Counselling for prenatal anomaly screening - a plea for integration of existential life questions

The availability in many countries of new prenatal anomaly screening methods, such as the non-invasive prenatal test (NIPT), and the potential broadening of testing for genetic conditions, creates an ongoing debate about the accompanying existential dilemmas at both societal level and for individual new parents. In many countries, the main goal of counselling for prenatal anomaly screening is to facilitate the reproductive decision-making process of future parents. Therefore, counsellors share information to enable a woman and her partner to think about the pros and cons of participating in screening, try to clarify possible moral dilemmas, and dwell on existential life questions. In line with the CanMEDS framework, healthcare professionals must combine the role of communicator (providing health education) with that of professional (by recognising and responding to existential life questions while facilitating decision-making). This is not easy but it is essential for providing balanced counselling. At present, counselling tends to be sufficient regarding health education, whereas guidance in decision-making, including attention for existential life questions and philosophy of life, offers room for improvement. In this paper, we suggest slowing down and turning the traditional prenatal counselling encounter upside down by starting as a counselling professional instead of a healthcare information sharing communicator and thus making the story of the woman and her partner, within their societal context, the starting point and the basis of the counselling encounter

Reasons for accepting or declining Down syndrome screening in Dutch prospective mothers within the context of national policy and healthcare system characteristics : a qualitative study

BACKGROUND: Uptake rates for Down syndrome screening in the Netherlands are low compared to other European countries. To investigate the low uptake, we explored women's reasons for participation and possible influences of national healthcare system characteristics. Dutch prenatal care is characterised by an approach aimed at a low degree of medicalisation, with pregnant women initially considered to be at low risk. Prenatal screening for Down syndrome is offered to all women, with a 'right not to know' for women who do not want to be informed on this screening. At the time this study was performed, the test was not reimbursed for women aged 35 and younger. METHODS: We conducted a qualitative study to explore reasons for participation and possible influences of healthcare system characteristics. Data were collected via ten semi-structured focus groups with women declining or accepting the offer of Down syndrome screening (n = 46). All focus groups were audio- and videotaped, transcribed verbatim, coded and content analysed. RESULTS: Women declining Down syndrome screening did not consider Down syndrome a condition severe enough to justify termination of pregnancy. Young women declining felt supported in their decision by perceived confirmation of their obstetric caregiver and reassured by system characteristics (costs and age restriction). Women accepting Down syndrome screening mainly wanted to be reassured or be prepared to care for a child with Down syndrome. By weighing up the pros and cons of testing, obstetric caregivers supported young women who accepted in the decision-making process. This was helpful, although some felt the need to defend their decision to accept the test offer due to their young age. For some young women accepting testing, costs were considered a disincentive to participate. CONCLUSIONS: Presentation of prenatal screening affects how the offer is attended to, perceived and utilised. By offering screening with age restriction and additional costs, declining is considered the preferred choice, which might account for low Dutch uptake rates. Autonomous and informed decision-making in Down syndrome screening should be based on the personal interest in knowing the individual risk of having a child with Down syndrome and system characteristics should not influence participation

Perspectives, preferences and needs regarding early prediction of preeclampsia in Dutch pregnant women : a qualitative study

BACKGROUND: To improve early risk-identification in pregnancy, research on prediction models for common pregnancy complications is ongoing. Therefore, it was the aim of this study to explore pregnant women's perceptions, preferences and needs regarding prediction models for first trimester screening for common pregnancy complications, such as preeclampsia, to support future implementation. METHOD: Ten focus groups (of which five with primiparous and five with multiparous women) were conducted (n = 45). Six focus groups were conducted in urban regions and four in rural regions. All focus group discussions were audio taped and NVIVO was used in order to facilitate the thematic analysis conducted by the researchers. RESULTS: Women in this study had a positive attitude towards first trimester screening for preeclampsia using prediction models. Reassurance when determined as low-risk was a major need for using the test. Self-monitoring, early recognition and intensive monitoring were considered benefits of using prediction models in case of a high-risk. Women acknowledged that high-risk determination could cause (unnecessary) anxiety, but it was expected that personal and professional interventions would level out this anxiety. CONCLUSION: Women in this study had positive attitudes towards preeclampsia screening. Self-monitoring, together with increased alertness of healthcare professionals, would enable them to take active actions to improve pregnancy outcomes. This attitude enhances the opportunities for prevention, early recognition and treatment of preeclampsia and probably other adverse pregnancy outcomes

Development of microreactors in LTCC technology for biodiesel production.

