Periodical abstracts

Abstract

This research analyzed physicians’ attitudes toward and use of genetic counseling. Data were obtained through mailed questionnaires sent to all 445 general and family practitioners, pediatricians, and obstetrician‐gynecologists in private practice and involved in direct patient care in Maricopa and Pima Counties, Arizona. Results indicated strong attitudinal support for genetic counseling. Almost all respondents felt that it was a useful and necessary medical service, and most felt that it resulted in more responsible patient decisions. Actual genetic counseling by physicians was comparatively rare, however. The data suggested that the paucity of counseling may have derived from a lack of training in genetics, scarcity of patient requests, and legal naïveté. Genetic counseling, amniocentesis, and abortion received the most support from younger physicians, obstetrician‐gynecologists, and those who were Jewish, less religious, and had few or no children.     

Report on the Moscow symposium on biological research in schizophrenia

Abstract

Genetic counseling, second trimester amniocentesis, reliable techniques for analyzing fetal amniotic fluid and selective abortion together have the potential to prevent a variety of serious birth defects. Advances in technique and/or changing patterns of childbearing may place a large number of women in age groups where genetic counseling programs are recommended. However, attitudes toward abortion may be a critical variable in ascertaining the potential of genetic counseling programs to reduce birth defects. If opposition to abortion is based on a moral commitment, greater awareness of genetic counseling programs will lead to opposition to these programs. If attitudes toward abortion are based upon an evaluative process, such opposition is less likely to occur. Using a sample of women from the Rochester, New York, area (N = 1,616) whose attitudes toward abortion match U.S. estimates, we find that the greater the knowledge about prenatal screening, the less prevalent are attitudes opposed to abortion in circumstances necessary for birth defect reduction. This relationship holds when controlled for religion and family size. We conclude that educational and counseling programs concerning the potential benefits of prenatal screening are unlikely to arouse opposition to these programs.     

Veterinary Students’ Beliefs About Animal Sentience: What Role Does Gender Play?

ABSTRACT

Across a 15-year period, annual cohorts of first-year veterinary science students (n = 1,380; 77% female) at a British university completed the Belief in Animal Sentience (BiAS) questionnaire, in which they reported their beliefs about the sentience (capacity to feel) of ten species: dogs, cats, lions, pigs, sheep, rats, rabbits, chickens, bees, and spiders. On the basis of previous findings regarding people’s beliefs about animals’ capacities for mind, it was hypothesized that female students would ascribe more human-like sentience to animals than would male students. It was also hypothesized that the proportion of female students in each of the cohorts studied would have an influence on the beliefs of the year group as a whole: cohorts comprising a larger percentage of women would have higher animal sentience beliefs in both males and females. The data were analyzed using two-level regression models to concurrently investigate the effects of individual respondents’ gender and the percentage of female students in their cohort. Compared with their male counterparts, female veterinary students across all the cohorts studied attributed significantly higher (more human-like) sentience to each of the ten animals listed in the BiAS questionnaire, but the percentage of female students in each year group was not associated with students’ sentience beliefs. It was also found that childhood experience of having owned pet cats or dogs was related to students’ beliefs about the sentience of these species, although this association did not contribute to the differences found between male and female respondents. Given the increasing number of women entering the veterinary profession, and previous findings that beliefs about animals’ capacities for sentience may be associated with the veterinary care they are given, we conclude that gender differences in sentience beliefs could have a significant impact on the future of veterinary practice and patient welfare.     

On Abortion: Exploring Psychological Meaning and Attitudes in a Sample of Mexican Gynecologists

Elective abortion has become an issue of ethical and political debate in many countries including Mexico. As gynecologists are directly involved in the practice of abortion, it is important to know the psychological meaning that the term ‘elective abortion’ has for them. This study explores the psychological meaning and attitudes toward elective abortion of one hundred and twenty‐three Mexican gynecologists. We used the semantic networks technique, which analyzed the words the participants associated with the term ‘elective abortion’. The defining words most frequently used by participants implied a negative sanction. There were important differences by gender and religiosity: male gynecologists, as well as those with strong religious beliefs (mainly Catholics), revealed a more negative psychological meaning and more negative attitudes than females or physicians with weak religious beliefs. A contribution of the present study is that it highlights the importance of psychology to enhancing understanding of the issue of elective abortion.     

