Measuring postnatal demoralisation: adaptation of the Demoralisation Scale-II (DS-II) for postnatal use.

OBJECTIVE: To examine the psychometric properties of the Demoralisation Scale II (DS-II) and adapt it for use with women in the postnatal period. BACKGROUND: Demoralisation is a psychological state characterised by a sense of incompetence and feelings of helplessness and hopelessness in response to a stressful situation. The postnatal period is a life stage of many disruptions. Women may lose their confidence and become demoralised if feeling unprepared for the tasks of motherhood. The DS-II is a 16-item scale developed among cancer patients, but with content that is also relevant postnatally, including items on sense of failure, helplessness, hopelessness, isolation, entrapment and loss of purpose. METHODS: Rasch analysis was used to investigate the psychometric properties of the DS-II and refine the scale for postnatal use. RESULTS: Participants were 209 women admitted with their babies to a residential early parenting programme. A 14-item revised scale was derived, the Postnatal DS-II, showing good psychometric properties, discriminant validity and sensitivity to change, and being well targeted to the sample. CONCLUSION: The Postnatal DS-II could have utility as an assessment tool, helping clinicians to understand better women's postnatal experiences, assess the effectiveness of interventions and communicate with women in a meaningful and non-stigmatising way.

Fertility management experiences of women with polycystic ovary syndrome in Australia.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) are usually told that the condition is associated with fertility difficulties. However, little is known about their fertility management including contraceptive use, childbearing desires, and pregnancy outcomes. AIM: To compare the fertility management experiences and outcomes of Australian women with and without PCOS. METHOD: The 2013 Australian electoral roll was used to identify a random sample of 18- to 50-year-old women who were sent the Understanding Fertility Management in Australia survey to be completed anonymously. Factors associated with fertility management and outcomes were identified in multivariable analyses. RESULTS: Among the 1543 women who completed and returned the survey, 113 (7.3%) reported having PCOS. Women with PCOS reported a similar rate of current contraceptive use as women without PCOS (50.4% vs. 52.6%, p = .66). However, they were significantly younger at first pregnancy (24.9 vs. 26.8 years, p = .015), more likely to have consulted a health professional about fertility management (OR: 3.86, 95% CI: 2.50-5.96, p < .001), and perceive that it would be difficult to conceive (OR: 2.31, 95% CI: 1.41-3.79, p = .001) than women without PCOS. There were no significant differences in the number of desired children, unintended pregnancies, live births, abortions or miscarriages between women with and without PCOS. CONCLUSION: These findings indicate that women with PCOS need more nuanced information about their fertility potential. While they may experience fertility difficulties because of their condition, they should also be informed that they can conceive spontaneously and need reliable contraception to avoid pregnancy when it is not wanted.

The Fertility Management Experiences of Australian Women with a Non-communicable Chronic Disease: Findings from the Understanding Fertility Management in Contemporary Australia Survey.

Introduction Despite the considerable and increasing proportion of women of reproductive age with a chronic non-communicable disease (NCD) and the potential adverse implications of many NCDs for childbearing, little is known about the fertility management experiences of women with an NCD, including their contraceptive use, pregnancy experiences and outcomes, and reproductive health care utilisation. The aim of this study was to investigate the fertility management experiences of women with an NCD and draw comparisons with women without an NCD. Method A sample of 18-50 year-old women (n = 1543) was randomly recruited from the Australian electoral roll in 2013. Of these women, 172 women reported a physical, chronic non-communicable disease: diabetes, arthritis, asthma, hypertension, heart disease, thyroid disorders, and cystic fibrosis. Respondents completed an anonymous, self-administered questionnaire. Factors associated with fertility management were identified in multivariable analyses. Results Women who reported having an NCD were significantly more likely than women who did not report an NCD to have ever been pregnant (75.9 vs. 67.5%, p = 0.034), have had an unintended pregnancy (33.47 vs. 25.5%, p = 0.026), and have had an abortion (20.3 vs. 14.2%, p = 0.044); they were less likely to consult a healthcare provider about fertility management (45.0 vs. 54.4%, p = 0.024). Similar proportions were using contraception (48.8 vs. 54.5%, p = 0.138). Conclusion The findings have implications for healthcare providers and women with an NCD and highlight the importance of addressing possible assumptions about the inability of women with an NCD to become pregnant, and ensuring women receive information about suitable methods of contraception and pre-pregnancy care.