O escopo deste trabalho foi o desenvolvimento de microrreatores em tecnologia LTCC para produção de biodiesel, com foco na otimização de uma geometria de micromisturador. Esta proposta é resultado das oportunidades identificadas em três áreas do conhecimento: Microtecnologia, Intensificação de processos e Biocombustíveis. A principal ferramenta de desenvolvimento desta proposta é a fluidodinâmica computacional. Os microcanais baseados em geometrias com sucessivos cotovelos foram os escolhidos, para a investigação computacional e experimental. A metodologia computacional desenvolvida para alcançar os objetivos propostos envolve as etapas de: definição de um padrão de comparação, projeto das distâncias entre cotovelos, escolha de uma geometria com base na comparação entre diversas geometrias baseadas em sucessivos cotovelos e a otimização da geometria em função dos parâmetros fluidodinâmicos. Paralelamente, ensaios para a produção de biodiesel foram realizados, bem como, a investigação da produção de emulsões para avaliar como uma etapa do processo de produção do biodiesel. A geometria escolhida e otimizada foi a serpentina 3D, o que permitiu a otimização do módulo de tempo de residência e o projeto do microrreator. Finalizando, um microrreator foi projetado com parâmetros ótimos, obtendo assim a intensificação de processo por meio de conceitos de microtecnologia, para aplicação na produção de biocombustíveis.The scope of this work was the development of microreactors in LTCC technology for biodiesel production, with a focus on the optimization of a micromixer geometry. This proposal is resulted from the opportunities identified in three areas of knowledge: Microtechnology, processes intensification and Biofuels. The main tool for development of this proposal is the computational fluid dynamics (CFD). The microchannels geometry with successive elbows were chosen for computational and experimental research. The computational methodology developed to achieve the proposed goals involves the following steps: defining a standard of comparison, a project of the distances between elbows, a choice of geometry based on the comparison between different geometries based on successive elbows and geometry optimization for the parameters hydrodynamic. In addition, tests for the production of biodiesel were being made and the investigations of production of emulsions to evaluate a step in the producing of biodiesel process. The geometry was chosen and optimized serpentine 3D, allowing the optimization of residence time module and the design of the microreactor. Finally, a microreactor was designed with optimal parameters, thus obtaining the intensification process through microtechnology concepts for application in the biofuels production

A cross-country comparison of pregnant women’s decision-making and perspectives when opting for non-invasive prenatal testing in the Netherlands and Belgium

Background: The Netherlands and Belgium have been among the first countries to offer non-invasive prenatal testing (NIPT) as a first-tier screening test. Despite similarities, differences exist in counseling modalities and test uptake. This study explored decision-making and perspectives of pregnant women who opted for NIPT in both countries. Methods: A questionnaire study was performed among pregnant women in the Netherlands (NL) (n = 587) and Belgium (BE) (n = 444) opting for NIPT, including measures on informed choice, personal and societal perspectives on trisomy 21, 18 and 13 and pregnancy termination. Results: Differences between Dutch and Belgian women were shown in the level of informed choice (NL: 83% vs. BE: 59%, p < 0.001), intention to terminate the pregnancy in case of confirmed trisomy 21 (NL: 51% vs. BE: 62%, p = 0.003) and trisomy 13/18 (NL: 80% vs. BE: 73%, p = 0.020). More Belgian women considered trisomy 21 a severe condition (NL: 64% vs. BE: 81%, p < 0.001). Belgian women more frequently indicated that they believed parents are judged for having a child with trisomy 21 (BE: 42% vs. NL: 16%, p < 0.001) and were less positive about quality of care and support for children with trisomy 21 (BE: 23% vs. NL: 62%, p < 0.001). Conclusion: Differences in women's decision-making regarding NIPT and the conditions screened for may be influenced by counseling aspects and country-specific societal and cultural contexts