Counseling Considerations Research Articles

Dental considerations for dietary counselling

A decline in the prevalence of dental caries over three decades has occurred without a significant change in the consumption of fermentable carbohydrates, indicating that good dental health is achievable with the presence of cariogenic factors in the diet. Since, in many countries 80% of the caries is present in only 20% of the population, 'targeted intervention' would seem a better preventive option, stressing the judicious use of fluoride, plaque control, fissure sealants and a sensible diet. Dietary modification is notoriously difficult to achieve, being incumbent upon the subject's willingness to effect a change in behaviour. Many texts refer to the frequency of consumption of carbohydrates as being all-important, recommending a reduction in the frequency. However, recent evidence suggests it is the frequency of toothbrushing with a fluoride containing dentifrice which is of fundamental importance in promoting remineralisation of enamel. Dietary advice should be formulated which is both realistic and positive. Trying to dissuade children from consuming products, which they perceive to be tasty and pleasurable is counter productive and more emphasis should be given to tooth brushing using a fluoride toothpaste. Also, a fundamental shift away from the idea of 'good foods versus bad foods' is required and more emphasis laid on good diets as opposed to bad diets. Children should be able to enjoy foods traditionally considered 'bad' from a dental viewpoint, as long as they brush their teeth with a fluoride containing dentifrice and have a sensible approach to their consumption.

Intimacy, Gender and Self Psychology: Considerations for Relationship Counselling

This paper reviews major conceptualisations of intimacy and the blocks, frequently attributed to gender, which are thought to contribute to problems in couple relationships. The paper concludes that gender is often not the limiting factor that inhibits intimacy in heterosexual couples. It may be more productive to consider individual rather than couple therapy to deal with impasses that appear to be associated with gender. Ideas from self psychology provide insights into how some requests for intimacy may be related to immature self‐object needs, which may better be handled through individual rather than couple therapy. A range of therapeutic goals and strategies that focus directly on intimacy are then outlined.

The spectrum of molecular defects of the CYP21 gene in the Hellenic population: variable concordance between genotype and phenotype in the different forms of congenital adrenal hyperplasia.

Defective steroid synthesis due to 21-hydroxylase deficiency is the most common form of congenital adrenal hyperplasia. Knowledge of the molecular defects causing 21-hydroxylase deficiency in different populations is of both theoretical and practical interest. The types and the relative frequencies of molecular defects and the correlation between the genotype and the phenotype were examined in the Hellenic population. We searched for deletions, conversions, and 11 of the most frequent mutations of the CYP21 gene by Southern blot and allele-specific PCR in 222 chromosomes from 111 unrelated subjects and their parents. The most frequent molecular defects were 1) in the salt wasting form, I(2) splice (42.9%), deletions and conversions (24.5%), and Q318stop (14.3%); 2) in the simple virilizing form, I172N (35.3%), I(2) splice (29.4%), and P30L (19.1%); and 3) in the nonclassical form, V281L (41.1%), P30L (21.4%), and P453S (14.3%). Compared with other populations, Greek patients had a higher frequency of Q318stop in the salt-wasting form, of P30L in both simple virilizing and nonclassical forms and of P453S in the nonclassical form. The concordance of genotype to phenotype in the total sample was 87%. However, the concordance rate was different in the three forms of the disease. Thus, complete concordance was detected in the genotypes predicting the salt-wasting phenotype, a slightly lower concordance (95.2%) was detected in the genotypes predicting the simple virilizing phenotype, and the lowest concordance (67.6%) was observed in genotypes predicting the nonclassical phenotype. In conclusion, the concordance between genotype and phenotype decreases as the severity of the disease diminishes. This should be taken into consideration in genetic counseling and antenatal intervention.

Study of the occurrence of interchromosomal effect in spermatozoa of chromosomal rearrangement carriers by fluorescence in-situ hybridization and primed in-situ labelling techniques.