Using the Edinburgh postnatal depression scale to screen for anxiety disorders: conceptual and methodological considerations.

BACKGROUND: Perinatal anxiety symptoms and disorders are prevalent and disabling but have not to date been a focus for specific clinical and public health attention. The EPDS is widely used to detect probable depression, and many studies have also found that three items from this scale load on an anxiety factor, in both the antenatal and postnatal periods. In addition, studies have found clinically significant correlations between the EPDS and various anxiety-specific measures in the perinatal period. The aim of this paper is to examine studies which address the capacity of the EPDS to detect anxiety disorders, to assess whether the EPDS performs differently in women with depressive or anxiety disorders and to consider the implications for future research and clinical practice. METHODS: The English-language perinatal mental health literature was searched. Six studies with data pertaining to the capacity of the EPDS to detect perinatal anxiety disorders in women were identified. These studies provide information on i) comparison of total EPDS score by diagnoses of anxiety and depression and ii) comparison of the anxiety subscale score (EPDS-3A) by diagnoses of anxiety and depression. RESULTS: There is evidence from both sets of information that the EPDS is useful for screening for anxiety in women and emerging evidence that Total EPDS and EPDS-3A can distinguish depression from anxiety reliably. LIMITATIONS: The findings are based on a small number of studies, conducted in a variety of clinical and community settings in different languages and countries, and with variable sample sizes, some of which lack power to ensure reliable conclusions. CONCLUSIONS: The EPDS appears to detect perinatal anxiety disorders, but further research is required to establish the clinical and public health value of the EPDS for this purpose, and whether it has more robust psychometric properties or is more feasible and acceptable than existing anxiety-specific measures.

The childbearing concerns and related information needs and preferences of women of reproductive age with a chronic, noncommunicable health condition: a systematic review.

BACKGROUND: Certain chronic health conditions and their treatments may compromise women's fertility; some chronic conditions are more likely to affect women of reproductive age than others, and some are heritable. All have implications for women's future childbearing and fertility management. OBJECTIVE: The aim of this systematic review was to identify the concerns about childbearing and related information needs and preferences of women with a chronic, noncommunicable health condition. METHOD: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedure. Relevant social science and medical science databases (Ovid MEDLINE, ProQuest, and CINAHL plus) were searched for peer-reviewed, English-language papers published from 1995 to August 2012 of empirical research using quantitative or qualitative methods. RESULTS: Of the 5,350 articles identified, 29 met inclusion criteria and were reviewed. Despite variation in methods, the studies demonstrated consistently that women with a chronic health condition are concerned about childbearing and have questions about the reproductive implications of their condition. The evidence suggests that there is less consistency about women's preferences for the mode and timing of information about the effect of the condition and its treatment on childbearing. Most research to date has focused on the needs and experiences of women with cancer; there is almost none about other noncommunicable conditions. CONCLUSION: There are serious evidence gaps about the childbearing concerns and related information needs and preferences of women with chronic, noncommunicable health conditions. Research is required to address these gaps and to inform the development of appropriate tools to assist women in this situation with their childbearing decisions.

A complex interplay of three R2R3 MYB transcription factors determines the profile of aliphatic glucosinolates in Arabidopsis.

