Counseling Issues Research Articles

Understanding Gender and Culture Within the Context of Spirituality: Implications for Counselors

This article examines roles that gender, culture, and spirituality play in elements of therapeutic process. It presents an initial literature review of gender, culture, and spirituality as these factors relate to shaping identities and defining one's behavior. Discussions on how these 3 dimensions influence the level of understanding and effective responsiveness that competent counseling professionals should consider in a culturally and spiritually diverse society are presented. Three case studies provide a framework to illuminate the complexity that professionals face when counseling issues are viewed through unique gender, cultural, and spiritual worldviews. Implications for counselors and the counseling profession are provided.

Fertility choices and management for HIV-positive women

It is becoming increasingly important to address the issue of reproductive counselling and management of HIV-infected individuals during their reproductive years. Sexual and reproductive health-related needs and aspirations are similar to those of uninfected individuals but some differences require specific attention, which are discussed in this review. Hormonal contraception should be used with caution in women on antiretroviral treatment. Its impact on both HIV infectivity and disease progression is still controversial. An intrauterine device can be considered for pregnancy prevention and pregnancy termination should be offered in safe conditions. HIV-infected women have a lower spontaneous fertility rate, which may persist after assisted reproduction. Data on safety of antiretroviral treatment during conception are reassuring. No clear association can be found between exposure to antiretrovirals and fetal abnormalities. Secondary prevention remains crucial and condom use remains a key method. Different topics related to fertility choices among HIV-infected patients should be addressed. Family planning methods and termination of pregnancy have specific aspects among infected individuals. When needed, medically assisted reproduction may be required and antiretroviral treatment should be adapted before conception. Secondary prevention has a key role in reducing newly acquired infections.

Genetic Testing and Genetic Counseling in Cardiovascular Genetic Medicine: Overview and Preliminary Recommendations

In this emerging era of cardiovascular genetic medicine, increasing responsibility will be placed on cardiovascular practitioners to be aware of the latest clinical genetic testing methods and the knowledge base needed to interpret genetic test results. Some cardiovascular specialists will develop the expertise within the field to order genetic testing and interpret results, while other practitioners will refer patients to centers of excellence in cardiovascular genetic medicine. A previous article in the Cardiovascular Genetic Medicine: Clinical Perspectives and Future Applications series(1) highlighted an increasing recognition of the cardiomyopathies (hypertrophic [HCM], dilated [DCM], arrhythmogenic right ventricular dysplasia [ARVD]) and channelopathies (long QT syndrome [LQTS] and others) as genetic diseases, and focused on the importance of a targeted family history as a critical part of patient evaluation. The goal of this article, second in the series, is to provide a general framework for understanding the principles of genetic testing and genetic counseling. We review the growing number of genetic tests currently available to cardiac specialists, the selection of an appropriate test, and the numerous genetic counseling issues raised by the testing process. We also provide our preliminary recommendations for genetic testing in cardiovascular genetic medicine.

Assessing educational priorities in genetics for general practitioners and specialists in five countries: factor structure of the Genetic-Educational Priorities (Gen-EP) scale

PurposeA scale assessing primary care physicians' priorities for genetic education (The Gen-EP scale) was developed and tested in five European countries. The objective of this study was to determine its factor structure, to test scaling assumptions and to determine internal consistency. MethodsThe sample consisted of 3686 practitioners (general practitioners, gyneco-obstetricians, pediatricians) sampled in France, Germany, the Netherlands, Sweden, and United Kingdom. We first determined the factor structure of the Gen-EP scale (30 items) on the whole sample. Scaling assumptions were then tested on each country using multitrait scaling analysis. Internal consistency was assessed across the five countries. ResultsSix factors were identified accounting for 63.3% of the variance of the items. They represented the following priorities for genetic education: “Genetics of Common Diseases”; “Ethical, Legal, and Public Health Issues”; “Approaching Genetic Risk Assessment in Clinical Practice”; “Basic Genetics and Congenital Malformations”; “Techniques and Innovation in Genetics” and “Psychosocial and Counseling Issues.” In each country, convergent and discriminant validity were satisfactory. Internal-consistency reliability coefficients (Cronbach's α) were all above the acceptable threshold (0.70). ConclusionThe Gen-EP scale could be a helpful instrument in different countries to organize and evaluate the impact of genetic educational programs for primary care providers.