The possibility that a chromosomal rearrangement might disturb the meiotic behaviour of chromosomes not involved in the rearrangement and favour non-disjunction is a controversial issue in human cytogenetics. Using two-colour fluorescence in-situ hybridization and primed in-situ labelling techniques, we have investigated the segregation pattern of 10 chromosomes (chromosomes 1, 4, 9, 13, 15, 16, 20, 21, X and Y) in spermatozoa from nine carriers of balanced structural rearrangements and three normal men. The patients were divided into two groups according to their semen parameters. In rearrangement carriers and normal subjects, sex chromosomes and chromosome 21 displayed a higher rate of disomy than the other chromosomes. No evidence for the occurrence of interchromosomal effect was found in the spermatozoa of fertile rearrangement carriers, but significant variations were observed for all chromosomes tested in the group of infertile translocation carriers, suggesting a direct correlation between poor quality spermatozoa and increased aneuploidy rate in this group. In fertile carriers of chromosomal rearrangements, the occurrence of non-disjunction of chromosomes not involved in the rearrangement might therefore be considered as fortuitous, whereas in infertile carriers, the risk for interchromosomal effect appears to be real and should be taken into consideration in the genetic counselling of infertile couples with a male partner carrying a chromosomal rearrangement.

TRANSITION COUNSELING IN THE COMMUNITY COLLEGE

According to the U.S. Department of Education, 44% of students entering American colleges and universities in 1995 were over age 25.As increasing numbers of students make changes to enter community college, it is imperative that counselors address the fundamental dilemmas facing this population. Addressing the transition concerns of these students as they navigate through community college may provide a counseling perspective that effectively enhances overall student development while simultaneously influencing future growth and success. This article outlines counseling considerations, from assessment to intervention, designed to help the community college counselor meet students' transition needs.

Maternal age and fetal loss: population based register linkage study

Objective: To estimate the association between maternal age and fetal death (spontaneous abortion, ectopic pregnancy, stillbirth), taking into account a woman's reproductive history.Design: Prospective register linkage study.Subjects: All women with...

Managed Care: Ethical Considerations for Counselors

Key factors and trends in health care will have an impact on the ethical practice of counselors. Ethical challenges to clinical practice presented by trends in managed care are discussed in relation to the American Counseling Association (1995) Code of Ethics and Standards of Practice. Recommendations for practice are also included.

Experience in prenatal testing for Huntington's disease in The Netherlands: procedures, results and guidelines (1987-1997)

We have performed 31 exclusion tests (43 per cent) and 41 direct tests (57 per cent) in 43 couples at risk, in the period 1987 to 1997 in Leiden, The Netherlands. This resulted in termination of 28 pregnancies (39 per cent), with an increased risk. In 28 couples (65 per cent), the woman was at risk. Prenatal testing in consecutive pregnancies (mean number: 3) was performed in 15 couples (35 per cent), with a mean time interval of 15 months. Parents should make an independent choice for (every) pregnancy, although most (86 per cent) did not change their initial choice. It is important that the position of children in the same family, of whom some know their status as a result of prenatal testing, whereas others remain at risk, is taken into consideration in counselling. The relative number of exclusion tests when compared with direct tests has diminished since the mutation was identified. The prenatal exclusion-definitive test (Fig. 1) was rarely used (2/72, 3 per cent). Nowadays, direct mutation testing of the fetus only is simpler and faster and the risk of disclosure of the genetic status of the at-risk parent is only 25 per cent. This test should therefore be offered as another option and included in the international guidelines. The uptake for prenatal testing is low: for 2 per cent of the at-risk persons, 11 per cent of the tested carriers and a small group of at-risk persons wishing not to be tested themselves, prenatal testing seems an acceptable choice regarding reproduction.