Basis for Physician Recommendations for Adjuvant Radioiodine Therapy in Early-Stage Thyroid Carcinoma: Principal Findings of the Canadian-American Thyroid Cancer Survey

ObjectiveTo explore physician recommendations regarding radioiodine remnant ablation (RRA) as adjuvant treatment in early-stage well-differentiated thyroid carcinoma (WDTC), their rationale for administration of RRA, and their willingness to involve patients’ opinions in decision making about the use of RRA.MethodsWe surveyed a representative sample of specialty physicians in Canada and the United States and asked survey participants whether they would recommend adjuvant RRA after thyroidectomy for a 1.6-cm papillary thyroid carcinoma (Likert scale of agreement responses from 1 to 7; strong agreement ≥ 6). Factor analysis was performed to explore the rationale for recommendations. We asked whether physicians accepted the role of patients’ preferences in decision making about administration of RRA, and backward conditional logistic regression analysis was used to identify predictors of strong acceptance.ResultsThe effective response rate for the survey was 56.3% (486 of 864), with 62.8% (295 of 470 respondents) strongly recommending RRA. Strong RRA recommendations were founded in opinions that RRA (1) decreases WDTC-related mortality and recurrence and (2) facilitates WDTC follow-up at low risk of adverse effects. Approximately a third of the survey respondents (152 of 474) strongly agreed with incorporation of patients’ preferences in decision making regarding the use of RRA. Physicians without firm convictions about the efficacy of RRA in decreasing disease-related outcomes and those practicing in the United States were most likely to indicate strong support for incorporating patients’ preferences in decision making about RRA.ConclusionThe recommendations of physicians regarding use of adjuvant RRA are founded in beliefs in intervention efficacy and follow-up practices. Physicians in medical practice in the United States and those without strong convictions about RRA efficacy are most likely to incorporate patients’ views in individualizing decisions about RRA therapy. (Endocr Pract. 2008;14:175-184)     

Causes of low utilization of amniocentesis by women of advanced maternal age

Abstract

The objectives of this study were to determine current usage of amniocentesis by women of advanced maternal age in a southwestern Ohio county and to determine potential usage levels by surveying women not utilizing the procedure to understand their reasons. For women age 35 and older giving birth in Hamilton County, Ohio, the estimated percentage using amniocentesis was 3.9 in 1978, 7.6 in 1979, and 13.3 in 1980. Approximately comparable statewide utilization rates were 7.0, 11.5, and 17.2 respectively. A telephone survey during the summer of 1980 of 81 Hamilton County women age 35 and older recently giving birth to a normal baby found four main reasons why they did not utilize amniocentesis: (1) they did not feel at an increased risk (29.6 per cent); (2) they had never heard of the test (24.7 per cent); (3) they were opposed to abortion (21.0 per cent); and (4) no one suggested they have the test done (19.8 per cent). Their physicians reported that 81 per cent of these women had received prenatal counseling. Thus, of those counseled, over two‐thirds apparently missed at least one essential message of the counseling they were presumably provided. These findings, coupled with 47.7 per cent of women who knew about amniocentesis saying they would most likely use it if they became pregnant again and their physician recommended it, indicate that utilization of prenatal diagnosis by at least 50 per cent of women age 35 and older is likely with greater public education and greater support of the procedure by obstetricians.     

Rewarding the good and punishing the bad: The role of karma and afterlife beliefs in shaping moral norms

Moralizing religions encourage people to anticipate supernatural punishments for violating moral norms, even in anonymous interactions. This is thought to be one way large-scale societies have solved cooperative dilemmas. Previous research has overwhelmingly focused on the effects of moralizing gods, and has yet to thoroughly examine other religious moralizing systems, such as karma, to which more than a billion people subscribe worldwide. In two pre-registered studies conducted with Chinese Singaporeans, we compared the moralizing effects of karma and afterlife beliefs of Buddhists, Taoists, Christians, and the non-religious. In Study 1 (N = 582), we found that Buddhists and Taoists (karmic religions) judge individual actions as having greater consequences in this life and the next, compared to Christians. Pointing to the specific role of karma beliefs in these judgements, these effects were replicated in comparisons of participants from the non-karmic religions/groups (Christian and non-religious) who did or did not endorse karma belief. Study 2 (N = 830) exploited religious syncretism in this population by reminding participants about either moral afterlife beliefs (reincarnation or heaven/hell), ancestor veneration beliefs, or neither, before assessing norms of generosity in a series of hypothetical dictator games. When reminded of their ancestor veneration beliefs, Buddhists and Taoists (but not Christians) endorsed parochial prosocial norms, expressing willingness to give more to their family and religious group than did those in the control condition. Moral afterlife beliefs increased generosity to strangers for all groups. Taken together, these results provide evidence that different religious beliefs can foster and maintain different prosocial and cooperative norms.     

