Ethical,legal and societal considerations on Zika virus epidemics complications in scaling-up prevention and control strategies

Much of the fear and uncertainty around Zika epidemics stem from potential association between Zika virus (ZIKV) complications on infected pregnant women and risk of their babies being born with microcephaly and other neurological abnormalities. However, much remains unknown about its mode of transmission, diagnosis and long-term pathogenesis. Worries of these unknowns necessitate the need for effective and efficient psychosocial programs and medical-legal strategies to alleviate and mitigate ZIKV related burdens. In this light, local and global efforts in maintaining fundamental health principles of moral, medical and legal decision-making policies, and interventions to preserve and promote individual and collectiveHuman Rights, autonomy, protection of the most vulnerable, equity, dignity, integrity and beneficence that should not be confused and relegated by compassionate humanitarian assistance and support. This paper explores the potential medical and ethical-legal implications of ZIKV epidemics emergency response packages and strategies alongside optimizing reproductive and mental health policies, programs and best practice measures. Further long-term cross-borders operational research is required in elucidating Zika-related population-based epidemiology, ethical-medical and societal implications in guiding evidence-based local and global ZIKV maternal-child health complications related approaches and interventions. Core programs and interventions including future Zika safe and effective vaccines for global Zika immunization program in most vulnerable and affected countries and worldwide should be prioritized.     

The Psychological Impact of Prenatal Diagnosis and Disclosure of Susceptibility Loci: First Impressions of Parents’ Experiences

Genomic microarray may detect susceptibility loci (SL) for neurodevelopmental disorders such as autism and epilepsy, with a yet unquantifiable risk for the fetus. The prenatal disclosure of susceptibility loci is a topic of much debate. Many health care professionals fear that reporting susceptibility loci may put a psychological burden on pregnant couples. It is our policy to disclose prenatal susceptibility loci as we recognize them as actionable for prospective parents. The aim of this report was to evaluate the psychological impact of disclosing a prenatal diagnosis of susceptibility loci. The psychological impact of disclosing susceptibility loci was evaluated in the first patients who received such results. Eight out of 15 women who had a susceptibility locus disclosed and four of their partners consented to share their experiences through a telephonic evaluation (n?=?12). Follow-up time ranged from 3 to 15 months after their prenatal test result. The reporting of susceptibility loci was initially ‘shocking’ for five parents while the other seven felt ‘worried’. Ten out of 12 participants indicated they would like to be informed about the susceptibility locus again, two were unsure. Most had no enduring worries. Participants unanimously indicated that pregnant couples should have an individualized pre-test choice about susceptibility loci (non)disclosure. We observed no negative psychological impact with the prenatal diagnosis and disclosure of SL on participants. A key factor in mitigating parental anxiety with SL disclosure appears to be post-test genetic counseling. Our report confirms that pregnant women and their partners prefer an individualized choice regarding the scope of prenatal testing.     

Effects of group prenatal care on psychosocial risk in pregnancy: results from a randomised controlled trial

Few interventions have succeeded in reducing psychosocial risk among pregnant women. The objective of this study was to determine whether an integrated group prenatal care intervention already shown to improve perinatal and sexual risk outcomes can also improve psychosocial outcomes compared to standard individual care. This randomised controlled trial included pregnant women ages 14-25 from two public hospitals (N = 1047) who were randomly assigned to standard individual care, group prenatal care or integrated group prenatal care intervention (CenteringPregnancy Plus, CP+). Timing and content of visits followed obstetrical guidelines, from 18-week gestation through birth. Each 2-h group prenatal care session included physical assessment, education/skills building and support via facilitated discussion. Using intention-to-treat models, there were no significant differences in psychosocial function; yet, women in the top tertile of psychosocial stress at study entry did benefit from integrated group care. High-stress women randomly assigned to CP+ reported significantly increased self-esteem, decreased stress and social conflict in the third trimester of pregnancy; social conflict and depression were significantly lower 1-year postpartum (all p-values < 0.02). CP+ improved psychosocial outcomes for high-stress women. This 'bundled' intervention has promise for improving psychosocial outcomes, especially for young pregnant women who are traditionally more vulnerable and underserved.     

