At the Heart of the Pregnancy: What Prenatal and Cardiovascular Genetic Counselors Need to Know about Maternal Heart Disease

In the last decade, an increasing number of cardiac conditions have been shown to have a genetic basis. Cardiovascular genetic counseling has emerged as a subspecialty aiming to identify unaffected at-risk individuals. An important sector of this at-risk population also includes expectant mothers, in whom unique clinical challenges may arise. Genetic counselors, especially those in cardiovascular and prenatal settings, have an opportunity to identify and assist women who may benefit from cardiovascular care during pregnancy. This paper provides basic management and genetic evaluation principles for affected women, as well as guidance on identifying those who are at risk. We provide considerations for cardiac surveillance in pregnancy and the post-partum period. Finally, key psychosocial issues that appraise how to best provide support to at risk women as they make informed decisions are discussed. We propose that a team approach including cardiology, maternal fetal medicine, and genetic counseling best serves this patient population. Ongoing questions addressing an evidence based approach to cardiovascular genetic conditions in pregnancy still remain. Thus, well-designed research protocols are essential to mark progress in this area.     

See the Triumph Healing Arts Workshops for Survivors of Intimate Partner Violence and Sexual Assault

Existing research demonstrates the potential value of arts-based interventions for survivors of abuse and other forms of trauma. The See the Triumph Healing Arts Workshops were designed to provide survivors of intimate partner violence and sexual assault with an opportunity to express themselves and connect with others through arts-based interventions. When appropriate, using the art developed through the workshops to create an art exhibit can be useful for raising awareness and giving voice to survivors in the local community. The preliminary results of the pilot evaluation suggest that the workshops were well-received and allowed participants to experience emotional expression, connection with others, and greater self-awareness.     

Rhesus monkeys (<Emphasis Type="Italic">Macaca mulatta</Emphasis>) discriminate between knowing and not knowing and collect information as needed before acting

Humans use memory awareness to determine whether relevant knowledge is available before acting, as when we determine whether we know a phone number before dialing. Such metacognition, or thinking about thinking, can improve selection of appropriate behavior. We investigated whether rhesus monkeys (Macaca mulatta) are capable of a simple form of metacognitive access to the contents of short-term memory. Monkeys chose among four opaque tubes, one of which concealed food. The tube containing the reward varied randomly from trial to trial. On half the trials the monkeys observed the experimenter baiting the tube, whereas on the remaining trials their view of the baiting was blocked. On each trial, monkeys were allowed a single chance to select the tube containing the reward. During the choice period the monkeys had the opportunity to look down the length of each tube, to determine if it contained food. When they knew the location of the reward, most monkeys chose without looking. In contrast, when ignorant, monkeys often made the effort required to look, thereby learning the location of the reward before choosing. Looking improved accuracy on trials on which monkeys had not observed the baiting. The difference in looking behavior between trials on which the monkeys knew, and trials on which they were ignorant, suggests that rhesus monkeys discriminate between knowing and not knowing. This result extends similar observations made of children and apes to a species of Old World monkey, suggesting that the underlying cognitive capacities may be widely distributed among primates.     

The interpersonal expression of perfection: perfectionistic self-presentation and psychological distress

A concept involving the interpersonal expression of perfection, perfectionistic self-presentation, is introduced. It is argued that perfectionistic self-presentation is a maladaptive self-presentational style composed of three facets: perfectionistic self-promotion (i.e., proclaiming and displaying one's perfection), nondisplay of imperfection (i.e., concealing and avoiding behavioral demonstrations of one's imperfection), and nondisclosure of imperfection (i.e., evading and avoiding verbal admissions of one's imperfection). Several studies involving diverse samples demonstrate that perfectionistic self-presentation is a valid and reliable construct and a consistent factor in personal and interpersonal psychological distress. It is argued that the need to promote one's perfection or the desire to conceal one's imperfection involves self-esteem regulation in the interpersonal context.     

The cost-effectiveness of cognitive behavior therapy for borderline personality disorder: results from the BOSCOT trial

Borderline personality disorder places a significant burden on healthcare providers and other agencies. This study evaluated the cost-effectiveness of cognitive behavior therapy plus treatment as usual compared to treatment as usual alone for patients with borderline personality disorder. The economic analysis was conducted alongside a multi-center, randomized controlled trial. The costs of primary and secondary healthcare utilization, alongside the wider economic costs, were estimated from medical records and patient self-report. The primary outcome measure used was the quality-adjusted life year (QALY), assessed using EuroQol. On average, total costs per patient in the cognitive behavior therapy group were lower than patients receiving usual care alone (-689 pounds sterling), although this group also reported a lower quality of life (-0.11 QALYs). These differences were small and did not approach conventional levels of statistical significance. The use of cognitive therapy for borderline personality disorder does not appear to demonstrate any significant cost-effective advantage based on the results of this study.     

Belief in a just world and social perception: evidence for automatic activation

The authors tested the hypothesis that beliefs in a just world are automatically activated and used in social perception. Under the guise of a perceptual vigilance task, the authors exposed 34 undergraduate women preconsciously to words that were either rape-related or neutral. Immediately after the exposure, participants read a date scenario that was ambiguous with respect to the man's aggressiveness and the extent to which the woman was responsible for the man's behavior. Afterwards, all participants evaluated the target man and woman on an impression task. The primary finding was that participants holding stronger beliefs in a just world perceived the target woman more negatively after experiencing the rape-related prime words than after experiencing the neutral words. This pattern is consistent with a research literature that shows that believers in a just world will often "blame the victim" in cases of rape. The present findings are important because they provide evidence that general, orienting beliefs are automatically activated in a manner similar to that shown by stereotype beliefs. The authors discussed implications for social perception.