While R2R3 MYB transcription factors are a large gene family of transcription factors within plants, comprehensive functional data in planta are still scarce. A model for studying R2R3 MYB control of metabolic networks is the glucosinolates (GLSs), secondary metabolites that control plant resistance against insects and pathogens and carry cancer-preventive properties. Three related members of the R2R3 MYB transcription factor family within Arabidopsis (Arabidopsis thaliana), MYB28, MYB29, and MYB76, are the commonly defined regulators of aliphatic GLS biosynthesis. We utilized new genotypes and systems analysis techniques to test the existing regulatory model in which MYB28 is the dominant regulator, MYB29 plays a minor rheostat role, and MYB76 is largely uninvolved. We unequivocally show that MYB76 is not dependent on MYB28 and MYB29 for induction of aliphatic GLSs and that MYB76 plays a role in determining the spatial distribution of aliphatic GLSs within the leaf, pointing at a potential role of MYB76 in transport regulation. Transcriptional profiling of knockout mutants revealed that GLS metabolite levels are uncoupled from the level of transcript accumulation for aliphatic GLS biosynthetic genes. This uncoupling of chemotypes from biosynthetic transcripts suggests revising our view of the regulation of GLS metabolism from a simple linear transcription factor-promoter model to a more modular system in which transcription factors cause similar chemotypes via nonoverlapping regulatory patterns. Similar regulatory networks might exist in other secondary pathways.

Women who are well informed about prenatal genetic screening delay emotional attachment to their fetus.

BACKGROUND: Prenatal maternal serum screening allows assessment of risk of chromosomal abnormalities in the fetus and is increasingly being offered to all women regardless of age or prior risk. However ensuring informed choice to participate in screening is difficult and the psychological implications of making an informed decision are uncertain. The aim of this study was to compare the growth of maternal-fetal emotional attachment in groups of women whose decisions about participation in screening were informed or not informed. METHODS: A prospective longitudinal design was used. English speaking women were recruited in antenatal clinics prior to the offer of second trimester maternal screening. Three self-report questionnaires completed over the course of pregnancy used validated measures of informed choice and maternal-fetal emotional attachment. Attachment scores throughout pregnancy in informed and not-informed groups were compared in repeated measures analysis. RESULTS: 134 completed the first assessment (recruitment 73%) and 68 (58%) provided compete data. The informed group had significantly lower attachment scores (p = 0.023) than the not-informed group prior to testing, but scores were similar (p = 0.482) after test results were known. CONCLUSION: The findings raise questions about the impact of delayed maternal-fetal attachment and appropriate interventions to facilitate informed choice to participate in screening.

The chromatin remodeler SPLAYED regulates specific stress signaling pathways.

Organisms are continuously exposed to a myriad of environmental stresses. Central to an organism's survival is the ability to mount a robust transcriptional response to the imposed stress. An emerging mechanism of transcriptional control involves dynamic changes in chromatin structure. Alterations in chromatin structure are brought about by a number of different mechanisms, including chromatin modifications, which covalently modify histone proteins; incorporation of histone variants; and chromatin remodeling, which utilizes ATP hydrolysis to alter histone-DNA contacts. While considerable insight into the mechanisms of chromatin remodeling has been gained, the biological role of chromatin remodeling complexes beyond their function as regulators of cellular differentiation and development has remained poorly understood. Here, we provide genetic, biochemical, and biological evidence for the critical role of chromatin remodeling in mediating plant defense against specific biotic stresses. We found that the Arabidopsis SWI/SNF class chromatin remodeling ATPase SPLAYED (SYD) is required for the expression of selected genes downstream of the jasmonate (JA) and ethylene (ET) signaling pathways. SYD is also directly recruited to the promoters of several of these genes. Furthermore, we show that SYD is required for resistance against the necrotrophic pathogen Botrytis cinerea but not the biotrophic pathogen Pseudomonas syringae. These findings demonstrate not only that chromatin remodeling is required for selective pathogen resistance, but also that chromatin remodelers such as SYD can regulate specific pathways within biotic stress signaling networks.