The Utilization and Choices of Aneuploidy Screening in a Midwestern Population

The types, interpretation, and use of first- and second-trimester aneuploidy screening are often unclear for many women. This impairs appropriate decision making and understanding of the implications of prenatal genetic testing options. The purpose of this study was to examine the utilization of Stepwise Sequential screening in our Midwestern population, demographic factors associated with choice of screening and method of risk reporting and it’s potential impact on women’s choices. First trimester screening was performed for 2,634 women during the study period. Results were not reported or “framed” as “positive” or “negative”. Rather, the specific age-risk and screen-risk for T21 were relayed, along with options for follow-up Stepwise Sequential screening and invasive testing. Nearly 80 % of women declined Stepwise Sequential screening. Minorities and women of lower education were least likely to pursue further screening. Less than 4 % of the study population elected invasive testing. First trimester screening was associated with a 53 % reduction in amniocenteses and 20 % fewer CVS’s compared to pre-first trimester screening availability. Reporting age-and screen-risks for T21, rather than classifying results as “positive” or “negative” based on a pre-determined threshold, was associated with a low uptake of further testing.     

Does psychosocial stress exacerbate avoidant responses to cancer information in those who are afraid of cancer? A population-based survey among older adults in England

Objective: Communication of cancer information is an important element of cancer control, but cancer fear may lead to information avoidance, especially when coping is low. We examined the association between cancer fear and cancer information avoidance, and tested whether this was exacerbated by psychosocial stress.

Design: Cross-sectional survey of 1258 population-based adults (58–70 years) in England.

Main outcome measures: Cancer fear (intensity and frequency), perceived psychosocial stress and cancer information avoidance. Control variables were age, gender, ethnicity, marital status and education.

Results: A quarter (24%) of respondents avoided cancer information. Ordinal logistic regression analyses showed main effects of psychosocial stress (OR = 1.17, 95% CI 1.07–1.29) and cancer fear: cancer information avoidance was lowest in those with no cancer fear (13%), followed by those with moderate (24%; OR = 2.15, 95% CI: 1.49–3.12), and high cancer fear (35%; OR = 3.90, 95% CI: 2.65–5.73). In the adjusted model, the interaction between cancer fear and stress was significant (OR = 1.14, 95% CI 1.004–1.29, p < .05): 40% of those with high fear/high stress avoided cancer information compared with 29% with high fear/low stress.

Conclusion: Cancer fear and psychosocial stress interact to produce disengagement with cancer-related information, highlighting the importance of affective processes to cancer control efforts.     

Factors associated with poor quality of life among Iranian infertile women undergoing IVF

Infertility is a medical and social condition and has a considerable impact on a person’s quality of life (QoL). The aim of the study was to determine the QoL of women with fertility problem, and identify factors associated with poor QoL. This cross-sectional study included 155 women with fertility problems undergoing IVF in a referral fertility center in Tehran, Iran. The Fertility Quality of Life, the Hospital Anxiety and Depression Scale and demographic and fertility information questionnaire were administered to all women. The mean total QoL score was 62.57 ± 16.89. Multivariate analysis showed that the anxiety (β = ?1.59, p < 0.001) and depression (β = ?2.09, p < 0.001) had a negative impact on QoL. Cause of infertility and failure in previous treatment were also significant factors of poorer QoL. The findings indicate that the QoL was worse in women with high depression and anxiety level, failure in previous treatment and unknown cause of infertility. Thus, a comprehensive approach, including psychosocial interventions and support, is absolutely essential to improve the QoL in these women.     

