Public attitudes towards genomic risk profiling as a component of routine population screening.

Including low penetrance genomic variants in population-based screening might enable personalization of screening intensity and follow up. The application of genomics in this way requires formal evaluation. Even if clinically beneficial, uptake would still depend on the attitudes of target populations. We developed a deliberative workshop on two hypothetical applications (in colorectal cancer and newborn screening) in which we applied stepped, neutrally-framed, information sets. Data were collected using nonparticipant observation, free-text comments by individual participants, and a structured survey. Qualitative data were transcribed and analyzed using thematic content analysis. Eight workshops were conducted with 170 individuals (120 colorectal cancer screening and 50 newborn screening for type 1 diabetes). The use of information sets promoted informed deliberation. In both contexts, attitudes appeared to be heavily informed by assessments of the likely validity of the test results and its personal and health care utility. Perceived benefits included the potential for early intervention, prevention, and closer monitoring while concerns related to costs, education needs regarding the probabilistic nature of risk, the potential for worry, and control of access to personal genomic information. Differences between the colorectal cancer and newborn screening groups appeared to reflect different assessments of potential personal utility, particularly regarding prevention.

International case studies of psychosocial ripple effects of bovine spongiform encephalopathy (BSE) in European countries.

The public is increasingly concerned about risks associated with food. Food-borne diseases can easily mobilize public concerns and create strong emotional, behavioral, and political reactions with significant negative economic and psychosocial outcomes. This was observed in various countries globally experiencing the presence of prion disease bovine spongiform encephalopathy (BSE). This study highlights case-study material from various countries for key psychosocial impacts such as the public's worry and fear vis-a-vis beef consumption and the loss of confidence and trust in authorities stemming from the occurrence and management of the BSE crisis. These psychosocial impacts and resultant public behavioral responses are presented at a number of levels including individual, family, community, and societal for several European countries, with special emphasis on the UK case study. Given failures to identify the scope of individual concern about prion diseases, and to address these concerns in decision-making processes and risk communication strategies, there remains a need for further systematic research and psychosocial monitoring of the ripple effects of BSE.

Survey of public perceptions of prion disease risks in Canada: what does the public care about?

A national public survey on public perceptions of prion disease risk in Canada was conducted from October to December 2007. The survey aimed at documenting the public's perceptions of prion diseases, within the broader context of food safety, in establishing parameters of risk acceptability. It also documented the public's perceptions of prion diseases in delineating social values and ethics that can guide Canada's future policies on prion disease risk management. In addition, the survey served to establish baseline data against which to monitor the evolution of the public's views on and understanding of this important risk issue. In total, 1517 Canadians were randomly selected to be representative of the adult population by region, age, and gender, as per the 2001 Census. This study presents descriptive findings from the survey regarding perceived risk, perceived control, uncertainty, sources of information, trust and knowledge, and beliefs pertaining to bovine spongiform encephalopathy (BSE). The survey data reveal that Canadians do not perceive mad cow disease as a salient risk but consider it more of an economic, political, social, and foreign trade issue than a public health one. Canadians are somewhat prepared to pay a premium to have a safer food supply, but not to the same extent that they desire extra measures pertaining to BSE risk management. In the context of increasing accountability in risk management decisions about food safety and population health issues, it is important to understand the way Canadians perceive such matters and identify their information needs and the factors that influence the acceptability of risks and of risk management policies.

[Social etiology and remission factors]. / Etiologie sociale et facteurs de rémission.

According to the social etiology thesis of mental illness, disorders may be caused or precipitated by severe stressors or major life difficulties. The model has been supported for onset of depression and anxiety disorders. The reciprocal proposition stands that occurrence of positive life conditions may bring about remission. The analysis of 404 clinical files following up a community sample of mothers demonstrated the role of positive life events and of relief from chronic difficulties in the total or partial recovery of depressed or anxious women. Dimensions of Anchoring and of Fresh-start in life-events showed a specific and differential role according to disorders. Relief from chronic difficulties seemed to provide a beneficial interaction for remission factors.