Opinions regarding abortion among male Nigerian undergraduate students in the United States

Abstract

Acculturation theory suggests that contemporary Africa has been experiencing sociocultural changes (opinions, beliefs, values, and so on) because of the impact of Western culture, especially through the exposure to Western eduction. Based on first‐hand data on 117 male Nigerian students attending American colleges and universities at the undergraduate level, the issue of abortion is raised in terms of (1) whether these students favor or oppose abortion, and (2) what factors are statistically related to abortion. The analysis of the data indicates that 64.1 per cent of the students are against abortion, 18.8 per cent endorsed abortion, while 17.1 per cent were uncertain. The outcome of varying cross‐tabulations and chi‐square tests shows that abortion is statistically related to the number and sex of children. It is also revealed that marital status, religious preference, and opinion about the present population of Nigeria are related to abortion.     

Acceptance of trial of labor after cesarean (Tolac) among obstetricians in the Western Region of Saudi Arabia: A cross-sectional study

BackgroundBabies to women eligible for trial of labor after a cesarean (TOLAC) are sometimes delivered by cesarean section (CS). To obtain clinicians’ attitudes and beliefs about TOLAC, this study was designed to investigate the views of clinicians when advising TOLAC-eligible pregnant women about TOLAC, and to explore their reasons in favor of or against TOLAC.MethodsInterviews were carried out individually (face-to-face) with clinicians using a specially designed questionnaire to collect data from obstetricians in the Western Region of Saudi. Regression analysis was used as appropriate.ResultsAmong the 183 obstetricians included in the current study, approximately 79.2% were against offering TOLAC. However, most of the physicians (89.1%) were in favor of offering TOLAC to patients who had had a successful vaginal birth after CS. significant associations were found between physicians’ opposition to TOLAC and medical and most non-medical factors.ConclusionClinicians should recognize that the critical role they play in the delivery decision-making process and in boosting women’s confidence in TOLAC may be key to increasing the rate of TOLAC.     

A benefit‐cost analysis of amniocentesis

Abstract

This study applies benefit‐cost analysis to one area of prenatal diagnosis— amniocentesis. The ultimate purpose of such a study is to provide useful guidelines to policy makers. An attempt is made to exhaustively list benefits and costs, whether measurable or not. Those which can be quantified are estimated. On the basis of these benefit‐cost estimates, the study concludes that a program of amniocentesis for all pregnant women beyond age 32 would be warranted. This economic analysis, however, is only one aspect of a policy decision. Moral, legal, and ethical questions must also be considered.     

Authoritative knowledge and single women's unintentional pregnancies,abortions, adoption,and single motherhood: social stigma and structural violence

This article explores the sources of authoritative knowledge that shaped single, white, middle-class women's unintentional pregnancies and child-bearing decisions throughout five reproductive eras. Women who terminated a pregnancy were most influenced by their own personal needs and circumstances. birth mothers' decisions were based on external sources of knowledge, such as their mothers, social workers, and social pressures. In contrast, single mothers based their decision on instincts and their religious or moral beliefs. Reproductive policies further constrained and significantly shaped women's experiences. The social stigma associated with these forms of stratified maternity suggests that categorizing pregnant women by their marital status, or births as out-of-wedlock, reproduces the structural violence implicit to normative models of female sexuality and maternity. This mixed-method study included focus groups to determine the kinds of knowledge women considered authoritative, a mailed survey to quantify these identified sources, and one-on-one interviews to explore outcomes in depth.     

Lack of interest by nonpregnant couples in population-based cystic fibrosis carrier screening.