Care Orientation in the Teens as a Predictor of Young Adult Psychosocial Adjustment

The transition from adolescence to young adulthood is a watershed period in development that carries risk for poor psychosocial adjustment. It also carries potential for positive transitions into the caregiving roles and responsibilities of adult life. Research to date has predominantly focused on adolescent predictors of problematic rather than positive transitions; yet predictors of the latter hold equal (if not greater) promise for informing health promoting interventions. The purpose of this study was threefold: (1) to use Latent Profile Analysis (LPA) to define patterns of psychosocial adjustment and maladjustment in young adulthood (21-years of age); (2) to examine the unique role of adolescent prosocial behaviour (e.g., volunteering and civic engagement) in promoting adjustment and reducing maladjustment in young adulthood; and, (3) to examine whether protective developmental relationships are maintained after adjustment for other covariates including socio-economic background factors and personality characteristics. Data were drawn from the Victorian cohort of the International Youth Development Study (IYDS; N = 2407), a representative sample of students in Victoria, Australia. Students were assessed in Grade 9 (Mean age = 15-years) and followed up at age 21-years. LPA identified three psychosocial adjustment classes at age 21 defined as: (1) Adjusted (24.8 %); (2) Normative (63.9 %); and, (3) Maladjusted (11.3 %). Adolescent volunteering, belief in a moral order, family opportunities for prosocial behaviour, and commitment to school were associated with enhanced adjustment and reduced maladjustment in young adulthood. Findings highlight the potential benefit of interventions designed to enhance adolescent prosocial behaviours and care orientation in promoting healthy transitions into young adult life.     

Executive function and psychosocial adjustment in healthy children and adolescents: A latent variable modelling investigation

The objective of this study was to establish latent executive function (EF) and psychosocial adjustment factor structure, to examine associations between EF and psychosocial adjustment, and to explore potential development differences in EF-psychosocial adjustment associations in healthy children and adolescents. Using data from the multisite National Institutes of Health (NIH) magnetic resonance imaging (MRI) Study of Normal Brain Development, the current investigation examined latent associations between theoretically and empirically derived EF factors and emotional and behavioral adjustment measures in a large, nationally representative sample of children and adolescents (7–18 years old; N = 352). Confirmatory factor analysis (CFA) was the primary method of data analysis. CFA results revealed that, in the whole sample, the proposed five-factor model (Working Memory, Shifting, Verbal Fluency, Externalizing, and Internalizing) provided a close fit to the data, χ²(66) = 114.48, p < .001; RMSEA = .046; NNFI = .973; CFI = .980. Significant negative associations were demonstrated between Externalizing and both Working Memory and Verbal Fluency (p < .01) factors. A series of increasingly restrictive tests led to the rejection of the hypothesis of invariance, thereby precluding formal statistical examination of age-related differences in latent EF-psychosocial adjustment associations. Findings indicate that childhood EF skills are best conceptualized as a constellation of interconnected yet distinguishable cognitive self-regulatory skills. Individual differences in certain domains of EF track meaningfully and in expected directions with emotional and behavioral adjustment indices. Externalizing behaviors, in particular, are associated with latent Working Memory and Verbal Fluency factors.     

Fear of Rejection versus Religious Commitment as Predictors of Adjustment Among Reformed and Evangelical College Students in Canada

The contradictory findings about the (positive or negative) associations between religion and adjustment suggest that different aspects of religion might have different effects. A total of 160 men and 283 women attending two faith-affirming colleges in Canada completed measures of fear of rejection (by God and church members), religiosity, prosocial attitudes, social adjustment (work orientation, school attitudes), and personal adjustment (life satisfaction, self-esteem). Fear of rejection was found to be predictive of lower religious commitment and of poor social and personal adjustment. In contrast, religious commitment was found to be predictive of prosocial attitudes and of good adjustment. Religious commitment had much higher correlations with prosocial values and adjustment among men than among women. Regression analyses indicated that fear of rejection was a strong predictor of poor adjustment among religious persons.     

Impact of Genetic Counseling in Women with a Family History of Breast Cancer in Italy

As the impact of breast cancer (BC) risk assessment in asymptomatic women with a family history of BC had never been explored in Italy, we performed a study on a retrospective series of women who had undergone BC risk assessment. To this aim, a semi-structured telephone interview was administered to 82 women. Most participants considered the information received as clear (96.2 %) and helpful (76.8 %). Thirty-eight (46.3 %) stated that their perceived risk of BC had changed after the counseling: for 40.2 % it had decreased, for 6.1 % increased; however, women highly overestimating their risk at the baseline (≥4-fold) failed to show improvements in risk perception accuracy. Sixty-six women (80.5 %) stated they had followed the recommended surveillance, while 19.5 % had not, mainly due to difficulties in arranging examinations. Most women (89.0 %) had shared the information with their relatives, with 57.3 % reporting other family members had undertaken the recommended surveillance. BC risk assessment was associated with high rates of satisfaction and had a favorable impact on risk perception in a subgroup of women. The impact on surveillance adhesion extended to relatives. Organized programs for identification and surveillance may help identify a larger fraction of at-risk women and overcome the reported difficulties in arranging surveillance.     

