Implementation of INHERET, an Online Family History and Cancer Risk Interpretation Program for Primary Care and Specialty Clinics.

BACKGROUND: Individuals at increased risk for cancer are ascertained at low rates of 1% to 12% in primary care (PC). Underserved populations experience disparities of ascertainment, but data are lacking. INHERET is an online personal and family history tool to facilitate the identification of individuals who are eligible, according to guidelines, to be counseled on germline genetic testing and risk management. PATIENTS AND METHODS: INHERET data entry uses cancer genetics clinic questionnaires and algorithms that process patient data through NCCN Clinical Practice Guidelines in Oncology and best practice guidelines. The tool was tested in silico on simulated and retrospective patients and prospectively in a pilot implementation trial. Patients in cancer genetics and in PC clinics were invited to participate via email or a card. Informed consent was completed online. RESULTS: INHERET aimed to integrate patient data by algorithms based on professional and best practice guidelines to elicit succinct, actionable recommendations that providers can use without affecting clinic workflow or encounter length. INHERET requires a 4th-grade reading level, has simple navigation, and produces data lists and pedigree graphs. Prospective implementation testing revealed understandability of 90% to 100%, ease of use of 85%, and completion rates of 85% to 100%. Physicians using INHERET reported no added time to their encounters when patients were identified for counseling. In a specialty genetics clinic, INHERET's data were input, on average, within 72 hours compared with 4 to 6 weeks through standard care, and the queue for scheduling patients decreased from 400 to fewer than 15 in <6 months. CONCLUSIONS: INHERET was found to be accessible for all education and age levels, except patients aged >70 years, who encountered more technical difficulties. INHERET aided providers in conveying high-risk status to patients and eliciting appropriate referrals, and, in a specialty clinic, it produced improved workflows and shortened queues.

PSYCHOPATHY AND RISKY SEXUAL BEHAVIOR IN INCARCERATED WOMEN.

To date, very few studies have explored the association between psychopathic traits and risky sexual behavior (RSB) among women. Here, we investigated this relationship in a sample of 137 incarcerated women. Psychopathic traits were assessed via the Hare Psychopathy Checklist-Revised (PCL-R) and lifetime RSB measures, including number of lifetime sexual partners, frequency of engaging in sexual intercourse while intoxicated, and frequency of forgoing protection (e.g., condom usage) during sexual intercourse, were assessed through self-report. PCL-R Facet 3 scores (assessing lifestyle psychopathic traits) were associated with an increased frequency of engaging in sexual intercourse while intoxicated. In addition, women scoring high on the PCL-R were more likely to engage in sexual intercourse while intoxicated compared with a previously collected sample of men scoring high on the PCL-R. The results obtained in the current study help improve our understanding of the association between psychopathic traits and RSB among women.

The relationship between psychopathic traits and risky sexual behavior in incarcerated adult male offenders.

Individuals scoring high on psychopathic traits engage in various forms of risky behavior. However, the relationship between psychopathic traits and risky sexual behavior (RSB) is less understood, especially with participants recruited from incarcerated settings. Here, we investigated the relationship between RSB and psychopathic traits with n = 179 incarcerated adult male offenders who completed a self-report RSB questionnaire asking participants about their lifetime number of sexual partners and frequency of using a condom during sex. Psychopathic traits were assessed using the Hare Psychopathy Checklist - Revised (PCL-R). In independent-samples t-tests, participants scoring high on psychopathic traits (i.e., PCL-R total score ≥ 30) reported greater total number of sexual partners throughout their lifetime and were less likely to use a condom during sex compared to low-scorers (i.e., PCL-R total score ≤ 15). In multiple regression analyses, PCL-R total scores emerged as a significant predictor of reduced condom usage during sex, but covariate measures assessing general externalizing psychopathology, did not. Our results suggest that several public health concerns, including sexually transmitted infection transmittal and unwanted pregnancies, may arise due to individuals scoring higher on psychopathy engaging in risky sexual behavior to a greater extent compared to those scoring lower on psychopathy.

Traumatic Brain Injury and Psychopathic Traits in Justice-Involved Adult Women.