We used signs and letters to offer free cystic fibrosis (CF) carrier screening to nonpregnant adults in stable relationships who visited numerous clinical and nonclinical sites in Nashville. A total of 179 individuals (<<1% of those eligible) elected to be tested. To understand this observation, we used questionnaires to assess individuals' attitudes about genetic testing in general and about CF carrier screening in particular (n=873). Participants expressed conflicting views about carrier screening. More than 90% of people thought that genetic testing should at least be available. Most respondents said that the views of their partners and physicians were important in their decision making, and most believed that these others favored genetic testing. Yet, more than two-thirds indicated that such factors as insurability, being "at risk," what they would need to learn, abortion, and religious beliefs were important in their decision making, opinions that mitigated against genetic testing. In particular, one-third feared that carriers would lose their health insurance, one-quarter said that they would have been more interested had they been able to provide DNA by buccal swab rather than by finger stick, and less than one-sixth believed that genetic testing was meddling in God's plan. In the face of both the low level of use of free CF carrier screening by nonpregnant couples when it was not offered in person by health-care professionals and the wide variety of concerns demonstrated, we believe that clinicians should not routinely offer carrier screening to nonpregnant individuals who do not have a family history of CF.     

Folk conceptualizations of racism and antiracism in Brazil and South Africa

Abstract

Folk conceptualizations of racism can be defined as ordinary people's understandings of the sources and persistence of racism. They function as equalization strategies – by denying the legitimacy of racism – and guide beliefs regarding antiracism strategies. I explore folk explanations of racism among black professionals in Brazil and South Africa by drawing on sixty interviews with members of these groups. In Brazil, racism is understood as an historical lingering, a product of ignorance, which will disappear with time and education. In South Africa, racism is viewed as more resilient, as a part of human nature and as a consequence of the competition for resources. These explanations of racism are closely related to the antiracism narratives that are salient in these two contexts: while Brazilian respondents affirm their belief in racial mixture and moral education, South African respondents are more uncertain about the possibilities of weaker racial boundaries in their country, relying on institutional constraints as their main antiracism strategy.     

未婚人工流产女性生殖健康知识知晓现状调查及其影响因素分析

摘要 目的：探究未婚人工流产女性生殖健康知识知晓现状,并分析其影响因素。方法：随机选取2018年3月~2021年5月期间在同济大学附属第一妇婴保健院计划生育科终止妊娠的未婚女性486例作为研究对象。其中,拒绝调查者21例,实际调查465例,应答率95.68%（465/486）,数据清理后有效问卷459份,有效率为98.71%（459/465）。调查未婚人工流产女性生殖健康知识知晓现状,未婚人工流产女性生殖健康知识知晓情况的危险因素采用单因素及多因素Logistic回归分析。结果：研究对象中,女性生殖健康知识知晓总分最低分17分,最高分为92分,平均（65.74±10.82）分;得分大于80分者179例,优良率为39.00%（179/459）。得分在80分及其以下的女性280例。未婚人工流产女性生殖健康知识知晓情况与年龄、女方文化程度、父母婚姻状况、流产次数、工作性质、居住地、恋爱经历、男方文化程度有关（P<0.05）。而与家庭月收入、更换工作次数无关（P>0.05）。年龄、男方文化程度工作性质、居住地、女方文化程度、流产次数、父母婚姻状况是未婚人工流产女性生殖健康知识知晓情况的影响因素（P<0.05）。结论：未婚人工流产女性生殖健康知识知晓水平一般,受到年龄、女方文化程度、父母婚姻状况等多种因素影响,应针对其影响因素特点加强生殖健康知识的宣教,以降低人工流产的风险。     

Agreement of self-reported hormone receptor status with cancer registry data in young breast cancer patients

BackgroundThough breast cancer subtype is a key determinant of treatment choice and prognosis, few studies have assessed breast cancer patients’ knowledge of estrogen and progesterone receptor (ER/PR) status.MethodsWomen diagnosed with invasive breast cancer at age 18–64 years in 2007 were recruited from the Pennsylvania Cancer Registry, and mailed a questionnaire that asked respondents to identify their ER/PR status. There were 2191 respondents included in the analysis. Agreement between self-report and cancer registry ER/PR status was assessed using kappa statistic. Logistic regression was used to assess the association of demographic, socioeconomic, and tumor factors with inaccurate self-report of ER/PR status.ResultsFifty-nine percent of respondents reported ER/PR positive status, 15% reported ER/PR negative status, 17% responded ‘don’t know’, and 9% did not respond. Overall, there was 69% agreement between self-report and cancer registry data, and fair agreement as measured by kappa (0.36). After excluding women who did not know or did not report their ER/PR status, there was 93% agreement, and substantial agreement as measured by kappa (0.76). Women who were older, non-white, less educated, lower income, and had ER/PR negative disease were significantly more likely to inaccurately report their ER/PR status.ConclusionsThough a significant proportion of women do not know their hormone receptor status, women who reported their ER/PR status were accurate. Our results suggest room for improvement in patient knowledge of tumor subtypes, but also that self-reported ER/PR status may be a useful surrogate when medical record or cancer registry data is unavailable.     

