Counseling Considerations Research Articles

Book Review: Ginicola, Smith, and Fillmore: Affirmative Counseling with LGBTQI+ People

Affirmative Counseling with LGBTQI+ is a comprehensive, practical and user-friendly text written specifically for clinicians and educators to engage and support the LGBTQI+ populations. Separated into four sections: I - Foundations; II - Counseling Considerations and Counseling Strategies; III - Specialized Populations; and IV - Emerging Issues; each chapter begins with an awareness of attitudes and beliefs checklist, asking excellent questions related to the particular topic, then introducing the reader to a specific case study, also related to the specific chapter. At this juncture, the author(s) of each chapter introduce the reader to the particular topic, with the chapter ending in Questions for Further Discussion, and Resources.

Fostering Intrinsic Resilience: A Neuroscience-Informed Model of Conceptualizing and Treating Adverse Childhood Experiences

An increasingly common dialogue among mental health professionals revolves around adverse childhood experiences (ACEs) and developmental trauma. ACEs can occur in a number of ways with a myriad of potential outcomes, often making treatment choices difficult. During critical stages of neurodevelopmental growth, trauma makes a mark on the brain and body at a physiological level. Although the National Institute of Mental Health's Research Domain Criteria have been used to address this brain–body impact, the far-reaching scope of implications needs grounding in a theoretical framework. The current paper discusses developmental trauma and proposes a new reciprocally determinant model that advocates for neuroscience-informed counseling interventions such as neurofeedback therapy. Clinical implications and considerations for counselors are discussed.

Genetic Counseling and Surveillance Focused on Lynch Syndrome.

Lynch syndrome is a hereditary cancer syndrome caused by germline mutations in one of several DNA mismatch repair genes. Lynch syndrome leads to an increased lifetime risk of various cancers, particularly colorectal, and endometrial cancers. After identifying patients suspected of having Lynch syndrome by clinical criteria, computational prediction models, and/or universal tumor testing, genetic testing is performed to confirm the diagnosis. Before and after genetic testing, genetic counseling should be provided. Genetic counseling should involve a detailed personal and family history, information on the disorder and genetic tests, discussion of the management and surveillance of the disease, career plan, family plan, and psychosocial support. Surveillance of colorectal cancer and other malignancies is of paramount importance for properly managing Lynch syndrome. This review focuses on important considerations in genetic counseling and the latest insights into the surveillance of individuals and families with Lynch syndrome.

Predictors of swallow function after transoral surgery for locally advanced oropharyngeal cancer.

Transoral surgery (TOS) for oropharyngeal carcinoma (OPC) is steadily becoming more routine. Expected posttreatment swallow function is a critical consideration for preoperative counseling. The objective of this study was to identify predictors of swallow dysfunction following TOS for advanced tumor (T)-stage (T3-T4) OPC. A retrospective review from 1997 to 2016 at a single institution was performed. Eighty-two patients who underwent primary transoral resection of locally advanced OPCs with at least 1 year of postoperative follow-up were included. The primary outcome measure was swallow function, as measured by the Functional Outcomes Swallowing Scale (FOSS) at 1 year postoperatively. Operative reports were reviewed, and the extent of resection and type of reconstruction were documented. Conjunctive consolidation was then performed to incorporate multiple variables and their impact on swallow function into a clinically meaningful classification system. Fifty-six patients (68%) had acceptable swallowing at 1 year. T4 tumor stage and receipt of adjuvant chemoradiation therapy (CRT) were strongly associated with poor swallowing but did not reach statistical significance. Only base of tongue (BOT) resection ≥50% (odds ratio [OR] 3.19, 95% confidence interval [CI] 1.21-8.43) and older age (OR 1.06, 95% CI 1.00-1.12) were significantly associated. Utilizing T-stage, adjuvant CRT, and BOT resection, a conjunctive consolidation was performed to develop a classification system for swallow dysfunction at 1 year. This study provides risk stratification for swallow function at 1 year following primary transoral resection of locally advanced OPCs. BOT resection ≥50%, especially when coupled with T4 tumor stage or adjuvant CRT, was associated with poor long-term swallow outcomes. 3 Laryngoscope, 130:94-100, 2020.

