Maria Emília Costa

Direct and indirect effects of perceived social support on women's infertility-related stress

BACKGROUND Social support can be a critical component of how a woman adjusts to infertility, yet few studies have investigated its impact on infertility-related coping and stress. We examined relationships between social support contexts and infertility stress domains, and tested if they were mediated by infertility-related coping strategies in a sample of infertile women. METHODS The Multidimensional Scale of Perceived Social Support, the Copenhagen Multi-centre Psychosocial Infertility coping scales and the Fertility Problem Inventory were completed by 252 women seeking treatment. Structural equation modeling analysis was used to test the hypothesized multiple mediation model. RESULTS The final model revealed negative effects from perceived partner support to relationship concern (β = -0.47), sexual concern (β = -0.20) and rejection of childfree lifestyle through meaning-based coping (β = -0.04). Perceived friend support had a negative effect on social concern through active-confronting coping (β = -0.04). Finally, besides a direct negative association with social concern (β = -0.30), perceived family support was indirectly and negatively related with all infertility stress domains (β from -0.04 to -0.13) through a positive effect of active-avoidance coping. The model explained between 12 and 66% of the variance of outcomes. CONCLUSIONS Despite being limited by a convenience sampling and cross-sectional design, results highlight the importance of social support contexts in helping women deal with infertility treatment. Health professionals should explore the quality of social networks and encourage seeking positive support from family and partners. Findings suggest it might prove useful for counselors to use coping skills training interventions, by retraining active-avoidance coping into meaning-based and active-confronting strategies.

Disability, embodiment and ableism: stories of resistance

Non-disabled responses to visible impairment embody either social invisibility or over-attentiveness. The subjective and inter-subjective experiences of impaired bodies and intersubjective encounters within society are important aspects of disablement and the construction of a disabled identity. Impairment is read by and influences the social structure of ableism. This paper attempts to understand how ableist discourses about impaired bodies have impacted on and been resisted by disabled people and how embodiment is related to identity. In pursuit of these aims, a qualitative study was conducted with seven people who have visible physical impairments. The results indicate that disabled embodiment is produced and experienced within an ableist context that mobilizes the charitable gaze and the medical model to signify impaired bodies at the expense of the recognition of disabled identity. In order to deconstruct ableism and to recognize and respect the value of the disabled identity, a politics of recognition is required.

Interactive effects of social support and disclosure on fertility-related stress

Individuals perceiving high social support tend to perceive better adjustment to infertility. However, it remains unclear whether this benefit is affected by the actual disclosure of the infertility condition. The present study aimed to examine the role of disclosure of fertility status in moderating the relationship between perceived social support and fertility-related stress. The study population (N = 698) was drawn from a longitudinal cohort design of Danish men and women beginning fertility treatment with a 12-month follow-up. Participants were 698 subjects (364 women and 334 men) who completed self-administered questionnaires measuring perceived social support at T1, and fertility status disclosure and fertility stress at T2. Results indicated that when infertility is not disclosed to at least a close relationship, the beneficial effects of social support on both social and personal stress cease to exist. Also, when participants perceived high social support, higher levels of social and personal stress were associated with keeping infertility a secret within close relationships, but when low social support was perceived, high social and personal stress levels were associated with disclosing infertility to all close relationships. Findings from this study provide evidence that the prospective relationship between social support and fertility-related stress is moderated by the decision of disclosing infertility. Infertility health professionals can help couples in deciding to which contexts they should disclose their infertility by assessing social support.

Interrelationships of Adult Attachment Orientations, Health Status and Worrying among Fibromyalgia Patients

This study examined associations between adult attachment dimensions, perceived health status and worrying (coping strategy with chronic pain), and explored whether worrying mediated observed relationships between attachment dimensions and health outcomes within a sample of 128 Portuguese female fibromyalgia patients. Physical health status was inversely correlated with dependence and worrying; mental health status was positively correlated with trust, and inversely related to attachment-related ambivalence, dependence and worrying. Finally, worrying mediated relationships between dependence and both physical and mental health status; moreover, worrying partially mediated the relationship between ambivalence and mental health status. Implications of the findings are discussed.

