Breaking Difficult News in a Cross-cultural Setting: a Qualitative Study about Latina Mothers of Children with Down Syndrome

Giving difficult news to patients represents a common dilemma for health care professionals. Based on three decades of research, various authors have proposed guidelines outlining the ideal setting, delivery, and timing. Existing publications focus on patients of European descent and may not be applicable in cross-cultural settings. We explored perceptions of Spanish-speaking mothers who have a child with Down syndrome and how they preferred to receive the news of their child's diagnosis. We conducted semi-structured qualitative interviews (n?=?14), which were coded and analyzed by thematic networks to identify common themes. Six significant themes emerged: Cultural Belief System, Communication, Support/Lack of Support, Feelings Engendered, Medical Issues, and Medical System. One overarching theme of mother-child bonding encompassed all sub-themes. The mothers desired the news in a more positive, balanced light and with more complete explanations about the condition. Mothers felt excluded from the diagnostic process and wanted to be better informed about the need for diagnostic studies. Participants used religious beliefs to explain the reason for their child's condition. Many factors influenced Latina mothers' ability to bond initially with their children with Down syndrome. Ideally, these factors should be acknowledged during informing interviews to assist Latino families in adjustment.     

Identifying illness perception schemata and their association with depression and quality of life in cardiac patients

The purpose of this paper is to identify groups of cardiac patients who share similar perceptions about their illness and to examine the relationships between these schemata and psychosocial outcomes such as quality of life and depression. A total of 190 cardiac patients with diagnoses of myocardial infarction, stable angina pectoris or chronic heart failure, completed a battery of psychosocial questionnaires within four weeks of their admission to hospital. These included the Brief Illness Perceptions Questionnaire (BIPQ), Beck Depression Inventory II (BDI II) and The MacNew Health-related Quality of Life instrument (MacNew). BIPQ items were subjected to latent class analysis (LCA) and the resulting groups were compared according to their BDI II and MacNew scores. LCA identified a five-class model of illness perception which comprised the following: (1) Consequence focused and mild emotional impact, n?=?55, 29%; (2) Low illness perceptions and low emotional impact, n?=?45, 24%; (3) Control focused and mild emotional impact, n?=?10, 5%; (4) Consequence focused and high emotional impact, n?=?60, 32%; and (5) Consequence focused and severe emotional impact, n?=?20, 10%. Gender and diagnosis did not appear to reflect class membership except that class 2 had a significantly higher proportion of AMI patients than did class 5. There were numerous significant differences between classes in regards to depression and health-related quality of life. Notably, classes 4 and 5 are distinguished by relatively high BDI II scores and low MacNew scores. Identifying classes of cardiac patients based on their illness perception schemata, in hospital or shortly afterwards, may identify those at risk of developing depressive symptoms and poor quality of life.     

The mental wormhole: Internal attention shifts without regard for distance

Attention operates perceptually on items in the environment, and internally on objects in visuospatial working memory. In the present study, we investigated whether spatial and temporal constraints affecting endogenous perceptual attention extend to internal attention. A retro-cue paradigm in which a cue is presented beyond the range of iconic memory and after stimulus encoding was used to manipulate shifts of internal attention. Participants?? memories were tested for colored circles (Experiments 1, 2, 3a, 4) or for novel shapes (Experiment 3b) and their locations within an array. In these experiments, the time to shift internal attention (Experiments 1 and 3) and the eccentricity of encoded objects (Experiments 2?C4) were manipulated. Our data showed that, unlike endogenous perceptual attention, internal shifts of attention are not modulated by stimulus eccentricity. Across several timing parameters and stimuli, we found that shifts of internal attention require a minimum quantal amount of time regardless of the object eccentricity at encoding. Our findings are consistent with the view that internal attention operates on objects whose spatial information is represented in relative terms. Although endogenous perceptual attention abides by the laws of space and time, internal attention can shift across spatial representations without regard for physical distance.     

The Gestalt principle of similarity benefits visual working memory

Visual working memory (VWM) is essential for many cognitive processes, yet it is notably limited in capacity. Visual perception processing is facilitated by Gestalt principles of grouping, such as connectedness, similarity, and proximity. This introduces the question, do these perceptual benefits extend to VWM? If so, can this be an approach to enhance VWM function by optimizing the processing of information? Previous findings have demonstrated that several Gestalt principles (connectedness, common region, and spatial proximity) do facilitate VWM performance in change detection tasks (Jiang, Olson, & Chun, 2000; Woodman, Vecera, & Luck, 2003; Xu, 2002, 2006; Xu & Chun, 2007). However, one prevalent Gestalt principle, similarity, has not been examined with regard to facilitating VWM. Here, we investigated whether grouping by similarity benefits VWM. Experiment 1 established the basic finding that VWM performance could benefit from grouping. Experiment 2 replicated and extended this finding by showing that similarity was only effective when the similar stimuli were proximal. In short, the VWM performance benefit derived from similarity was constrained by spatial proximity, such that similar items need to be near each other. Thus, the Gestalt principle of similarity benefits visual perception, but it can provide benefits to VWM as well.     

Everyday Cognitive Functioning in Cardiac Patients: Relationships Between Self-report,Report of a Significant Other and Cognitive Test Performance

ABSTRACT

Candidates for cardiac bypass surgery often experience cognitive decline. Such decline is likely to affect their everyday cognitive functioning. The aim of the present study was to compare cardiac patients' ratings of their everyday cognitive functioning against significant others' ratings and selected neuropsychological tests. Sixty-nine patients completed a battery of standardised cognitive tests. Patients and significant others also completed the Everyday Function Questionnaire independently of each other. Patient and significant other ratings of patients' everyday cognitive difficulties were found to be similar. Despite the similarities in ratings of difficulties, some everyday cognitive tasks were attributed to different processes. Patients' and significant others' ratings were most closely associated with the neuropsychological test of visual memory. Tests of the patients' verbal memory and fluency were only related to significant others' ratings. Test scores of attention and planning were largely unrelated to ratings by either patients or their significant others.     