Satisfaction in Consensual Nonmonogamy

Inaccurate stigmas and stereotypes may prevent individuals involved in consensual nonmonogamous (CNM) relationships from getting the counseling they seek when facing relational issues. Misperceptions regarding the satisfaction level of individuals in CNM relationships may perpetuate stereotypes and complicate therapeutic care. The current research attempted to determine the satisfaction levels of those involved in CNM relationships using the Relationship Assessment Scale (RAS) and the Relational Assessment Questionnaire. Results of N = 150 find a mean of 4.12 (0.76) on the RAS for the CNM group indicating no difference in satisfaction between the CNM sample and individuals identifying as monogamous. This research offers important considerations for counselors in reviewing biases and judgments they may hold in working with this population and contributes to the dearth of literature on CNM populations.

Rehabilitation Counseling Considerations for People With Lifestyle-Related Disabilities Such as Diabetes Mellitus, Heart Disease, and Asthma: A Review and Synthesis of the Literature

BackgroundMany emerging disabilities that affect today's rehabilitation consumers are linked to lifestyle factors such as diet, exercise, smoking, substance use, and obesity. Lifestyle-related disabilities have dramatically increased in incidence and prevalence over the past two decades. Rehabilitation counselors play an important role in addressing the unique challenges and opportunities that face people with emerging lifestyle-related disabilities.ObjectiveThe goals of this article are to (a) examine lifestyle factors that have changed the constellation of the American and global disability communities over the past 20–30 years; (b) examine the health, psychosocial, and vocational implications of several emerging lifestyle-related disabilities; and (c) describe the changing role of rehabilitation counselors in addressing the growing needs of consumers with these disabilities.MethodA review of the literature on lifestyle-related disabilities and rehabilitation implications indicated new service delivery considerations for working with this growing clientele.ResultsDiabetes mellitus, asthma, heart disease, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), emphysema, stroke, and certain types of cancer were found to be among the most significant emerging lifestyle-related disabilities. New interventions are required to meet the rehabilitation needs of this growing clientele.ConclusionsThe increased presence of lifestyle-related disabilities has numerous implications for rehabilitation practice that are discussed in this article.

Genetic counseling considerations with rapid genome-wide sequencing in a neonatal intensive care unit.

As genome-wide sequencing (GWS; exome sequencing [ES] and whole genome sequencing [WGS]) is implemented more frequently in the neonatal intensive care unit (NICU), it is important to understand parents' opinions regarding GWS, and views toward incidental findings (IFs) (also known as secondary findings). RAPIDOMICS was a pilot study of rapid trio-based (biological parents and neonate) ES for 25 neonates with a suspected genetic condition at the BC Women's Hospital NICU. As part of RAPIDOMICS, we explored parents' motivations and concerns regarding ES of their child, uptake of IFs for themselves, and rates of anxiety and depression at the time of pre-test genetic counseling via administration of the Generalized Anxiety Disorder Assessment 7 and Patient Health Questionnaire 8. These findings were compared to those from the Clinical Assessment of the Utility of Sequencing and Evaluation as a Service (CAUSES) study (outpatient trio-based GWS) that includes pediatric patients with suspected genetic disease (with an average age of 10years). Parents in RAPIDOMICS were more likely to identify "diagnosis" as their primary motivation to pursue GWS (p=0.011), less likely to identify "no concerns" (p=0.003), and less likely to opt in to receive IFs (p=0.003) than parents in CAUSES. Rates of depression and anxiety in both groups were higher relative to the general population. We present novel findings regarding the similarities and differences in parental opinions and decisions of these cohorts.