Genetics in clinical practice: general practitioners' educational priorities in European countries

PurposeTo assess how general practitioners (GPs) from European countries prioritized their genetic educational needs according to their geographic, sociodemographic, and educational characteristics. MethodsCross-sectional survey, random and total samples of GPs in five European countries (France, Germany, the Netherlands, Sweden, and United Kingdom), mailed questionnaires; Outcome: Genetic Educational Priority Scale (30 items; six subscores). ResultsA total 1168 GPs answered. Priorities differed (P < 0.001) but were consistently ranked across the countries. Previous education had a marginal effect on priorities. Women gave higher priorities than men to Genetics of Common Disorders (adjusted odds ratio [ORadj], 2.5; 95% confidence interval [CI], 1.6–3.8), Psychosocial and Counseling Issues (ORadj, 1.6; 95% CI, 1.1–2.5), and Ethical, Legal, and Public Health Issues (ORadj, 1.3; 95% CI, 1.1–1.8), but lower than men to Techniques and Innovation in Genetics (ORadj, 0.7; 95% CI, 0.5–0.9). Older physicians gave higher priorities to Basic Genetics and Congenital Malformations (ORadj, 1.5; 95% CI, 1.1–1.9), and to Techniques and Innovation in Genetics (ORadj: 1.3; 95% CI, 1.0–1.7), compared with their younger colleagues. ConclusionsExpressed genetic educational needs vary according to the countries and sociodemographics. In accordance, training could be more focused on genetics of common disorders and on how to approach genetic risk in clinical practice rather than on ethics, new technologies, or basic concepts.

A Review of Boundary Issues in Counseling: Multiple Roles and Responsibilities

Book reviewed in this article:Barbara Herlihy and Gerald Corey (2006). Boundary Issues in Counseling: Multiple Roles and Responsibilities (2nd ed.)

Heart Disease in Pregnancy. Second Edition.

Celia Oakley and Carole A. Warnes, eds 354 pages. Oxford, UK: Blackwell Publishing; 2007. $114.95. ISBN: 1-4051-3488-7 Oakley and Warnes’ second edition of Heart Disease in Pregnancy is a concise portable text that incorporates the views and practices of international experts to aid the reader in caring for the unique patient population of gravid women with heart disease. The highly readable text has a logical framework, starting with physiological changes in pregnancy and flowing through common, then rare, high-risk cardiovascular states. The chapters culminate in labor and delivery, with anesthetic approaches, then transition to the important issues of genetic counseling and contraception. Providing quick, easy access to information on basic physiology, disease states, and management strategies, it will be of interest to a very broad professional base. The first few chapters offer standard reviews of the response of the heart to pregnancy and physiological rather than pathological secondary changes in the physical examination. Cardiac testing during pregnancy is detailed. Importantly, the first pathology addressed is congenital heart disease, which has overtaken rheumatic valvular disease as the most common preexisting cardiac condition in women of childbearing age. The British perspective is illuminating, with subtle changes in nomenclature, …

Real Scenarios and Complementary Lectures: A Classroom Training Approach to Increase Counselor Awareness, Knowledge, and Skill

The purpose of this article is to describe a classroom approach for training counseling students in the area of cross‐cultural competence. The authors describe real scenarios that form the foundation for an intensive classroom discussion and lecture format regarding cultural awareness, knowledge, and skills.

Positive Psychology: The Case of Uganda

The application of positive psychology concepts in professional psychology in Uganda is in its infancy. Both undergraduate and postgraduate psychology programmes in Ugandan universities have very limited emphasis on positive psychology concepts. Some applications are apparent in HIV/AIDS and disability counseling issues. Other practice areas with use of positive psychology concepts include the counseling of war victims, orphans and street children. There is potential for a greater infusion of positive psychology concepts in professional psychology in Uganda.

Current Issues in Child Counseling: The Paradigm Shifts

Current Issues in Child Counseling: The Paradigm Shifts

New Issues in Genetic Counseling of Hereditary Colon Cancer

Clinicians face significant challenges in the diagnosis and management of familial colorectal cancer predisposition. Many of the challenges concern the rarity of individual conditions and their unfamiliarity to most clinicians, even those in the subspecialty areas of gastroenterology, colorectal surgery, and medical oncology. Because the World Wide Web now offers a wealth of information, familiarity with available online resources should be a minimal expectation of clinicians. Notably, these same resources are available to the lay public, so a more informed group of patients can be expected and is already being encountered. The web sites noted throughout this article are merely early examples of what should become an opportunity for instant access to the most up-to-date knowledge of rare familial colorectal cancers and their clinical features, molecular diagnostics, and clinical management and prevention. Many professional organizations have produced guidelines (in print and online) for use by practitioners in various specialties. The consistency, growing evidence base, and ready availability of these guidelines to providers and patients alike will likely foster greater recognition of the need to be in compliance with them. Finally, as investigators make progress with the genetics of these rare diseases, one can anticipate a "cooperative group" approach to clinical trials.

