Nondirectiveness and Its Lay Interpretations: The Effect of Counseling Style, Ethnicity and Culture on Attitudes Towards Genetic Counseling Among Jewish and Bedouin Respondents in Israel

To evaluate the effects of ethnicity, culture, and counseling style on the interpretation of nondirectiveness in genetic counseling, a questionnaire containing premarital and prenatal case vignettes in two versions (pessimistic/optimistic) was administered to 281 Jewish and 133 Bedouin respondents. The first study population was comprised of Jewish students enrolled in a university and a community college in the Negev (southern part of Israel). The second study population was comprised of Muslim-Bedouin college students from the same area. The majority of Jewish respondents interpreted the nondirective message as intended by counselors, while the majority of Bedouin respondents did not. Counseling style was found to have a statistically significant effect on the interpretation of the general role of counseling. Gender and susceptibility were not found to have a significant effect on interpretation. Group differences are analyzed through a cultural lens in which different interpretive norms can generate expectations for either nondirectiveness or directiveness.     

Reproductive Genetic Counseling to Asian-Pacific and Latin American Immigrants

Latin and Asian-Pacific immigrants are the fastest growing new-comer groups in the U.S. contributing to 85% of immigration totals. New immigrants experience multiple barriers to accessing genetic counseling resulting from cultural, linguistic, financial, and educational factors as well as having unique perceptions on health, illness, reproduction, and life as a whole. In addition, new immigrants lack familiarity with Western medical practices as well as genetic risk and available interventions. We provided perinatal genetic services to 2430 clients, mostly new immigrants of Latin and Asian-Pacific descent over a period of 6 years. Counseling aides sharing the clients' cultural backgrounds were employed. A study assessing the efficacy of cross-cultural education regarding advanced maternal age risk and amniocentesis was implemented and linked to a database containing demographic and clinical information. Practical observations relating to cultural beliefs in the two groups relevant to perinatal genetic counseling were made.     

Practice variability in prenatal genetic counseling

This study demonstrated that the content of prenatal genetic counseling sessions varied from counselor to counselor and from center to center. The study was designed to examine which specific issues were included by genetic counselors in prenatal genetic counseling sessions, and to determine which factors led genetic counselors to include or exclude this information from such sessions. Data were collected by randomly surveying 200 full, master degree members of the National Society of Genetic Counselors (NSGC). Respondents provided information by deciding which of 45 specific issues they would include in a standard prenatal genetic counseling session, and which one factor from a bank of 11 factors most accurately described the reason for this decision. The results indicated that the issues included/excluded from sessions varied widely among genetic counselors. The results also indicated that Patient Education/Informed Decision Making (34.5%) played the largest role in decision making overall, with Standard at Center/Departmental Policy (17.6%), Personal Experience/Preference (12.4%), and Applicability (10.9%) serving as the next three most important reasons for including or excluding issues from prenatal genetic counseling sessions.     

Prenatal discrimination of a male and a female voice uttering the same sentence

Using a habituation/dishabituation procedure, near-term foetuses (36-39 weeks gestational age) were tested in a low variability HR state, to examine whether they could discriminate between a male and a female voice repeatedly uttering the same short sentence. Prosody and loudness of the two voices were controlled. Once the foetal heart rate (HR) habituated to the first voice, the effect of a second voice was investigated in two experimental conditions: male/female voice and female/male voice. HR variations after the onset of the second voice were compared to those occurring in two control conditions in which the same voice was presented twice (male/female voice and female/female voice). Highly conservative statistical criteria taking each subject's pre-stimulus HR variability into account showed that most foetuses exposed to the voice change displayed decelerative cardiac changes, with no significant difference between the two conditions. These HR decelerations were found in the first seconds following the onset of the new voice, and reached their peak amplitude within 10 s in most subjects. These responses lasted more than 10 s for two-thirds of the experimental subjects. Mostly transient HR accelerations and only a few decelerative changes were recorded in the control subjects. Furthermore, mean amplitudes of these changes were significantly lower than the HR decelerations induced by the new voice in the experimental conditions, suggesting that the latter were not spontaneous HR modifications but rather cardiac responses to the voice change. It is argued that near-term foetuses may perceive a difference between voice characteristics of two speakers when they are highly contrasted for fundamental frequency and timbre.     