Condition of Food Sanitation and Hygiene in East Bandung, West Java

Food security is one of the health problems in Indonesia which is related to the lack of knowledge of how the production process, the hygiene and health of the food. This study aims to describe the sanitary and hygienic conditions of food sold by merchant in Cibiru, Bandung City, West Java. The study was conducted in May-June 2017 by determining five sampling location based on the number of merchant in Cibiru. Data was obtained through questionnaire filling of 40 respondents at each sampling point which was then analyzed to find out the characteristics of social-demographic of the respondents, personal hygiene, and support of environmental sanitation. The results shows that the sanitation and hygiene of food in the aspect of knowledge of personal hygiene showed that the food handler was experienced food processors (88%) and 12% had no experience even though their last education was not linear with their trading profession. In addition, respondents' knowledge of individual hygiene shows that out of the nine aspects observed, 33% are in the high category, 11% are moderate and 56% are in the low category. Aspects of environmental sanitation and other support of food sanitation show that the conditions are in the clean and adequate category. All of these aspects can be used as a basic consideration in further counseling about food hygiene and food processing so that it can avoid unpredictable outbreaks.

Preconception counselling for low health literate women: an exploration of determinants in the Netherlands

BackgroundWomen from lower socioeconomic groups tend to be at greater risk of adverse perinatal outcomes, but are less likely to participate in preconception counselling compared to higher socioeconomic groups. This could be partly because of their limited skills to assess, understand and use health related information in ways that promote and maintain good health (health literacy skills). In this study we explored determinants of participation in preconception counselling among women with low health literacy in The Netherlands.MethodsPotential determinants of participation in preconception counselling were derived from the literature, and mapped onto a theoretical framework, which was tested for perceived relevance and completeness in an expert review (n = 20). The framework was used to prepare face-to-face interviews with women with low health literacy and a wish to conceive (n = 139). In the interviews we explored preconception counselling awareness, knowledge, considerations, subjective norms, self-efficacy, attitude, and intention. Linear regression analyses were used to test associations with intention to participate in preconception counselling.ResultsMost women (75%) were unaware of the concept of preconception counselling and the provision of counselling, even if they lived in areas where written invitations had been disseminated. Common considerations for participation were: preparation for pregnancy; perceived lack of information; and problems in a previous pregnancy. Considerations not to participate were mostly related to perceived sufficient knowledge and perceived low risk of perinatal problems. Respondents generally had a positive attitude towards participation in preconception counselling for themselves, and 41% reported that they would participate in preconception counselling.ConclusionWomen with low health literacy were generally unaware of the concept and provision of preconception counselling, but seemed to be interested in participation. Further research should investigate how to effectively reach and inform this group about preconception counselling. This knowledge is essential for evidence-based development of interventions to increase the accessibility and understanding of preconception counselling.

Retreatment after focal therapy for failure: a bridge too far?

To summarize the current knowledge about the evaluation of disease persistence and recurrence after focal therapy ablation (FTA) for small renal masses and to assess the outcomes and complications of related treatment options. FTA procedures continuously increased over the last 20 years, being now performed in more than one on 10 patients with T1a renal cell carcinoma. Disease recurrence seems to occur more often following radiofrequency ablation (RFA) compared with cryoablation. Evidence about the management of disease recurrence is scarce. Treatment options are similar to those available for de novo renal cell carcinomas, and include reablation, partial or radical nephrectomy and observation. Reablation is feasible, safe and can be easily done in the majority of cases. Oncological outcomes of repeated ablation, although encouraging, remain mostly uninvestigated and unreported. In case of disease persistence or recurrence after FTA, observation may be an acceptable approach, reserving repeated ablation or surgery only in those exhibiting significant tumor growth. In these patients repeated ablation with RFA is safe and noninvasive. Surgery after FTA presents technical difficulties related to perinephric scarring, especially with regards to nephron-sparing surgery. This should be taken into consideration in patients' counseling as well as in decision-making process.

Diabetes Comorbidity Increases Risk of Postoperative Complications in Traumatic Thoracic Vertebral Fracture Repair: A Propensity Score Matched Analysis