Needs for and Barriers to Correctional Mental Health Services: Inmate Perceptions

Needs for and Barriers to Correctional Mental Health Services: Inmate Perceptions

Genetics and Genomics

The October 15, 1997, issue of JAMA1 was devoted to genetics and featured articles on genomic screening in late-onset familial Alzheimer disease, BRCA1 sequence analysis, hereditary prostate cancer 1 locus, chromosome 19 single locus, and multilocus haplotype associations with multiple sclerosis, cancer incidence after retinoblastoma, prenatal genetic carrier testing, molecular diagnosis and carrier screening for β-thalassemia, genetic testing in hereditary colorectal cancer, molecular neurogenetics, family history and genetic risk factors, and preparing health professionals for the genetic revolution. During the past decade, there has been an explosion of progress in genetics and genomics including the sequencing of the human genome.2,3 In March 2008, JAMA will devote an entire theme issue to practical applications of genetics and genomics that are or might become clinically important. We invite authors to submit manuscripts reporting the results of original research, especially clinical trials; systematic reviews including meta-analyses; special communications; and commentaries. Evidence-based articles will be given priority. Topics of particular interest include genetic diagnosis including prenatal tests, genetic testing especially for illnesses for which presymptomatic intervention is possible, pharmacogenomics, gene therapy, evolutionary medicine such as genotypes with proven adaptive responses to emerging infections, genetic counseling, and ethical issues surrounding genetics. Manuscripts received by November 1, 2007, will have the best chance for consideration for this theme issue. All manuscripts will undergo our usual rigorous editorial review process. High-quality submissions not accepted for the theme issue may be considered for other issues of JAMA or, with the authors’ permission, for consideration by one of our Archives specialty journals, which are also devoting a March theme issue to this topic. Authors are encouraged to consult the JAMA Instructions for Authors4 for guidelines on preparing and submitting manuscripts.

NOVEL CFTR MISSENSE MUTATIONS IN BRAZILIAN PATIENTS WITH CONGENITAL ABSENCE OF VAS DEFERENS: COUNSELING ISSUES.

Screening for mutations in the entire Cystic Fibrosis gene (CFTR) of Brazilian infertile men with congenital absence of vas deferens, in order to prevent transmission of CFTR mutations to offspring with the use of assisted reproductive technologies. Specific polymerase chain reaction (PCR) primers were designed to each of the 27 exons and splicing sites of interest followed by single strand conformational polymorphism and Heteroduplex Analysis (SSCP-HA) in precast 12.5% polyacrylamide gels at 7 masculineC and 20 masculineC. Fragments with abnormal SSCP migration pattern were sequenced. Two novel missense mutations (S753R and G149W) were found in three patients (two brothers) together with the IVS8-5T allele in hetrozygosis. The available screenings for CF mutations do not include the atypical mutations associated to absence of vas deferens and thus, when these tests fail to find mutations, there is still a genetic risk of affected children with the help of assisted reproduction. We recommend the screening of the whole CFTR gene for these infertile couples, as part of the work-up before assisted reproduction.

Genetics and Genomics

The October 15, 1997, issue of JAMA1 was devoted to genetics and featured articles on genomic screening in late-onset familial Alzheimer disease, BRCA1 sequence analysis, hereditary prostate cancer 1 locus, chromosome 19 single locus, and multilocus haplotype associations with multiple sclerosis, cancer incidence after retinoblastoma, prenatal genetic carrier testing, molecular diagnosis and carrier screening for β-thalassemia, genetic testing in hereditary colorectal cancer, molecular neurogenetics, family history and genetic risk factors, and preparing health professionals for the genetic revolution. During the past decade, there has been an explosion of progress in genetics and genomics including the sequencing of the human genome.2,3 In March 2008, JAMA will devote an entire theme issue to practical applications of genetics and genomics that are or might become clinically important. We invite authors to submit manuscripts reporting the results of original research, especially clinical trials; systematic reviews including meta-analyses; special communications; and commentaries. Evidence-based articles will be given priority. Topics of particular interest include genetic diagnosis including prenatal tests, genetic testing especially for illnesses for which presymptomatic intervention is possible, pharmacogenomics, gene therapy, evolutionary medicine such as genotypes with proven adaptive responses to emerging infections, genetic counseling, and ethical issues surrounding genetics. Manuscripts received by November 1, 2007, will have the best chance for consideration for this theme issue. All manuscripts will undergo our usual rigorous editorial review process. High-quality submissions not accepted for the theme issue may be considered for other issues of JAMA or, with the authors’ permission, for consideration by one of our Archives specialty journals, which are also devoting a March theme issue to this topic. Authors are encouraged to consult the JAMA Instructions for Authors4 for guidelines on preparing and submitting manuscripts.