Experience in prenatal testing for Huntington's disease in The Netherlands: procedures, results and guidelines (1987–1997)

We have performed 31 exclusion tests (43 per cent) and 41 direct tests (57 per cent) in 43 couples at risk, in the period 1987 to 1997 in Leiden, The Netherlands. This resulted in termination of 28 pregnancies (39 per cent), with an increased risk. In 28 couples (65 per cent), the woman was at risk. Prenatal testing in consecutive pregnancies (mean number: 3) was performed in 15 couples (35 per cent), with a mean time interval of 15 months. Parents should make an independent choice for (every) pregnancy, although most (86 per cent) did not change their initial choice. It is important that the position of children in the same family, of whom some know their status as a result of prenatal testing, whereas others remain at risk, is taken into consideration in counselling. The relative number of exclusion tests when compared with direct tests has diminished since the mutation was identified. The prenatal exclusion–definitive test (Fig. 1) was rarely used (2/72, 3 per cent). Nowadays, direct mutation testing of the fetus only is simpler and faster and the risk of disclosure of the genetic status of the at-risk parent is only 25 per cent. This test should therefore be offered as another option and included in the international guidelines. The uptake for prenatal testing is low: for 2 per cent of the at-risk persons, 11 per cent of the tested carriers and a small group of at-risk persons wishing not to be tested themselves, prenatal testing seems an acceptable choice regarding reproduction. Copyright © 1999 John Wiley & Sons, Ltd.

Adjusting to Retirement: Considerations for Counselors

The purpose of this article is to examine retirement while focusing on issues older adults face in adjusting to retirement and to suggest implications for counseling people who are making this transition.

Considerations for fitness appraisal, programming, and counselling of people with intellectual disabilities.

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Considerations for fitness appraisal, programming, and counselling of individuals with sensory impairments.

Providing active living opportunities to all individuals, including people with disabilities, requires supporting each person's ability to participate. Successful inclusion often occurs, despite antiquated, inaccessible facilities, when everyone--leaders and participants alike--believes that each person has an equal right to participate, and programmes are offered that suit the varied interests and abilities of all participants.

In Utero Hematopoietic Stem Cell Transplantation

In utero hematopoietic stem cell transplantation is currently in its early stage of development, but it holds considerable promise as a therapeutic approach for the treatment of a large number of congenital hematologic diseases. Experimental evidence supports the concept of the early gestational fetus as a favorable recipient for cellular therapy. Unique aspects of normal hematologic and immunologic ontogeny allow engraftment and long-term persistence of transplanted hematopoietic stem cells without the requirement for myeloablation or immunosuppression. To date, 21 in utero transplants have been reported. Success has been limited to 4 fetuses, all with immunodeficiency disorders. Despite this limited evidence of clinical efficacy, interest in stem cell transplantation has been gaining momentum, and clinical application is likely to increase. Parallel advances in prenatal diagnosis, fetal intervention, and hematopoietic stem cell technology have removed many of the practical, technical, and ethical obstacles to clinical application. This progress has been accompanied by an increase in the number of centers with both the stated interest and perceived expertise to develop clinical programs. However, there is currently limited consensus among investigators on many important issues, such as the mode or timing of in utero transplantation, the ideal source or dose of donor cells, estimation of maternal and fetal risks, appropriate candidate diseases for treatment, and important ethical considerations in counseling and therapy.

Counseling Latino alcohol and other substance users/abusers. Cultural considerations for counselors.

This article presents a sociocultural alcohol/drug counseling model for counselors working with Latino users/abusers. Intended to supplement different treatment models, this model addresses pre-treatment issues of Latino users/abusers. A demographic overview of Latinos and a discussion of selected Latino cultural values and issues as they relate to substance use/abuse are included. These cultural values include Simpatía, Personalismo, Familismo, Gender Roles (Machismo and Hembrismo/Marianisimo), Vergüenza, and Espiritismo. Along with identifying misperceptions and issues that may occur within the counseling session, specific recommendations and interventions for counselors are provided.

Rehabilitation Counseling with the Deaf: Considerations for Counselors with General Caseloads

Due to the lack of adequately trained and experienced rehabilitation counselors for the deaf, the majority of vocational rehabilitation services will be provided by counselors with general caseloads. For those counselors who are assigned deaf clients, information is provided to facilitate greater awareness of the cultural, communication, assessment, and career development needs of this clientele.

