p>Conclusion</p> <p>Pediatricians and residents lack essential knowledge of genetics and communication skills for effective counseling of patients. The review indicated that successful communication of genetic information involves a number of important skills and considerations. It is likely that these skills and considerations are universally required for the communication of most complex specialized medical information. In the past, communication skills have not been considered a priority. Today, these skills have become a demanding professional and even legal obligation. However, the challenges involved in communicating complex medical information cannot be successfully addressed with universal, one-size-fits-all recommendations. Residency training programs require changes to adequately prepare future pediatricians for the growing challenge of communicating genetic information. Four important skills should be considered in the training of residents to improve the communication of complex information to patients. These skills are (1) discriminating, (2) understanding, (3) simplifying, and (4) explaining information.</p

Large losses in glacier area and water availability by the end of the twenty-first century under high emission scenario, Satluj basin, Himalaya

Glaciers in the Satluj river basin are likely to lose 53% and 81% of area by the end of the century, if climate change followed RCP 8.5 scenario of CNRMCM5 and GFDL-CM3 models respectively. The large variability in area loss can be due to difference in temperature and precipitation projections. Presently, Satluj basin has approximately 2000 glaciers, 1426 sq. km glacier area and 62.3 Gt glacier stored water. The current mean specific mass balance is –0.40 m.w.e. a–1. This will change to –0.42 and – 1.1 m.w.e. a–1 by 2090, if climate data of CNRM-CM5 and GFDL-CM3 are used respectively. We have used an extreme scenario of GFDL-CM3 model to assess the changes in the contribution of glacier melt to the Bhakra reservoir. Mass balance model suggests that glaciers are contributing 2 km3 a–1 out of 14 km3 of water. This will increase to 2.2 km3 a–1 by 2050, and then reduce to 1.5 km3 a–1 by the end of the century. In addition, loss in glacier area by the end of century, will also increase the vulnerability of mountain communities, suggesting need for better adaptation and water management practices