Thoracic vertebral fracture repair after a traumatic injury can be associated with significant risk for postoperative complications. Surgical outcomes are further complicated by patient comorbidity, particularly diabetes mellitus. This study compared outcomes and complication rates for traumatic thoracic vertebral fracture repair in a matched sample of patients with diabetes and nondiabetic control subjects. Patients with a surgical repair of a trauma-induced thoracic vertebral fracture treated from 2010 to 2015 were identified from the Trauma Quality Improvement Program database, yielding 5557 cases. Patients with comorbid diabetes were matched by propensity score matching (PSM) with patients without diabetes on age, race, and body type and were compared by postoperative complications and clinical outcomes. Prior to PSM, the diabetes group was older on average and had a greater proportion of patients who were obese (Ps < 0.001). After PSM, each group consisted of 544 patients (N= 1088) and no longer differed by any baseline characteristic. Comorbid diabetes was associated with longer average length of hospital stay and greater frequency of several major and minor postoperative complications (Ps < 0.05), including prolonged intensive care, pneumonia, acute renal failure, stroke, pressure ulcers, and urinary tract infections, but no differences were found in reoperation rates or in-hospital mortality. Diabetes comorbidity can significantly increase the risk of postoperative complications after traumatic thoracic vertebral fracture repair, which may lead to delayed recovery and greater health care-related costs. This finding is an important consideration for surgical decision-making and patient counseling on treatment options with this comorbid condition.

Long-Term Physical HRQOL Decreases After Single Lung as Compared With Double Lung Transplantation

Single lung transplantation (SLT) and double lung transplantation (DLT) are associated with differences in morbidity and mortality, although the effects of transplant type on patient-reported outcomes are not widely reported and conclusions have differed. Previous studies compared mean health-related quality of life (HRQOL) scores but did not evaluate potentially different temporal trajectories in the context of longitudinal follow-up. To address this uncertainty, this study was designed to evaluate longitudinal HRQOL after SLT and DLT with the hypothesis that temporal trajectories differ between SLT and DLT. Patients transplanted at a single institution were eligible to be surveyed at 1 month, 3 months, 6 months, and then annually after transplant using the Short Form 36 Health Survey, with longitudinal physical component summary (PCS) and mental component summary (MCS) scores as the primary outcomes. Multivariable mixed-effects models were used to evaluate the effects of transplant type and time posttransplant on longitudinal PCS and MCS after adjusting age, diagnosis, rejection, Lung Allocation Score quartile, and intubation duration. Time by transplant type interaction effects were used to test whether the temporal trajectories of HRQOL differ between SLT and DLT recipients. HRQOL scores were referenced to general population norms (range, 40 to 60; mean, 50 ± 10) using accepted standards for a minimally important difference (½ SD, 5 points). Postoperative surveys (n= 345) were analyzed for 136 patients (52% male, 23% SLT, age 52 ± 13 years, LAS 42 ± 12, follow-up 37 ± 29 months [range, 0.6 to 133]) who underwent lung transplantation between 2005 and 2016. After adjusting for model covariates, overall posttransplant PCS scores have a significant downward trajectory (p= 0.015) whereas MCS scores remain stable (p= 0.593), with both averaging within general population norms. The time by transplant type interaction effect (p= 0.002), however, indicate that posttransplant PCS scores of SLT recipients decline at a rate of 2.4 points per year over the total observation period compared to DLT. At approximately 60 months, the PCS scores of SLT recipients, but not DLT recipients, fall below general population norms. The trajectory of physical HRQOL in patients receiving SLT declines over time compared with DLT, indicating that, in the longer term, SLT recipients are more likely to have physical HRQOL scores that fall substantively below general population norms. Physical HRQOL after 5 years may be a consideration for lung allocation and patient counseling regarding expectations when recommending SLT or DLT.

Considerations in Dietetic Counseling for Vitamin D

Considerations in Dietetic Counseling for Vitamin D

Impact of frailty on complications in patients with thoracic and thoracolumbar spinal fracture