Antenatal Genetic Testing and the Right to Remain in Ignorance

As knowledge increases about the human genome,prenatal genetic testing will become cheaper,safer and more comprehensive. It is likelythat there will be a great deal of support formaking prenatal testing for a wide range ofgenetic disorders a routine part of antenatalcare. Such routine testing is necessarilycoercive in nature and does not involve thesame standard of consent as is required inother health care settings. This paper askswhether this level of coercion is ethicallyjustifiable in this case, or whether pregnantwomen have a right to remain in ignorance ofthe genetic make-up of the fetus they arecarrying. While information gained by genetictesting may be useful for pregnant women whenmaking decisions about their pregnancy, it doesnot prevent harm to future children. It isargued that as this kind of testing providesinformation in the interests of the pregnantwomen and not in the interests of any futurechild, the same standards of consent that arenormally required for genetic testing should berequired in this instance.     

产前超声检查的相关伦理学思考

超声检查是产前诊断的一项主要检查技术,应坚持将患者的利益放在首位的原则,并且在检查前充分告知孕妇超声检查的安全性及局限性。对知情同意、人工流产及性别鉴定等伦理问题进行了分析。医生应告知孕妇胎儿的异常情况。以便其做出决定。     

THE IMPACT OF DEPRESSION ON MATERNAL RESPONSES TO INFANT FACES IN PREGNANCY

Research has suggested that prenatal depression may be associated with disrupted maternal responses to infant stimuli, with depressed pregnant women not showing the bias toward distressed infants as that observed in nondepressed pregnant women. The current study examined the effects of depression on self‐ reported responses to infant stimuli, in early pregnancy. Women with clinical depression (n = 38), and nondepressed women (n = 67) were recruited from a wider cognitive behavioral therapy trial. They completed Maternal Response Scales in which they were presented with images of distressed, neutral, and happy infant faces, with no time limit. The women rated their responses to these images along three dimensions—wanting to comfort, wanting to turn away, and feelings of anxiety—using Likert scales via a computerized task. There was evidence that women with depression in pregnancy showed different responses than did women without depression. Women with depression were substantially more likely to be in the highest quartile for ratings of wanting to turn away, odds (OR) ratio = 4.15, 95% confidence intervals (CIs) = 1.63–10.5, p = .003, and also were substantially less likely to be in the highest quartile for wanting to comfort a distressed infant face, OR = 0.22, 95% CIs = 0.09–0.54, p < .001. Findings are consistent with there being both a heightened avoidant and a reduced comforting response toward distressed infants in depressed pregnant women, providing some support that depression disrupts maternal preparations at a conscious level.     

The Perceptions of Lutheran Pastors Toward Prenatal Genetic Counseling and Pastoral Care

The purpose of this study is to explore a theological perspective toward genetic counseling. A survey was sent to 207 ministers within the Evangelical Lutheran Church of America (ELCA), to determine their perspectives toward four different scenarios in a prenatal genetic counseling setting. The four different scenarios included situations involving Huntington disease, Down syndrome, trisomy 18, and anencephaly. Nearly all ELCA Lutheran pastors perceived genetic counseling as beneficial and useful and wanted to be involved in the decision-making process for whether or not to terminate the pregnancy. Their views toward termination of pregnancy varied depending on the severity of the genetic abnormality. Severity in this study was based upon life compatibility. As the severity of the genetic abnormality increased, the percentage of Lutheran pastors who viewed termination as an option increased from 23% (Down syndrome) to 62% (anencephaly). A better understanding of how spiritual leaders view genetic counseling would provide an insight into how genetics and religious beliefs together play a significant role in shaping the decisions of those faced with abnormal pregnancies.     

The Association of Children's Nonverbal Decoding Abilities With Their Popularity,Locus of Control,and Academic Achievement

The present study examined the relation between children's abilities to decode the emotional meanings in facial expressions and tones of voice, and their popularity, locus of control or reinforcement orientation, and academic achievement. Four hundred fifty-six elementary school children were given tests that measured their abilities to decode emotions in facial expressions and tones of voice. Children who were better at decoding nonverbal emotional information in faces and tones of voice were more popular, more likely to be internally controlled, and more likely to have higher academic achievement scores. The results were interpreted as supporting the importance of nonverbal communication in the academic as well as the social realms.