[Stressors and mental health : a contextual analysis of poverty.]. / Stresseurs et santé mentale : analyse contextuelle de la pauvreté

The author argues that social etiology of mental health, which suggests a causal link between living conditions and the occurence of mental disorders, is valid only when one applies a contextual evaluation of psycho-social stress factors. In that case, when life-events are cut from their environmental consequences, they are insufficient in themselves when trying to explain why mental disorders occur. However, once they are evaluated in function of the person's living conditions, the psycho-social stress factors become triggers and key to the person's stability. George W. Brown suggests a psycho-social model for a precipitative agent and for vulnerability factors linked to the significance and the impact of a life-event, relating also to the factual context at its origin and to the client's biographical history. Poverty then becomes a determining background for the life-event's repercussions. The LEDS (Life-Event and Difficulty Schedule) method of contextual analysis is based on a complete and systematical gathering of factual information on the events and on the context, stripped of the client's bias and emotional reactions. Furthermore, the grid of analysis allows one to qualify and organize this information while maintaining an optimal level of precision and objectivity. The empirical demonstration of the contextual analysis' predictive power is convincing in the case of disorders both mental (depression, anxiety, schizophrenia) and physical (infarction, appendicitis, ulcers). In such a frame of analysis and because of the chronic hardships experienced by the underpriveledged, poverty emerges as a determining contextual factor in the social etiology of mental disorders.

[Events anticipated as stress factors]. / Les événements anticipés comme stresseurs.

The majority of research work carried out on stress factors have dealt with life events from a person's past. In this article, the authors also look at the impact of anticipated events. Past events are measured according to Life Events and Difficulties Schedule, or LEDS (Brown and Harris, 1978). The characteristics of anticipated events, namely the number, life domain and valence (positive, negative or neutral), are compared to those of actual events. To illustrate the advances of LEDS in the area of anticipated events, the authors examined the infertility context. Thirty-five couples and seven woman without their spouse, all of whom are trying to have children, were recruited by two clinics of the Québec City region. Results show that anticipated events are fewer than actual events. In addition, the proportion of anticipated negative events is less than the proportion of actual negative events. However, in the last twelve months, the subjects experienced a significantly greater number of negative events as opposed to positive events. The authors discuss the possibility of the sampling having a positive cognitive bias concerning the future, in addition to examining the usefulness of an individual's capacity to anticipate.

[Recovery efforts following the ice storm: psychological stress of workers after the crisis.]. / Les efforts de recouvrement suite à la tempête de verglas : état de stress psychologique chez des travailleur-es après la crise.

The ice storm of 1998 required extraordinary efforts from workers mobilized by the crisis. In order to evaluate workers' stress levels some months after the crisis, identify worst stressors and to assess the role of cognitive appraisal and work parameters in stress, a study of 870 ice storm workers from Hydro-Quebec was conducted according to types of job, areas, and types of assignment. Results indicated high stress levels in workers, associated with ice storm effort but not with job levels. Women appeared especially stressed, significantly more than men. Uncertainty and overload were the most cited worst ice storm stressors. Stress was found to be mediated by Impact and Uncertainty appraisal. Contact with victims, first line work, being oneself a victim were key factors. Results are discussed in light of current stress models and organisational psychology in the context of work during a natural disaster.

Perceptions and experiences of environmental health risks among new mothers: a qualitative study in Ontario, Canada.

There is a growing awareness and concern in contemporary societies about potential health impacts of environmental contaminants on children. Mothers are traditionally more involved than other family members in managing family health and household decisions and thus targeted by public health campaigns to minimise risks. However little is known about how new mothers perceive and experience environmental health risks to their children. In 2010, we undertook a parallel case study using qualitative, in-depth interviews with new mothers and focus groups with public health key informants in two Public Health Units in Ontario Province, Canada. We found that the concern about environmental hazards among participants ranged from having no concerns to actively incorporating prevention into daily life. Overall, there was a common perception among participants that many risks, particularly in the indoor environment, were controllable and therefore of little concern. But environmental risks that originate outside the home were viewed as less controllable and more threatening. In response to such threats, mothers invoked coping strategies such as relying on the capacity of children's bodies to adapt. Regardless of the strategies adopted, actions (or inactions) were contingent upon active information seeking. We also found an optimistic bias in which new mothers reported that other children were at greater risk despite similar environmental circumstances. The findings suggest that risk communication experts must attend to the social and environmental contexts of risk and coping when designing strategies around risk reducing behaviours.

Social factors and recovery from anxiety and depressive disorders. A test of specificity.

Analysis of 33 instances of recovery or improvement among 92 women with anxiety, and 49 instances of recovery and improvement among 67 episodes of depression, showed that recovery and improvement, when compared with conditions not changing, were associated with a prior positive event. Such events were characterised by one or more of three dimensions: the 'anchoring' dimension involved increased security; 'fresh-start', increased hope arising from a lessening of a difficulty or deprivation; and 'relief', the amelioration of a difficulty not involving any sense of a fresh start. Events characterised by anchoring were more often associated with recovery or improvement in anxiety, and those characterised as fresh-start were associated with recovery or improvement in depression. Recovery or improvement in both disorders was more likely to be associated with both anchoring and fresh-start events. The study involved the reworking of some social and clinical material, and although done blind should be seen as exploratory.