Intersections of Identities

ABSTRACT This paper addresses several key issues related to counseling lesbian, gay, bisexual, and transgender (LGBT) Asian-Americans. An understanding of the intersections of these identities is important, yet can be complex because of the diversity within Asian-American cultural groups (i.e., ethnicity, generation, skin color, religion, levels of minority stress, and acculturation) and within LGBT communities. These factors may influence counselors' selection of developmentally appropriate and culturally sensitive counseling approaches for LGBT Asian-American clients. We propose a framework for understanding the intersection of racial/ethnic and sexual identity development, the Racial Ethnic and Sexual Orientation Identification Chart (RSIC), which is designed to assist therapists in determining relevant counseling issues and strategies. A case study is included along with a discussion of multidimensional assessment and clinical implications.

Proceedings of the 2006 Annual Meeting of the Clerkship Directors in Internal Medicine (CDIM)

The Clerkship Directors in Internal Medicine (CDIM) held its annual meeting October 26 through 28, 2006 in New Orleans, with the theme of “Renewal and Revitalization.” Topics included developing appropriate clinical skills, factors influencing teaching effectiveness, enhancing interest in internal medicine, professionalism, recognizing student abuse, and how to incorporate into the clerkship the updated set of goals and objectives developed cooperatively by CDIM and the Society of General Internal Medicine. The CDIM meeting was part of Academic Internal Medicine Week, where educators and administrators involved in student, resident, and fellow education gather for the meetings of their individual organizations as well as for joint sessions of mutual interest. Participants share expertise and develop solutions to common problems. The week's themes included disaster preparedness, teaching patient safety, residents as teachers, improving feedback, and future directions for internal medicine education. Thirty research posters were presented; the following seven abstracts represent those that were chosen by CDIM for oral presentation or as one of the three Best Research Posters. Chheda determined that many clerkships do not explicitly address ethnic and racial disparities, outlined what is covered in the curricula that do exist, and explored barriers to inclusion of this topic. Griffith showed that the reporter-interpreter-manager-educator (RIME) framework of student assessment is effective even without formal group meetings and that housestaff RIME ratings are accurate, perhaps more so than those of attendings. Mintz described efficacy of an innovative intervention to raise student awareness about interacting with representatives of pharmaceutical companies. Walden demonstrated that students who have higher patient care workloads actually perform better on standardized examinations. Denton, in his study of accuracy of student logbook entries, discovered that students tend to underreport clinical exposures, calling into question the validity of this method for student and medical school evaluation. Hoellein demonstrated the effectiveness of using standardized patients to teach students how to address more complex history-taking and counseling issues. Kuzma added to her work on teaching cardiac auscultation, using computer resources to conduct a “virtual classroom.”

Vaginal Birth After Cesarean Delivery: Evidence-based Practice

Given the high national rate of cesarean delivery in current obstetric practice, patients considering vaginal birth after cesarean (VBAC) in subsequent pregnancies are frequently encountered. A recently growing body of literature on VBAC has produced concrete evidence to define the VBAC-associated risks and identify factors influencing success. An evidence-based approach can guide practitioners and patients through the complex counseling, decision-making, and management issues when considering VBAC delivery.

A Statewide Survey of School Counselors’ Perceptions on School Issues

School counselors maintain a unique professional role in a school setting. This article explores the perceptions of 255 school counselors in the State of Michigan on three contemporary school counseling issues: (a) pre-service training, (b) the professional role of counselors, and (c) school- related issues, related to the professional role of counselors. The results found no differences based on age among school counselors regarding school issues, while gender differences were found on three school issues. The results suggest that on certain issues, school counselors continue to be challenged with role ambiguity.

An Interview With Sunny Hansen: Pioneer and Innovator in Counseling and Career Development

During her 45‐year career, Sunny Hansen was a pioneer and innovator in counseling and career development. She has lived the holistic life about which she writes and teaches. In this interview, she discussed the major influences on her life, the evolution of her professional career from English and journalism teacher to counselor and counselor educator, and her teaching and scholarship. She also shared her insights on balancing life roles, holistic life planning, and the counselor as a change agent.