The Relationship Between Agentic and Communal Personality Traits and Psychosocial Adjustment to Breast Cancer

Agency, communion, unmitigated agency (UA), and unmitigated communion (UC) are related to psychosocial health outcomes in nonclinical and medical populations. This study examined the relationship between these personality traits and emotional and interpersonal well-being, as up to 50% of women experience difficulties in psychosocial adjustment after being diagnosed with breast cancer. Seventy-four women newly diagnosed with breast cancer completed baseline assessment measures within 2 weeks prior to their first chemotherapy treatment or at the beginning of their hormonal therapy. Findings indicate that (1) agency and UA are important correlates of emotional and interpersonal adjustment and should be considered when attempting to identify women at high risk for psychosocial distress, and (2) UC deserves increased attention in behavioral medicine research, given its strong relationship with emotional distress in a breast cancer population. Thus, evidence continues to accumulate regarding the important relationship of these personality traits to psychosocial outcomes in medical populations.     

The Integration of Noninvasive Prenatal Screening into the Existing Prenatal Paradigm: a Survey of Current Genetic Counseling Practice

Since its introduction four years ago, noninvasive prenatal screening for fetal aneuploidy (NIPS) has been widely adopted as a screening tool for women at a high risk for fetal aneuploidy. As use expands into the general population, questions arise concerning the integration of NIPS into preexisting screening paradigms. This study aims to examine the use of NIPS in current practice among prenatal counselors, predominantly in the United States, in order to inform strategies for the optimal use of both new and existing screening techniques. We electronically surveyed 208 members of the National Society of Genetic Counselors to ascertain how NIPS is currently being used. Genetic counselors were also queried as to the advantages and disadvantages of offering NIPS to all patients regardless of a priori risk. Results indicate substantial variation in practice regarding which patients are offered NIPS and how counselors have incorporated this technology into existing screening routines. The majority of participants report offering NIPS in conjunction with another method of screening for fetal aneuploidy, indicating that NIPS is being used as an addition rather than as a replacement. These screening methods primarily include nuchal translucency (NT) (45.1 %, n = 78) and first trimester serum screening, with or without an NT (19.7 %, n = 34). Furthermore, the majority report that they would be concerned about losing the clinical value of an NT in a complete transition to NIPS (85.4 %, n = 164). Counselors are evenly split on the merits of expanding the use of NIPS to the general population (con: 55.3 %, n = 105; pro: 44.7 %, n = 85). The lack of consensus suggests that updated practice guidelines might benefit counselors. In addition, respondents emphasized the need to better educate patients and providers about the risks, benefits, and limitations of the test.     

Counseling adolescents with problem pregnancies

The whole gamut of problems involved in counseling pregnant teens, from the national statistics and psychosocial context to the goals of counseling and follow-up are discussed. In the U.S. 40% of women have become pregnant by age 20 (1982 data), making this one of the highest rates of teenage pregnancy worldwide. Many factors contribute to this problem: adolescent development with its unresolved conflicts; teenage cultural myths about sex roles, such as the idea that it is harmful to deny sex to males; cultural roles for women such as being passive and therefore unprepared with contraception. The teen pregnancy, then, evokes a personal, interpersonal, moral and medical crisis. Goals for counseling are to help the young woman mjake a fully integrated, final decision; provide emotional support and referral information; to help her use the experience for growth. The decision often has to be rapid, because many teens delay revealing their pregnancy out of fear, yet prenatal care is essential, while a second trimester abortion should be avoided. Decisions about whether to bear the child, involve the father, the family, where to live, how to get financial support become complex. Even the counselor's background can be counterproductive, especially when the teen chooses STET unlikely to succeed. Issues of client's autonomy and confidentiality regarding family, the male partner, and even local regulations may confuse the process. Follow-up counseling may be indicated, for post-abortion or pregnancy support, for future contraception, for a committed relationship, or for balancing her needs versus her sexual partner's.     