College Students' Perceptions of the Relationship Between Fee and Counseling

Fee as a variable that could have an impact on college students' perceptions of counseling was explored because of the authentic concerns about college counseling centers needing to charge direct fees for their services. Participants (N = 350) represented a cross‐section of potential consumers of psychological services, not just individuals currently receiving services. On an overt level, fees seemed to be less influential in counseling considerations, but were taken into account on a more covert level. This study supports the psychological literature, which suggests that fee is not the most important factor in clients' decisions to seek counseling. Implications for counselors, administrators, researchers, and program planners are discussed.

Pharmacists’ Views of Patient Counseling: Pharmacists believe that patient familiarity with a medication and the seriousness of possible outcomes from its use are important considerations in counseling.

The goal of this study was to assess whether pharmacists rate eight elements of counseling of equal importance in different dispensing situations. A sample of 708 pharmacists was asked to complete a pretested questionnaire about patient counseling; 697 provided usable responses for a response rate of 98%. Using multivariate analysis of variance, analysis of variance, we found significant differences (p<0.01) in pharmacists' ratings of the importance of counseling patients in different situations. Pharmacists used patient familiarity with the medication and the perceived seriousness of potential consequences to the patient to determine the importance of each element of counseling.

Chicana/o Family Structure and Gender Personality: Chodorow, Familism, and Psychoanalytic Sociology Revisited

Les AA. discutent du modele theorique de sociologie psychoanalytique realise par Nancy Chodorow, concernant le role de la mere dans le developpement et la reproduction de l'identite sexuelle. Elles testent en effet ce modele sur une population particuliere, les chicano aux Etats-Unis. Notamment comment la structure de la communaute familiale joue sur le developpement de la personnalite sexuelle et ethnique des chicanos et chicanas.

Genetic and environmental factors in hypospadias.

A case control study of hypospadias was performed from 1979 to 1987 in Alsace, north-eastern France. A total of 176 out of 60 847 male infants had hypospadias giving a prevalence at birth of 2.89 per 1000 male newborns; 15.3% of all infants with hypospadias also had other malformations. Renal and urinary tract malformations were present in 37.0% of the infants with hypospadias and other additional malformations. None of the numerous aetiological factors which were studied was correlated with hypospadias except low weight of the placenta. The recurrence risk for brothers was 17.0% (an empirical risk of about 1 in 6) and the heritability coefficient was 56.9%. First degree relatives of infants with hypospadias had more malformations other than hypospadias than controls. These results have to be taken into consideration for genetic counselling.

Cardiac malformations in relatives of children with truncus arteriosus or interruption of the aortic arch

Familial recurrence risks for congenital cardiac malformations have been estimated at 1 to 4%, but little is known of recurrence risks for uncommon congenital cardiac malformations. This study determined the incidence of congenital cardiac malformations in relatives of patients with either truncus arteriosus (TA) or interruption of the aortic arch (IAA) seen between 1955 and 1985. Prior to this study, only 2 cases of IAA in siblings had been reported and the recurrence risk of TA had been estimated at 1.2%. In the families of 36 index cases of IAA, there were 98 siblings, 2 with congenital cardiac malformations (2.1%). All recurrences were in IAA type B families. Single cases of congenital cardiac malformations were found in second- and third-degree relatives and 2 cases in more distant relatives. In the families of 49 index cases of TA, there were 106 siblings, 7 with congenital cardiac malformations (6.6%). Two had TA, 3 had other conotruncal anomalies and 2 had other congenital cardiac malformations. Two parents had congenital cardiac malformations, 1 with TA and 1 with conotruncal malformation. Among second- and third-degree relatives, 7 had congenital cardiac malformations (5 were conotruncal, including 1 half sibling). Among greater than third-degree relatives, 3 had congenital cardiac malformations. Thus, in IAA, the recurrence rate of congenital cardiac malformations (2.1%) was higher than expected and could be related to the etiology of IAA type B as a conotruncal malformation. In TA, the recurrence rate of congenital cardiac malformations was 6.6%, higher than previously reported. When TA was complex the recurrence risk was higher (13.6%). These findings must be taken into consideration for satisfactory genetic counseling.