Studies have documented associations between traumatic brain injury (TBI) and mental disorders. The relationship between psychopathic personality and TBI remains poorly understood, though both are associated with similar characteristics (e.g., low empathy, aggression, disturbances in social/moral behavior). Yet, it is not clear whether assessment of psychopathic features is influenced by presence versus absence of TBI, and which aspects of TBI may be associated with psychopathic traits. This study examined the psychopathy-TBI association in justice-involved women (N = 341) with structural equation modeling. We tested if measurement invariance of psychopathic traits was evident among those with versus without TBI and which TBI variables (number, severity, age at first TBI) predicted psychopathic features in conjunction with symptoms of psychopathology, IQ, and age. Results provided evidence of measurement invariance, and more women with TBI, compared to those without, met criteria for psychopathy. Younger age of TBI and TBI severity predicted interpersonal-affective psychopathic features.

Self-care needs of caregivers dealing with stroke.

Education is essential for successful transition from hospital to home, for both persons with stroke and their caregivers. Guided by Orem's self-care deficit nursing theory, this article identifies self-care needs about which physical and occupational therapists believe caregivers most frequently want information. The therapists (N=113), who responded to a mailed survey, were mostly White women prepared at the graduate educational level in the eastern United States. Descriptive statistics revealed that demonstrating safe transfer techniques was the most frequently chosen information need (82%) identified by physical and occupational therapists surveyed.

Evaluation of potential adverse health effects resulting from chronic domestic exposure to the organophosphate insecticide methyl parathion.

Methyl parathion (MP) was used illegally to spray homes for insect control over approximately an 8-yr period. In an attempt to determine if there were any adverse health effects from this, health-screening evaluations were performed on 353 individuals living in homes that were illegally sprayed. The average subject spent 15.5 h a day in the home. Subjects from homes with high levels of MP (exposure group) were compared to controls that lived in homes with minimal or no MP. Subjects were aware of the levels of MP found in their homes and recall bias was likely. There were no significant differences in the symptoms reported or by the physician assessment of subacute or chronic toxicity between those in the exposure group and controls. No significant differences were found in growth and developmental evaluations. Three subjects were identified who most likely suffered acute toxicity from the initial exposure and were not appropriately diagnosed and treated. Cholinesterase determinations also did not differ between those in the exposure group and controls. When subjects from the exposure group were stratified by the level of MP in their home, those from homes with the highest levels appeared to have an increased likelihood of subacute toxicity and reported an increased number of neuropsychiatric symptoms (OR 2 for both evaluations).

The Organism/Organic Exposure to Orbital Stresses (O/OREOS) satellite: radiation exposure in low-earth orbit and supporting laboratory studies of iron tetraphenylporphyrin chloride.

We report results from the exposure of the metalloporphyrin iron tetraphenylporphyrin chloride (FeTPPCl) to the outer space environment, measured in situ aboard the Organism/Organic Exposure to Orbital Stresses nanosatellite. FeTPPCl was exposed for a period of 17 months (3700 h of direct solar exposure), which included broad-spectrum solar radiation (∼122 nm to the near infrared). Motivated by the potential role of metalloporphyrins as molecular biomarkers, the exposure of thin-film samples of FeTPPCl to the space environment in low-Earth orbit was monitored in situ via ultraviolet/visible spectroscopy and reported telemetrically. The space data were complemented by laboratory exposure experiments that used a high-fidelity solar simulator covering the spectral range of the spaceflight measurements. We found that thin-film samples of FeTPPCl that were in contact with a humid headspace gas (0.8-2.3% relative humidity) were particularly susceptible to destruction upon irradiation, degrading up to 10 times faster than identical thin films in contact with dry headspace gases; this degradation may also be related to the presence of oxides of nitrogen in those cells. In the companion terrestrial experiments, simulated solar exposure of FeTPPCl films in contact with either Ar or CO2:O2:Ar (10:0.01:1000) headspace gas resulted in growth of a band in the films' infrared spectra at 1961 cm(-1). We concluded that the most likely carriers of this band are allene (C3H4) and chloropropadiene (C3H3Cl), putative molecular fragments of the destruction of the porphyrin ring. The thin films studied in space and in solar simulator-based experiments show qualitatively similar spectral evolution as a function of contacting gaseous species but display significant differences in the time dependence of those changes. The relevance of our findings to planetary science, biomarker research, and the photostability of organic materials in astrobiologically relevant environments is discussed.