Maternal Guilt and Shame: The Role of Self-discrepancy and Fear of Negative Evaluation

Guilt and shame are emotions commonly associated with motherhood. Self-discrepancy theory proposes that guilt and shame result from perceived discrepancies between one’s actual and ideal selves. Fear of negative evaluation by others may enhance the effects of self-discrepancy especially for shame, which involves fear of others’ reproach. The purpose of this study was to examine the relationships between self discrepancy, guilt, shame, and fear of negative evaluation in a cross-sectional, self report study of mothers. Mothers of children five and under (N = 181) completed an on-line survey measuring guilt, shame, fear of negative evaluation, and maternal self-discrepancies. Guilt and shame were related to maternal self-discrepancy and fear of negative evaluation. In addition, fear of negative evaluation moderated the relationship between maternal self-discrepancy and shame such that mothers who greatly feared negative evaluation had a very strong relationship between these variables. Maternal self-discrepancy and shame were not related among mothers who had low fear of negative evaluation. The results are discussed in terms of the detrimental effects of internalizing idealized standards of perfect motherhood.     

The effect of exercise and childbirth classes on fear of childbirth and locus of labor pain control

This study sought to track changes in intensity of fear of childbirth and locus of labor pain control in women attending an exercise program for pregnant women or traditional childbirth classes and to identify the predictors of these changes. The study was longitudinal/non-experimental in nature and run on 109 healthy primigravidae aged from 22 to 37, including 62 women participating in an exercise program for pregnant women and 47 women attending traditional childbirth classes. The following assessment tools were used: two scales developed by the present authors – the Fear of Childbirth Scale and the Control of Birth Pain Scale, three standardized psychological inventories for the big five personality traits (NEO Five Factors Inventory), trait anxiety (State–Trait Anxiety Inventory) and dispositional optimism (Life Oriented Test–Revised) and a questionnaire concerning socioeconomic status, health status, activities during pregnancy, relations with partners and expectations about childbirth. Fear of childbirth significantly decreased in women participating in the exercise program for pregnant women but not in women attending traditional childbirth classes. Several significant predictors of post-intervention fear of childbirth emerged: dispositional optimism and self-rated health (negative) and strength of the belief that childbirth pain depends on chance (positive).     

Nature and Role of Change in Anxiety Sensitivity During NRT-Aided Cognitive-Behavioral Smoking Cessation Treatment

This study evaluated the associations between change in anxiety sensitivity (AS; fear of the negative consequences of anxiety and related sensations) and lapse and relapse during a 4-week group NRT-aided cognitive-behavioral Tobacco Intervention Program. Participants were 67 (44 women; M _age = 46.2 years, SD = 10.4) adult daily smokers. Results indicated that participants who maintained high levels of AS from pretreatment to 1 month posttreatment, compared to those who demonstrated a significant reduction in AS levels during this time period, showed a significantly increased risk for lapse and relapse. Further inspection indicated that higher continuous levels of AS physical and psychological concerns, specifically among those participants who maintained elevated levels of AS from pre- to posttreatment, predicted significantly greater risk for relapse. Findings are discussed with respect to better understanding change in AS, grounded in an emergent taxonic-dimensional factor mixture model of the construct, with respect to lapse and relapse during smoking cessation.     

Social Support and Postpartum Depression Revisited: The Traditional Female Role as Moderator among Mexican Women

Women who lack social support tend to have a higher risk of postpartum depression. The present study examined the traditional female role, understood here as the adoption of passive and submissive traits specific to Mexican women, as another risk factor for postpartum depressive symptomatology that interacts with social support. Using two waves of data from a longitudinal study of 210 adult Mexican women (20–44 years-old, M _age = 29.50 years, SD = 6.34), we found that lacking social support during the third trimester of their pregnancy was associated with greater depressive symptoms at 6 months in the postpartum, although this relationship depended on the level of endorsement of the traditional female role during pregnancy. Lower social support during pregnancy predicted greater postpartum depressive symptoms for women with higher endorsement of the traditional female role, even when accounting for prenatal depressive symptoms. These results suggest that Mexican women’s experience of social support may depend on their individual adherence to gender roles. Understanding the association between women’s traditional roles and social support in the risk for postpartum depression can improve prevention and educational programs for women at risk.     