ObjectivesIt is well-documented that geriatric patients are at risk for serious injuries after fracture due to pre-existing medical conditions, physical changes of aging, and medication effects. Frailty has been demonstrated to be a predictor of morbidity and mortality in inpatient head and neck surgery, and for surgical intervention for adult spinal deformity and degenerative spine disease. However, the impact of frailty on complications following thoracolumbar/thoracic fractures are unknown and has not been previously assessed in the literature, particularly in a nationwide setting. Patients and MethodsThis was a retrospective study of the prospectively-collected American College of Surgeons National Surgical Quality Improvement database for the years 2007 through 2012. Patients who underwent spinal decompression (+/− fusion) or an alternative intervention, defined as vertebroplasty or kyphoplasty (VP/KP) for thoracic or thoracolumbar fracture were identified. Frailty status was determined using a modified frailty index from the Canadian Study of Health and Aging Frailty Index, with frailty defined as a score = 0.27. 30-day morbidity and mortality were compared between frail and non-frail patients in each treatment group. ResultsA total of 303 patients were included in this study. Of these, 38% of patients had VP/KP and 62% underwent surgery. Within the VP/KP cohort, 26% were frail. The proportion of these patients who developed at least one complication was 3.3% versus 3.6% for non-frail patients (p = 1.0). The 30-day mortality for frail versus not frail patients in this cohort was 0% versus 2.4% (p = 1.0). Among the surgical group, 13% were frail. In contrast, the likelihood of complications was 33.3% among frail patients and 4.2% for non-frail patients (p < 0.001). Frail patients also had a 16.7% 30-day mortality rate as compared to 0.6% in the non-frail group (p = 0.001). When comparing the frail versus non-frail patients overall, frail patients had a complication rate of 16.7%, as opposed to 4.0% in non-frail patients. ConclusionFrailty and surgical intervention are correlated with a higher 30-day complication rate in patients with thoracic and thoracolumbar fracture. This finding is an important consideration for surgical decision-making and patient counseling on treatment options.

Medicine as a calling among male and female medical students in Israel: Does it make a difference?

This study focused on the perception of medicine as a calling and its associations with medical training satisfaction, career certainty, career satisfaction, career commitment, and well-being among 176 Israeli medical students. Participants replied to an online questionnaire including the Brief Calling Scale (Duffy and Sedlacek in Career Dev Q 59:27–41, 2010) and measures related to medical training, a medical career, and well-being. Calling was positively associated with all outcome measures, and gender moderated these associations, which were stronger for female medical students in comparison with male medical students. The importance of taking these gender differences regarding calling under consideration for career counseling is discussed.

Counseling Issues: Addressing Behavioral and Emotional Considerations in the Treatment of Communication Disorders.

Counseling is an important fundamental professional activity and an established component of the speech-language pathology/audiology scope of practice as documented by the American Speech-Language-Hearing Association (2004a, 2016a). Appropriate incorporation of counseling into practice can optimize service provision, help address comorbid behavioral and emotional reactions to communication disorders, and enhance prognosis. Practitioner insecurity in incorporating counseling into practice has been documented by Phillips and Mendel (2008), as well as Atkins (2007). This tutorial seeks to present general counseling constructs and treatment applications primarily utilizing a humanistic counseling perspective. This tutorial incorporated relevant publications from communication disorders and counseling psychology literature databases over a 3-year period. The tutorial evolved through interviews with practicing speech-language pathology practitioners and educators and was undertaken to provide transparency and clarity to support the assertions and recommendations offered. This tutorial organizes and presents general counseling considerations along with specific suggestions, which can help practitioners who are seeking to expand their understanding, skill, and confidence in incorporating counseling into their practice. The tutorial identifies some of the potential and impactful comorbid emotional and behavioral responses to experiencing a communication disorder and/or to the treatment process for the communication disorder issue(s). Theoretically grounded considerations for mitigating such potentially impactful responses are offered. Continued and enhanced efforts may be necessary to meet American Speech-Language-Hearing Association's mandate for universal incorporation of empirically supported counseling approaches and in advancing universal speech-language pathology/audiology training in this area. It is hoped that this tutorial serves as an initial guide for addressing this need until universal preparation and practice is achieved.

Inherited Cancer in the Age of Next-Generation Sequencing.

Next-generation sequencing (NGS) technology has led to the ability to test for multiple cancer susceptibility genes simultaneously without significantly increasing cost or turnaround time. With growing usage of multigene testing for inherited cancer, ongoing education for nurses and other health-care providers about hereditary cancer screening is imperative to ensure appropriate testing candidate identification, test selection, and posttest management. The purpose of this review article is to (1) provide an overview of how NGS works to detect germline mutations, (2) summarize the benefits and limitations of multigene panel testing, (3) describe risk categories of cancer susceptibility genes, and (4) highlight the counseling considerations for patients pursuing multigene testing.

