Reproductive issues in carriers of germline pathogenic variants in the BRCA1/2 genes: an expert meeting

Background Healthy individuals and patients with cancer who are carriers of germline pathogenic variants in the BRCA1/2 genes face multiple reproductive challenges that require appropriate counseling and specific expertise. Main body On December 5th–7th, 2019, patient advocates and physicians with expertise in the field of reproductive medicine, fertility preservation, and oncology were invited to “San Giuseppe Moscati” Hospital in Avellino (Italy) for a workshop on reproductive management of women with germline pathogenic variants in the BRCA1/2 genes. From the discussion regarding the current evidence and future prospective in the field, eight main research questions were formulated and eight recommendations were developed regarding fertility, fertility preservation, preimplantation genetic testing, and pregnancy in healthy carriers and patients with cancer. Conclusion Several misconceptions about the topic persist among health care providers and patients often resulting in a discontinuous and suboptimal management. With the aim to offer patient-tailored counseling about reproductive issues, both awareness of current evidences and research should be promoted.

A new quality metric for dermatology: The “SPA” (sunscreen, protective gear, and avoidance) questionnaire to assess sun protection practices

Background: Given the importance of counseling patients on UV radiation exposure, a Sunscreen, Protective Gear, and Avoidance (SPA) Questionnaire was developed to assess patients’ sun exposure and help physicians provide tailored counseling to their patients regarding safe sun protection practices. Materials and methods: Six Denver Veterans Affairs (VA) dermatology providers who were trained in using the questionnaire randomly selected patients in the Denver VA Dermatology clinic to pilot-test the questionnaire. Demographic information and responses were collected using the SPA Questionnaire. Results: 43/61 (70.5%) of patients answered “no” to at least one sun protection strategy. Of these 43 patients, 40 (93%) were provided with tailored counseling. Five out of six providers indicated that the questionnaire encouraged conversations about sun protection for skin cancer prevention. Conclusion: The SPA questionnaire is a simple measure of UV exposure risk, which can help clinicians determine the sun-protective behavior of patients and initiate dialogue to increase patient knowledge of sun protection practices.

Facilitators and Barriers to Exclusive Breastfeeding Among Women Working in the Informal Sector: A Qualitative Exploration in Moshi, Tanzania

Objectives Paid work is a barrier to exclusive breastfeeding (EBF) worldwide. In Tanzania, most women work in the informal sector and cannot access paid maternity leave or other employment benefits, exacerbating these challenges. The objectives of this research were to examine barriers and facilitators to EBF among women working in the informal sector, and identify the strategies women use to meet infant care and feeding and informal work responsibilities. Methods We conducted semi-structured interviews with 20 mothers of children 1–5 months of age who work in the informal sector in Moshi Urban District, Tanzania. Recorded interviews were transcribed and translated into English. We used Atlas.ti to code transcripts, retrieve text segments, and conduct thematic analysis. Results Participants’ mean age was 31 years (range 18–43) and their children's mean age was 2.9 months. Mothers worked as vendors (i.e., food, clothes, or goods) or provided services (e.g., tailor) resulting in varied levels of flexibility and time away from home. Women had very different experiences with work, which was influenced by their job type. However, there was considerable variation between women with the same type of job. Although some women brought their baby to their worksites, most participants thought it was challenging as workplaces are unsafe, it is difficult to simultaneously meet customers’ and infants’ demands, and women are not comfortable breastfeeding in public. Some women left their worksites during the day to go home and breastfeed, but this was not an option for many women who reported long distances to their child, missing customers, and travel costs. Participants’ responses about expressing breastmilk were mixed with many voicing concerns about safety, milk quality, amount, preparation, and feeding. Conclusions While informal work may be perceived to facilitate EBF compared to formal work, our findings indicate that in this context it was highly variable and dependent on women's individual circumstances. Targeted strategies and tailored counseling are needed to support women who work in the informal sector to overcome these barriers as well as policy level changes that provide paid parental leave to informal workers. Funding Sources International Society for Research on Human Milk and Lactation (ISRHML) and the Family Larsson-Rosenquist Foundation.