童年中晚期同伴侵害对儿童心理社会适应影响的纵向分析

采用间隔两年的纵向设计, 通过对1767名儿童的同伴侵害以及孤独、抑郁、攻击、行为不良、同伴接纳、同伴拒绝等心理社会适应指标进行调查, 综合运用变量定向的方法和个体定向的方法考察了童年中晚期儿童心理社会适应发展的结果模式, 以及同伴侵害对儿童心理社会适应发展的影响。结果发现, (1)身体侵害、关系侵害与心理社会适应各指标存在显著的即时与纵向相关关系。(2)儿童心理社会适应结果表现为内化问题、外化问题、同伴拒绝、正常发展4种模式。(3)判别分析显示, 9岁的同伴侵害(主要为身体侵害)能预测同伴拒绝、外化问题适应结果模式, 11岁的同伴侵害(主要为关系侵害)能预测内化问题、同伴拒绝适应结果模式。这些结果表明同伴侵害与儿童心理社会适应间的联系具有异质性, 并且先前和当前的侵害经历以及不同类型的侵害与心理社会适应间的联系因适应领域的不同而存在差异。     

Reproductive Decision-Making in MMR Mutation Carriers After Results Disclosure: Impact of Psychological Status in Childbearing Options

Reproductive techniques such as prenatal diagnosis (PND) or preimplantation genetic diagnosis (PGD), although debated, are legally forbidden in France in case of Lynch syndrome. The preference of mutation carriers about their reproductive options is not systematically considered in France. We aimed to prospectively assess the reproductive preferences of mismatch repair mutation carriers consulting in our institution (2003–2010, n?=?100). We also considered the short- and long-term post-disclosure psychological impact using the Impact of Events Scale-Revised questionnaire to measure the prevalence of posttraumatic stress disorder (PTSD) in those patients. Complete data were obtained for 34 respondents (17 males, 17 females, median age of 33.5 years [22–59]). Seventeen respondents (57 %) preferred spontaneous natural conception versus 28 % and 35 % choosing PND and PGD, respectively. At results disclosure, respondents mainly explained their distress by fear of premature death (43 %) and transmitting mutated genes (42 %). One year later, this last fear remained predominant in 55 % of subjects. None of the main socio-demographical, psychological or medical variables (including fear of transmitting mutations) was significantly associated with the reproductive preferences. Results disclosure had a real and time-decreasing psychological impact on mutation carriers. Reproductive techniques, expected to decrease the hereditary risk, were not significantly preferred to natural conception.     

Psychological Adjustment,Social Responsiveness and Parental Distress in an Italian Sample of Siblings of Children with High-Functioning Autism Spectrum Disorder

The psychosocial adjustment of siblings of children with autism spectrum disorder (ASD) is a relatively recent field of study, but results in literature are often inconsistent, and studies specifically focused on samples of siblings of children with high-functioning ASD are very few. This paper analyzes the level of social impairment (index of broader autism phenotype), the risk of internalizing and externalizing problems (index of psychological adjustment) and the parenting distress in an Italian sample of siblings of children with high-functioning ASD (n = 26). The presence of risk factors (birth order, sex and number of siblings in the family) and the role of the siblings’ age are also explored. The data were collected through self-report instruments administered to parents. The results do not show higher average risk levels for psychosocial adjustment problems, even though a minority of the cases is at risk for social impairments (7.7 %), internalizing (23.1 %), externalizing (3.8 %) and total difficulties (11.5 %) and for distress in the parent–child system (15 %). Distress in the parent-sibling system seems to be modulated by the sibling’s features and to be higher when the sibling is older than the child with ASD. Additionally, a link between difficulties in psychological adjustment and broader autism phenotype is suggested.