International Students in Community Colleges: On-Campus Services Used and Its Affect on Sense of Belonging

ABSTRACTWhile the enrollment trends of international students studying in universities and four-year colleges have been well documented over the recent years, there is evidence that international students are also enrolling at higher rates in community colleges. Although the issues and student service needs and trends of international students studying at four-year universities and colleges have received much attention in the literature over the years, there appears to be a dearth of literature that focuses on international students studying in community colleges. Thus, in response to this gap in the training literature, this study examined the prevalence of on-campus services used and their contribution to the development of sense of belonging for international students studying in US community colleges. Utilizing the Community College Survey of Student Engagement (CCSSE) as our data collection instrument, results of this study suggest that services used by international students in US community colleges are varied. Furthermore, results of multiple regression analyses indicate that academic advising services most contributed to international students’ sense of belonging on US community college campuses. Based on the findings of this study, recommendations on working with international students are provided for community college faculty and student affairs personnel including special recommendations and counseling considerations for college counselors who work with international students.

Genomic mosaicism in paternal sperm and multiple parental tissues in a Dravet syndrome cohort

Genomic mosaicism in parental gametes and peripheral tissues is an important consideration for genetic counseling. We studied a Chinese cohort affected by a severe epileptic disorder, Dravet syndrome (DS). There were 56 fathers who donated semen and 15 parents who donated multiple peripheral tissue samples. We used an ultra-sensitive quantification method, micro-droplet digital PCR (mDDPCR), to detect parental mosaicism of the proband’s pathogenic mutation in SCN1A, the causal gene of DS in 112 families. Ten of the 56 paternal sperm samples were found to exhibit mosaicism of the proband’s mutations, with mutant allelic fractions (MAFs) ranging from 0.03% to 39.04%. MAFs in the mosaic fathers’ sperm were significantly higher than those in their blood (p = 0.00098), even after conditional probability correction (p’ = 0.033). In three mosaic fathers, ultra-low fractions of mosaicism (MAF < 1%) were detected in the sperm samples. In 44 of 45 cases, mosaicism was also observed in other parental peripheral tissues. Hierarchical clustering showed that MAFs measured in the paternal sperm, hair follicles and urine samples were clustered closest together. Milder epileptic phenotypes were more likely to be observed in mosaic parents (p = 3.006e-06). Our study provides new insights for genetic counseling.

Orchidopexy in children with Prader–Willi syndrome: Results of a long-term follow-up study

Prader-Willi syndrome (PWS) is a rare (1:20.000) genetic condition affecting both males and females. Among other features, in boys, the syndrome is characterized by cryptorchidism in 86-100% of cases, hypogonadism, delayed puberty and infertility. The aim of the present study is to appraise the results of orchidopexy in this selected population of children. A follow-up study of children with PWS treated for undescended testes at a single institution over a 20-year period was performed. Patients were identified from a National PWS registry and reviewed at a special follow-up clinic. Data were collected from electronic and hard copies records and reported as median (range). Thirty-three children (1-17 years) were identified. Co-morbidities were present in 22 (66%) and 15 (45%) were on growth-hormone therapy. Six patients (19%) had normal testes palpable in the scrotum; twenty-seven (81%) had undescended testes and required orchidopexy. Thirteen (48%) underwent a bilateral procedure for a total of 40 procedures. A 2-stage Fowler-Stephens orchidopexy was required in 2 (7%) testes. At surgery hypotrophic testes were documented in 6 (22%) patients. Age at orchidopexy was 1.4 years (0.5-5.5). Age at FU was 7.2 years (1.7-17). Length of follow-up is 3.5 years (0.4-14). At follow-up 16 (40%) testes were of normal size and palpable in the scrotum; 7 (17.5%) testes required redo-orchidopexy. All patients (6/33) over 16 years of age that had testosterone levels tested had values below normal limits after successful orchidopexy. This study evaluates the results of orchidopexy in a large population of children with PWS. At follow-up, only 40% of testes were of normal size and in the scrotum. This information should be taken into consideration for patients' management and pre-operative parents' counseling.