The Use of the MacAndrew Alcoholism Scale in Detecting Substance Abuse and Antisocial Personality

We evaluated the hypothesis that characterological factors, particularly antisocial personality, influence scores on the MacAndrew Alcoholism Scale (MAC). Using the Washington University research criteria to establish diagnoses, the following subgroups were defined: subjects who received no psychiatric diagnoses; subjects who received diagnoses other than alcoholism, drug dependence, or antisocial personality; and subjects who received a diagnosis of alcoholism, drug dependence, and/or antisocial personality, alone or in combination with other psychiatric diagnoses. The highest MAC scores were obtained by subjects diagnosed as having antisocial personality without alcoholism or drug dependence and subjects diagnosed with antisocial personality, drug dependence, and alcoholism. Alcoholics without antisocial personality or drug dependence, and subjects with other psychiatric diagnoses scored lowest. Although higher MAC scores were obtained by males, MAC scores greater than 24 correctly classified the greatest number of males and females as alcoholic, drug dependent and/or antisocial. These findings are interpreted as consistent with MacAndrew's reinterpretation of the scale as assessing a dimension of personality, rather than solely a tendency to addiction.     

Child physical abuse and neglect in Kenya,Zambia and the Netherlands: A cross‐cultural comparison of prevalence,psychopathological sequelae and mediation by PTSS

This study compared the prevalence of self‐reported childhood physical abuse and neglect and the associated psychopathological sequelae among Kenyan, Zambian, and Dutch university students. In addition, we sought to find out the differentiated role of posttraumatic stress symptoms (PTSS) in mediating the associations between childhood maltreatment experiences and psychopathology symptoms. The sample consisted of 862 university students from Kenya (n = 375), Zambia (n = 182), and The Netherlands (n = 305) who completed the Personal and Relationships Profile (PRP). Results showed that physical abuse was highly prevalent in Kenya (59%) and Zambia (40%), and that neglect was even more prevalent than physical abuse in Zambia and The Netherlands at 59%, 54%, and 42% for the Kenyan, Zambian, and Dutch samples respectively. Neglect was associated with psychopathological symptoms in all three samples, whereas physical abuse was associated with psychopathological sequelae in the Kenyan and Zambian samples only. PTSS mediated the association between neglect and psychopathology symptoms in the Dutch sample and between physical abuse and psychopathology symptoms in the Dutch and Kenyan samples. We conclude that physical abuse and neglect are associated with psychopathology symptoms independently of country and cultural context. However, the pathways through which physical abuse and neglect may lead to psychopathological sequelae may be dependent on perceptions of specific parental behavior in different sociocultural contexts.     

Is elevated risk of child maltreatment in immigrant families associated with socioeconomic status? Evidence from three sources

In this study we tested whether children from Dutch‐immigrant families are at increased risk for maltreatment, and if so, what factors could explain this risk. Three data sources from the second Netherlands Prevalence Study of Maltreatment of Youth (NPM‐2010) were used to answer these questions. First, 1127 professionals from various occupational branches (sentinels) were asked to report each child (including some background information on the child and family) for whom they suspected child maltreatment during a period of three months. Second, we included the 2010 data from the Dutch Child Protective Services and third, 1759 high school students aged 11–17 years filled out a questionnaire on their experiences of maltreatment in the past year. We found that children from traditional immigrant families with a relatively long migration history in the Netherlands (Turkish, Moroccan, Surinamese, and Antillean) and from nontraditional immigrant families (African [except Morocco], Eastern European, Central Asian, and South and Central American; often refugees) were at increased risk for child maltreatment compared to native Dutch families. However, in the professionals’ and CPS data this risk disappeared for the traditional immigrant families after correction for educational level of the parents and for step‐parenthood. Within the group of families with low education or step‐parents, the risk for child maltreatment was similar for traditional immigrant families as for native Dutch families. Nontraditional families remained at increased risk after correction for sociodemographic and family factors. In conclusion, we found that children from both traditional and nontraditional immigrant families are at increased risk for maltreatment as compared to children from native Dutch families. For the traditional immigrants this risk could partially be explained by socioeconomic status. This implies that socioeconomic factors should be taken into account when outlining policies to fight child maltreatment.     

Reasons for Declining Preconception Expanded Carrier Screening Using Genome Sequencing

Genomic carrier screening can identify more disease-associated variants than existing carrier screening methodologies, but its utility from patients’ perspective is not yet established. A randomized controlled trial for preconception genomic carrier screening provided an opportunity to understand patients’ decisions about whether to accept or decline testing. We administered a survey to potential genomic carrier screening recipients who declined participation (N = 240) to evaluate their reasons for doing so. Two thirds of women declined participation. We identified major themes describing reasons these individuals declined to participate; the most common were time limitation, lack of interest, not wanting to know the information, and potential cause of worry or anxiety. Most women eligible for genomic carrier screening indicated that their reasons for opting out were due to logistical issues rather than opposing the rationale for testing. As expanded carrier screening and genomic sequencing become a more routine part of clinical care, it is anticipated there will be variable uptake from individuals for this testing. Thus, the advancement of clinical carrier screening from single genes, to expanded screening panels, to an exome- or genome-wide platform, will require approaches that respect individual choice to receive genetic testing for reproductive risk assessment.