Marital stability and repartnering: infertility-related stress trajectories of unsuccessful fertility treatment

OBJECTIVE To compare the trajectories of infertility-related stress between patients who remain in the same relationship and patients who repartner. DESIGN Longitudinal cohort study using latent growth modeling. SETTING Fertility centers. PATIENT(S) Childless men and women evaluated before starting a new cycle of fertility treatment and observed for a 5-year period of unsuccessful treatments. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Marital stability and infertility-related stress. RESULT(S) The majority of patients (86%) remained with their initial partner, but 14% of participants separated and repartnered while pursuing fertility treatments. Marital stability significantly predicted the initial status of infertility stress and infertility stress growth levels. Specifically, patients who repartnered had higher infertility stress levels at all time points compared with those who remained in the same relationship, regardless of the partner they were with at assessment. Furthermore, results showed an increasing stress trajectory over time for those who repartnered, compared with those who remained in a stable relationship. CONCLUSION(S) Men and women in fertility treatment who form a second union have higher initial levels of stress in their original relationship and higher changes in stress levels over the course of treatments. These findings suggest that high infertility-related stress levels before entering fertility treatment can negatively affect the stability of marital relationships and lead to repartnering.

Couples’ discontinuation of fertility treatments: a longitudinal study on demographic, biomedical, and psychosocial risk factors

PurposeThis study aims to explore the role of infertility-psychosocial variables on treatment discontinuation after controlling for demographic and biomedical variables in couples seeking reimbursed fertility treatment.MethodsA prospective study was conducted in 139 couples seeking fertility treatment. Between February 2010 and March 2011, participants completed measures of anxiety (STAI-State), depression (BDI-II), infertility-stress (FPI), and infertility coping strategies (COMPI-CSS). Medical data related to diagnosis, treatment, and discontinuation were collected in December 2013. A multiple logistic regression was performed to identify the predictors of discontinuation.ResultsThe discontinuation rate was 29.5%. Female education level, engagement in ART procedures, and female causation decreased the likelihood of treatment discontinuation, whereas female age and depression increased the likelihood of discontinuation. Female depression was the strongest predictor in this model. The model correctly identified 75.5% of cases.ConclusionsFemale age and female depression are associated with a higher likelihood of treatment discontinuation in couples seeking treatment. Reproductive health professionals should therefore inform couples about the link between the fertility treatment discontinuation and both female age and female depression. Couples in which female partners present clinically relevant depression should be referred to a mental health professional to prevent premature abandonment of fertility treatments and thus increase success rates.

As Relações de Vinculação e a Imagem Corporal: Exploração de um Modelo

The present study explored the differential effects of the principal development contexts (attachment to parents and peers) on the way in which adolescents experience their bodies. Six hundred and ninety adolescents and young adults (242 male and 448 female) participated in this study, with ages varying between 15 and 23 years (M = 17,8 and SD= 2,00). The results of the prediction model revealed that gender and romantic attachment were the variables that showed the strongest effect on the variation in body image. A mediation effect was observed among attachment to parents and body image through romantic and friendship relationships. The results highlight the need of understanding body experience in an interpersonal context.

Quality of recovery after anaesthesia measured with QoR-40: a prospective observational study

BACKGROUND QoR-40, a 40-item questionnaire on quality of recovery from anaesthesia, has been shown to measure health status after surgery. Our aim was to evaluate the incidence of poor quality of recovery in our Post Anaesthesia Care Unit and to compare their QoR-40 scores before surgery and 3 months later. METHODS A prospective observational study was conducted in adult patients consecutively admitted from 18 June to 12 July 2012. The follow-up period was 3 months. We exclude patients submitted to cardiac surgery, neurosurgery, obstetric surgery and with a mini-mental state examination test score lower than 25. The primary endpoint was quality of recovery measured with the validated Portuguese for Portugal version of the QoR-40 before surgery (T0), 24h after surgery (T1) and 3 months after (T2). RESULTS A total of 114 patients completed the study. Mean QoR-40 score was 169 and patients with poor quality of recovery were identified if their QoR-40 score was lesser than 142. This occurred in 26 patients (24%). Global median scores for patients with poor quality of recovery were lower at T0 (121 vs. 184, p<0.001), at T1 (120 vs. 177, p<0.001) and at T2 (119 vs. 189, p<0.001). CONCLUSION Patients with poor quality of recovery had lower quality of life. This fact may allow earlier and more effective interventions, in order to improve quality of life after surgery. Beside its utility after surgery, QoR-40 may be important prior to surgery to identify patients who will develop a poor quality of recovery.

