Improving supportive care for women with breast cancer in Australia: The challenge of modifying health systems

Although the benefits of many psychosocial support strategies in improving well being in women with breast cancer have been demonstrated, few women receive these programs as part of routine care. This paper provides some recommendations, based on experience in Australia, about how access to evidence-based supportive care strategies might be improved through modification of health systems. It demonstrates the paucity of research about the costs and health service implications of psychosocial support strategies, which is vital to health planning and service delivery change. It outlines the systematic approach taken in Australia to improving psychosocial support nationally by: the development of research reviews; preparation of guidelines about supportive care, implementation of programs to foster the adoption of guidelines through modification of policy, health service delivery and clinician training; and monitoring programs. Coalitions of government, health care professionals and consumers are key to effective lobbying for change. If all women with breast cancer are to receive better supportive care, there is a need for approaches which: refocus the research effort in psycho-oncology; develop more strategic approaches to generating change in health systems and health policy and foster partnerships to advocate for improved resources. Copyright (C) 2003 John Wiley Sons, Ltd.

International images and mass media: The effects of media coverage on Canadians' perceptions of ethnic and race relations in Australia

Recently, there has been much speculation about the impact of international media coverage of Australia's position on Indigenous people, migrants and asylum seekers on other nations' images of Australia. In this experiment we examined whether there was any basis for such concerns by considering the short-term impact of negative TV coverage of Australians on Canadian viewers. A questionnaire provided baseline data on Canadian students' perceptions of Australians and Australian race relations. Four months later, the students were assigned to one of three conditions that varied media contact with Australians. Students viewed one of two television programs (about right-wing political independent, Pauline Hanson, and her emotive criticisms of Aborigines and Asian immigrants or about an ethnically-mixed group of young Australians and their positive sense of cultural identity), or they viewed no program (no contact control). Results indicated that both positive and negative media coverage of Australians affected Canadians' views of Australia in the short-term. In particular, negative coverage (of Hanson) promoted less favourable views of Australians and Australian race relations over time and relative to the positive media and no media control conditions. The media's role in shaping international images is discussed.

Attributional analysis of rumour denials

Politicians do it, corporations do it, and defendants in court do it. Many social encounters involve denials of rumours or accusations of wrongdoing. However, denials are not always effective. Sometimes, denials lead to an even more negative evaluation of the target of the rumour (in other words, the denial 'boomerangs'). We argue that this is more likely to happen in situations where people only hear the denial and are not aware of the rumour. Denial in the absence of a rumour leads to uncertainty about the reasons for the denial and the audience attributes the denial to internal reasons ('there must be something wrong about you') instead of external masons ('you are just responding to false rumours'). We conducted two studies comparing conditions involving denial in the presence of a rumour (rumour + denial) versus denial in the absence of a rumour (denial only). Study 1 found greater uncertainty about the reasons for denial and negative evaluation of the rumour target in denial-only condition, confirming the boomerang effect. Study 2 replicated the boomerang effect. Further, as predicted, the denial was attributed more to internal rather than external causes in the denial-only condition. Finally, mediation analysis revealed that attributions underlie the boomerang effect.

An attachment perspective on adult sibling relationships

This study investigated adult sibling relationships from an attachment perspective. A total of 817 adults (253 males; 564 females) ranging in age from 16 to 90 years completed a modified version of the WHO-TO measure of attachment strength (Hazan & Zeifman, 1994). This measure records multiple attachment figures, in order of importance, across four functions of attachment. One hundred and seventy four siblings of the participants also completed the measure as part of a larger sibling study. There were 29 brother dyads, 83 sister dyads and 62 brother-sister dyads. Results revealed that siblings have the potential to fulfil attachment-related functions, with 37% of the sample judged to be attached to a sibling. Females, and those not in romantic relationships reported stronger attachment to a sibling. Furthermore, sibling dyads were generally congruent in their perception of their relationship as an attachment bond. More than half of the sister-sister dyads (54%) agreed their relationship was an attachment bond, compared to 33% of brother-brother dyads and 24% of brother-sister dyads. Taken together, the findings support the applicability of attachment theory as a framework for investigating sibling relationships in adulthood.

Telephone counselling for adolescent suicide prevention: Changes in suicidality and mental state from beginning to end of a counselling session

Telephone counselling is an accessible and confidential means by which distressed young people can seek help. Telephone counselling services were funded under Australia's National Youth Suicide Prevention Strategy between 1997 and 2000. In this study, the effectiveness of telephone counselling for young people seeking help in the context of suicidal ideation or intent was evaluated in an investigation of calls made by suicidal young people to a telephone counselling service. Independent raters measured callers' suicidality and mental state at the beginning and, end of 100 taped counselling sessions. Changes in suicidality and mental state were measured using a reliable rating scale developed for the study. Significant decreases in suicidality and significant improvement in mental state were found to occur during the course of counselling sessions, suggesting positive immediate impact.-Limitations of the study with respect to longer-term outcomes and the relevance of the results for suicide prevention are discussed. Notwithstanding the study limitations, the results lend support for continuing development of hotline services.

A genetic two-factor model of the covariation among a subset of Multidimensional Aptitude Battery and Wechsler Adult Intelligence Scale - Revised subtests

The phenotypic and genetic factor structure of performance on five Multidimensional Aptitude Battery (MAB) subtests and one Wechsler Adult Intelligence Scale-Revised (WAIS-R) subtest was explored in 390 adolescent twin pairs (184 monozygotic [MZ]; 206 dizygotic (DZ)). The temporal stability of these measures was derived from a subsample of 49 twin pairs, with test-retest correlations ranging from .67 to .85. A phenotypic factor model, in which performance and verbal factors were correlated, provided a good fit to the data. Genetic modeling was based on the phenotypic factor structure, but also took into account the additive genetic (A), common environmental (C), and unique environmental (E) parameters derived from a fully saturated ACE model. The best fitting model was characterized by a genetic correlated two-factor structure with specific effects, a general common environmental factor, and overlapping unique environmental effects. Results are compared to multivariate genetic models reported in children and adults, with the most notable difference being the growing importance of common genes influencing diverse abilities in adolescence. (C) 2003 Elsevier Inc. All rights reserved.