National Survey of Endocrinologists and Surgeons Regarding Active Surveillance for Low-Risk Papillary Thyroid Cancer

ObjectiveActive surveillance for low-risk papillary thyroid cancer (PTC) was endorsed by the American Thyroid Association guidelines in 2015. The attitudes and beliefs of physicians treating thyroid cancer regarding the active surveillance approach are not known.MethodsA national survey of endocrinologists and surgeons treating thyroid cancer was conducted from August to September 2017 via professional society emails. This mixed-methods analysis reported attitudes toward potential factors impacting decision-making regarding active surveillance, beliefs about barriers and facilitators of its use, and reasons why physicians would pick a given management strategy for themselves if they were diagnosed with a low-risk PTC. Survey items about attitudes and beliefs were derived from the Cabana model of barriers to guideline adherence and theoretical domains framework of behavior change.ResultsAmong 345 respondents, 324 (94%) agreed that active surveillance was appropriate for at least some patients, 81% agreed that active surveillance was at least somewhat underused, and 76% said that they would choose surgery for themselves if diagnosed with a PTC of ≤1 cm. Majority of the respondents believed that the guidelines supporting active surveillance were too vague and that the current supporting evidence was too weak. Malpractice and financial concerns were identified as additional barriers to offering active surveillance. The respondents endorsed improved information resources and evidence as possible facilitators to offering active surveillance.ConclusionAlthough there is general support among physicians who treat low-risk PTC for the active surveillance approach, there is reluctance to offer it because of the lack of robust evidence, guidelines, and protocols.     

Fears and Beliefs in Rheumatoid Arthritis and Spondyloarthritis: A Qualitative Study

ObjectivesTo explore beliefs and apprehensions about disease and its treatment in patients with rheumatoid arthritis and spondyloarthritis.Methods25 patients with rheumatoid arthritis and 25 with spondyloarthritis participated in semi-structured interviews about their disease and its treatment. The interviews were performed by trained interviewers in participants'' homes. The interviews were recorded and the main themes identified by content analysis.ResultsPatients differentiated between the underlying cause of the disease, which was most frequently identified as a hereditary or individual predisposition. In patients with rheumatoid arthritis, the most frequently cited triggering factor for disease onset was a psychological factor or life-event, whereas patients with spondyloarthritis tended to focus more on an intrinsic vulnerability to disease. Stress and overexertion were considered important triggering factors for exacerbations, and relaxation techniques were frequently cited strategies to manage exacerbations. The unpredictability of the disease course was a common source of anxiety. Beliefs about the disease and apprehensions about the future tended to evolve over the course of the disease, as did treatment expectations.ConclusionsPatients with rheumatoid arthritis and spondyloarthritis hold a core set of beliefs and apprehensions that reflect their level of information about their disease and are not necessarily appropriate. The physician can initiate discussion of these beliefs in order to dispel misconceptions, align treatment expectations, provide reassurance to the patient and readjust disease management. Such a dialogue would help improve standards of care in these chronic and incapacitating diseases.     

Factors influencing stakeholders' attitudes toward cross-kingdom gene transfer in rice

The purpose of this study was to identify the relevant factors influencing stakeholders' attitudes toward the transfer of an animal (mouse) gene into rice for vitamin C enhancement. A survey was carried out on 434 respondents from various stakeholder groups in Malaysia. Results of the survey have confirmed that attitudes toward cross-kingdom gene transfer, such as genetically modified (GM) rice, are the result of a complex decision-making process that involves the cumulative interaction of various factors. The most important direct predictors of a positive attitude toward GM rice were specific application-linked perceptions about the religious acceptability and risks of such rice. The attitude toward GM rice also involves interplay between other factors, such as familiarity and the perceived benefits of GM rice, and more general attitudinal variables, such as moral beliefs about biotechnology, attitudes toward labeling, attitudes toward patenting, attitudes toward nature, and confidence in biotechnology regulations.