COMPI Fertility Problem Stress Scales is a brief, valid and reliable tool for assessing stress in patients seeking treatment.

STUDY QUESTION Are the Copenhagen Multi‐Centre Psychosocial Infertility research program Fertility Problem Stress Scales (COMPI-FPSS) a reliable and valid measure across gender and culture? SUMMARY ANSWER The COMPI-FPSS is a valid and reliable measure, presenting excellent or good fit in the majority of the analyzed countries, and demonstrating full invariance across genders and partial invariance across cultures. WHAT IS KNOWN ALREADY Cross-cultural and gender validation is needed to consider a measure as standard care within fertility. The present study is the first attempting to establish comparability of fertility-related stress across genders and countries. STUDY DESIGN SIZE, DURATION Cross-sectional study. First, we tested the structure of the COMPI-FPSS. Then, reliability and validity (convergent and discriminant) were examined for the final model. Finally, measurement invariance both across genders and cultures was tested. PARTICIPANTS/MATERIALS, SETTING, METHODS Our final sample had 3923 fertility patients (1691 men and 2232 women) recruited in clinical settings from seven different countries: Denmark, China, Croatia, Germany, Greece, Hungary and Sweden. Participants had a mean age of 34 years and the majority (84%) were childless. MAIN RESULTS AND THE ROLE OF CHANCE Findings confirmed the original three-factor structure of the COMPI-FPSS, although suggesting a shortened measurement model using less items that fitted the data better than the full version model. While data from the Chinese and Croatian subsamples did not fit, all other counties presented good fit (&khgr;2/df ⩽ 5.4; comparative fit index ≥ 0.94; root-mean-square error of approximation ⩽ 0.07; modified expected cross-validation index ⩽ 0.77). In general, reliability, convergent validity, and discriminant validity were observed in all subscales from each country (composite reliability ≥ 0.63; average variance extracted ≥ 0.38; squared correlation ≥ 0.13). Full invariance was established across genders, and partial invariance was demonstrated across countries. LIMITATIONS REASONS FOR CAUTION Generalizability regarding the validation of the COMPI-FPSS cannot be made regarding infertile individuals not seeking treatment, or non-European patients. This study did not investigate predictive validity, and hence the capability of this instrument in detecting changes in fertility-specific adjustment over time and predicting the psychological impact needs to be established in future research. WIDER IMPLICATIONS OF THE FINDINGS Besides extending knowledge on the psychometric properties of one of the most used fertility stress questionnaire, this study demonstrates both research and clinical usefulness of the COMPI-FPSS. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by European Union Funds (FEDER/COMPETE—Operational Competitiveness Program, and by national funds (FCT—Portuguese Foundation for Science and Technology) under the projects PTDC/MHC-PSC/4195/2012 and SFRH/BPD/85789/2012). There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A

Permanent neonatal diabetes by a new mutation in KCNJ11: unsuccessful switch to sulfonylurea

Permanent neonatal diabetes (PNDM) can result from activating heterozygous mutations in KCNJ11 gene, encoding the Kir6.2 subunit of the pancreatic ATP-sensitive potassium channels (KATP). Sulfonylureas promote KATP closure and stimulate insulin secretion, being an alternative therapy in PNDM, instead of insulin. Male, 20 years old, diagnosed with diabetes at 3 months of age. The genetic study identified a novel heterozygous mutation in exon 1 of the KCNJ11 gene - KCNJ11:c1001G>7 (p.Gly334Val) - and confirmed the diagnosis of PNDM. Therefore it was attempted to switch from insulin therapy to sulfonylurea. During glibenclamide institution C-peptide levels increased, however the suboptimal glycemic control lead us to restart an intensive insulin scheme. This new variant of KCNJ11 mutation had a phenotypic lack of response to sulfonylurea therapy. Age, prior poor metabolic control and functional change of KATP channel induced by this specific mutation may explain the observed unsuccessful switch to sulfonylurea. Interestingly, C-peptide levels raise during glibenclamide administration support some degree of improvement in insulin secretory capacity induced by the treatment. Understanding the response to sulfonylurea is crucial as successful treatment may be life-changing in these patients.