When Shall Coronavirus Disease-19 Stop? Review of Literature

In December 2019, a new coronavirus, now labeled as severe acute respiratory syndrome coronavirus 2, induced an episode of acute atypical respiratory illness started in Wuhan, Province of Hubei, China. The illness triggered by this virus was called coronavirus disease-19 (COVID-19). The infection is spread within humans and has triggered a global pandemic. The amount of death tolls continues to increase and a growing number of countries have been driven to create social barriers and lock-ups. The shortage of tailored counseling remains an issue. Epidemiological researches have shown that elderly patients are more vulnerable to serious diseases, while children tend to have milder symptoms. Here, we checked the latest understanding of this disease and found a possible explanation of the potential sequel and the expectations for the future.

Predictors of Self-Determination and Mental Health Symptoms Among Youth in Juvenile Justice Facilities

The purpose of this article was to examine the relationships between (a) youth and facility characteristics and (b) youth risk and resilience factors (i.e., mental health, self-determination [SD]) in juvenile justice facilities. Extant self-report data from 205 nationally representative correctional facilities and 7,073 youth, collected as part of the Office of Juvenile Justice and Delinquency Survey of Residential Placement, were analyzed. Youth charateristics included sex, race, disability classification, mental health status, traumatic events/abuse encountered, offense committed, and SD. Facility factors included facility climate and counseling services. Results indicated that both prior abuse and victimization in the facility were positively correlated with mental health symptoms and SD. Positive perceptions of facility climate were associated with lower mental health symptoms. Youth who were female, younger, with a learning disability, and had committed a violent offense, reported more mental health symptoms. Positive perceptions of facility climate and receipt of counseling in the facility were associated with higher SD. Contrary to expectations, prior abuse and victimization in the facility were associated with higher SD. Recommendations include creating positive facility climates, developing targeted SD instruction, and providing tailored counseling services to facilitate successful transitions out of juvenile justice.

Examining the Utility of Photovoice as an Audiological Counseling Tool

Photovoice is a participatory action research method in which people take photographs to represent real-world experiences, so that issues of interest/concern can be documented. There are no published studies in which photovoice has been used in audiological rehabilitation (AR). The purpose of this feasibility study was to examine whether photovoice could have application in audiology.A feasibility study was designed to determine whether photovoice could be adapted for use as a clinical auditory rehabilitation tool (1) to facilitate provision of tailored communication strategy counseling, (2) as a post–hearing aid fitting counseling tool, (3) to enhance communication between partners regarding hearing loss, and (4) to provide an understanding of the emotional impacts of hearing loss.In this combined qualitative and quantitative feasibility study, a photovoice intervention was given to four groups of participants.Twenty-four individuals were recruited from a research subject data repository at the National Center for Rehabilitative Auditory Research.The study involved two visits to the laboratory during which participants received instruction in photovoice methodology (visit 1) and then, one to two weeks later, discussed their photographs during a debriefing session (visit 2).The mean number of photographs taken by participants was 12.6 (range: 4–29); the mean duration of the debriefing sessions was 40:39 min:sec (range: 14:30–66:22 min:sec). Participants reported that participating had made them think more about their hearing problems, appreciate their hearing aids more, and be more aware of the situations in which their hearing aids did and did not help. The taking and discussion of the photographs was also described as a learning tool, and it had facilitated conversations with others about hearing problems. Participants who completed the study with their communication partner (use case 3) said it had assisted with problem-solving and gave insight into the perspective of their partner. The research team noted that photovoice facilitated highly tailored counseling and provision of evidence-based recommendations for hearing assistive technology, enhanced interaction between communication partners, provided insight into participants’ lifestyle and communication needs, and seemed to generate rapport and trust.This feasibility study indicated that participants were willing to engage in photovoice and that it could be used to guide selection of rehabilitation recommendations and for postfitting counseling. Its application in audiological practice would seem timely and valuable for improving patient-centered and family-centered AR.

Acculturative Stress, Psychological Distress, and Religious Coping Among Latina Young Adult Immigrants

Religion is a source of strength in Latina/o culture during challenging life transitions, such as the immigration process. Guided by a sociological stress–process model, this study examines relations between dimensions of religious coping, acculturative stress, and psychological distress among 530 young Latina women (ages 18-23 years) who recently immigrated to the United States (i.e., approximately 12 months prior to assessment). Higher levels of acculturative stress were associated with higher levels of psychological distress. Negative religious coping (i.e., the tendency to struggle with faith) moderated the relation between acculturative stress and psychological distress. Participants experiencing higher levels of acculturative stress reported greater psychological distress when they indicated more negative religious coping. Positive religious coping (i.e., the tendency to relate to faith with comfort and certainty) was not linked with acculturative stress or psychological distress. Implications for culturally tailored counseling interventions for this underserved and understudied population are discussed.