Doctors and their patients: A context for understanding the wish to hasten death

There is a paucity of research that has directly examined the role of the health professional in dealing with a terminally ill patient's wish to hasten death (WTHD) and the implications of this for the support and services needed in the care for a dying patient. Themes to emerge from a qualitative analysis of interviews conducted on doctors (n = 24) involved in the treatment and care of terminally ill patients were (i) the doctors' experiences in caring for their patients (including themes of emotional demands/expectations, the duration of illness, and the availability of palliative care services); (ii) the doctors' perception of the care provided to their respective patients (comprising themes concerning satisfaction with the care for physical symptoms, for emotional symptoms, or overall care); (iii) the doctors' attitudes to euthanasia and (iv) the doctors' perception of their patients' views/beliefs 'regarding euthanasia and hastened death. When responses were categorised according to the patients' level of a WTHD, the theme concerning the prolonged nature of the patients' illnesses was prominent in the doctor group who had patients with the highest WTHD, whereas there was only a minority of responses concerning support from palliative care services and satisfaction with the level of emotional care in this group. This exploratory study presents a set of descriptive findings identifying themes among a small group of doctors who have been involved in the care of terminally ill cancer patients, to investigate factors that may be associated with the WTHD among these patients. The pattern of findings suggest that research investigating the doctor-patient interaction in this setting may add to our understanding of the problems (for patients and their doctors) that underpins the wish to hasten death in the terminally ill. Copyright (C) 2003 John Wiley Sons, Ltd.

Professional status, employee attitudes and multiple identifications at work

We conducted two studies exploring the influence of professional status on three targets of organisational identification. In the first study, 180 employees from a large metropolitan hospital completed an organisation-wide survey. As predicted, employees belonging to high-status professional groups reported higher levels of identification with their profession, followed by their work unit and the organisation. In contrast, employees belonging to low-status professional groups reported higher levels of identification with their work unit and the organisation, compared to their profession. Identification with the various targets was also associated with higher levels of job satisfaction and organisational commitment, and lower levels of uncertainty and emotional exhaustion. In the second study, 60 employees from the same hospital took part in semi-structured interviews to further explore issues relating to professional identification. In line with the results of the first study, the professional group was viewed as a central target of identification at work, particularly for those employees belonging to high status professional groups. Professional identification was also identified as a conduit for social meaning and a signifier of intergroup boundaries. Implications for the management of multiple identifications and heterogeneous teams are discussed.

Genetic and environmental sources of covariance between reading tests used in neuropsychological assessment and IQ subtests

In this study, we examined genetic and environmental influences on covariation among two reading tests used in neuropsychological assessment (Cambridge Contextual Reading Test [CCRT], [Beardsall, L., and Huppert, F. A. ( 1994). J. Clin. Exp. Neuropsychol. 16: 232 - 242], Schonell Graded Word Reading Test [SGWRT], [ Schonell, F. J., and Schonell, P. E. ( 1960). Diagnostic and attainment testing. Edinburgh: Oliver and Boyd.]) and among a selection of IQ subtests from the Multidimensional Aptitude Battery (MAB), [Jackson, D. N. (1984). Multidimensional aptitude battery, Ontario: Research Psychologists Press.] and the Wechsler Adult Intelligence Scale-Revised (WAIS-R) [Wechsler, D. (1981). Manual for the Wechsler Adult Intelligence Scale-Revised (WAIS-R). San Antonio: The Psychological Corporation]. Participants were 225 monozygotic and 275 dizygotic twin pairs aged from 15 years to 18 years ( mean, 16 years). For Verbal IQ subtests, phenotypic correlations with the reading tests ranged from 0.44 to 0.65. For Performance IQ subtests, phenotypic correlations with the reading tests ranged from 0.23 to 0.34. Results of Structural Equation Modeling (SEM) supported a model with one genetic General factor and three genetic group factors ( Verbal, Performance, Reading). Reading performance was influenced by the genetic General factor ( accounting for 13% and 20% of the variance for the CCRT and SGWRT, respectively), the genetic Verbal factor ( explaining 17% and 19% of variance for the CCRT and SGWRT), and the genetic Reading factor ( explaining 21% of the variance for both the CCRT and SGWRT). A common environment factor accounted for 25% and 14% of the CCRT and SGWRT variance, respectively. Genetic influences accounted for more than half of the phenotypic covariance between the reading tests and each of the IQ subtests. The heritabilities of the CCRT and SGWRT were 0.54 and 0.65, respectively. Observable covariance between reading assessments used by neuropsychologists to estimate IQ and IQ subtests appears to be largely due to genetic effects.

Copulas in QTL mapping

The standard variance components method for mapping quantitative trait loci is derived on the assumption of normality. Unsurprisingly, statistical tests based on this method do not perform so well if this assumption is not satisfied. We use the statistical concept of copulas to relax the assumption of normality and derive a test that can perform well under any distribution of the continuous trait. In particular, we discuss bivariate normal copulas in the context of sib-pair studies. Our approach is illustrated by a linkage analysis of lipoprotein(a) levels, whose distribution is highly skewed. We demonstrate that the asymptotic critical levels of the test can still be calculated using the interval mapping approach. The new method can be extended to more general pedigrees and multivariate phenotypes in a similar way as the original variance components method.