The Psychological Impact of Infertility. Directions for the Development of Interventions

Introduction: Infertility represents a major health problem that oftentimes is experienced as a crisis situation. Because it interposes with achieving an important life goal, that of having children, its implications on the psycho-emotional level are robust. Purpose: The present article aimed at exploring the multidimensional effects of infertility on mental health, as well as suitable psychological intervention strategies for patients both at an individual and couple level. Methodology: An extensive literature review was conducted to select the most relevant information. Articles included were searched in PubMed, Google Scholar and other similar databases within a seven years interval (2014-2021) to assure the up-to-date quality of the paper. The main criteria of inclusion were: studies about the consequences of infertility on mental health, epidemiology, risk and protective factors, psychological models for infertility, psychological evaluation, established instruments, psycho-social and therapeutic interventions, intervention protocols used in public health for infertility patients. Results and Discussion: Infertility is often experienced as a crisis situation, in which the most common consequences are visible at the level of mood disorders (e.g. anxiety, depression, marked distress) and at the social level (stigma, divorce, social isolation, financial difficulties). Psychological counseling is needed throughout medical treatment and therapeutic interventions (e.g. cognitive-behavioral therapy) have shown favorable results in managing the emotional balance of the individual/couple and reducing the risk of psychopathology. Conclusions: Research highlights the beneficial effects of psychological interventions on reducing levels of stress related to infertility, anxiety and depressive symptoms and on improving the quality of life and couple dynamic

On the asymptotics of Bessel functions in the Fresnel regime

We introduce a version of the asymptotic expansions for Bessel functions $J_\nu(z)$, $Y_\nu(z)$ that is valid whenever $|z| > \nu$ (which is deep in the Fresnel regime), as opposed to the standard expansions that are applicable only in the Fraunhofer regime (i.e. when $|z| > \nu^2$). As expected, in the Fraunhofer regime our asymptotics reduce to the classical ones. The approach is based on the observation that Bessel's equation admits a non-oscillatory phase function, and uses classical formulas to obtain an asymptotic expansion for this function; this in turn leads to both an analytical tool and a numerical scheme for the efficient evaluation of $J_\nu(z)$, $Y_\nu(z)$, as well as various related quantities. The effectiveness of the technique is demonstrated via several numerical examples. We also observe that the procedure admits far-reaching generalizations to wide classes of second order differential equations, to be reported at a later date

Using CBT for Depression: A Case Study of a Patient with Depressive Disorder Due to a Medical Condition (Infertility)

Introduction: Infertility increases the risk for psychopathology more often in women, who can develop symptoms in mood disorders and chronic stress. Depression is one frequent psychological consequence of this medical condition and if it’s not being addressed accordingly, depressive symptoms can lead to delays in the onset of medical treatment, impairments in its outcomes and, likewise, poses a risk on the patient's mental health. Purpose: The purpose of this case study was to disseminate a specific example of how infertility affects mental health, offering a multidisciplinary approach from both traditional CBT and health psychology. In addition to this, the case study presents important cultural aspects regarding psychotherapeutic process and access to health care. Methodology: This is a descriptive and explanatory case study where multiple quantitative data sources have been used such as self-reported inventories: The Fertility Problem Inventory (FPI), Beck Depression Inventory (BDI) and The Coping Inventory for Stressful Situations (CISS), in addition to a semi-structured clinical interview. Results: Results showed an improvement in mood, acquisition of a more adaptive thinking style, healthy coping mechanisms and self-help strategies to support the patient post-therapy. The contribution of cultural orientation and wellbeing-centered recommendations are being discussed. Conclusion: The improvement of healthcare services relies on such presentations of case studies that can shift the focus in new directions of good clinical practices

On the number of Mordell-Weil generators for cubic surfaces

Let S be a smooth cubic surface over a field K. It is well-known that new K-rational points may be obtained from old ones by secant and tangent constructions. A Mordell-Weil generating set is a subset B of S(K) of minimal cardinality which generates S(K) via successive secant and tangent constructions. Let r(S,K) be the cardinality of such a Mordell-Weil generating set. Manin posed what is known as the Mordell-Weil problem for cubic surfaces: if K is finitely generated over its prime subfield then r(S,K) is finite. In this paper, we prove a special case of this conjecture. Namely, if S contains two skew lines both defined over K then r(S,K) = 1. One of the difficulties in studying the secant and tangent process on cubic surfaces is that it does not lead to an associative binary operation as in the case of elliptic curves. As a partial remedy we introduce an abelian group H_S(K) associated to a cubic surface S/K, naturally generated by the K-rational points, which retains much information about the secant and tangent process. In particular, r(S, K) is large as soon as the minimal number of generators of H_S(K) is large. In situations where weak approximation holds, H_S has nice local-to-global properties. We use these to construct a family of smooth cubic surfaces over the rationals such that r(S,K) is unbounded in this family. This is the cubic surface analogue of the unboundedness of ranks conjecture for elliptic curves

Early motion and directed exercise (EMADE) versus usual care post ankle fracture fixation: study protocol for a pragmatic randomised controlled trial

Background: Following surgical fixation of ankle fractures, the traditional management has included immobilisation for 6 weeks in a below-knee cast. However, this can lead to disuse atrophy of the affected leg and joint stiffness. While early rehabilitation from 2 weeks post surgery is viewed as safe, controversy remains regarding its benefits. We will compare the effectiveness of early motion and directed exercise (EMADE) ankle rehabilitation, against usual care, i.e. 6 weeks’ immobilisation in a below-knee cast. Method/design: We have designed a pragmatic randomised controlled trial (p-RCT) to compare the EMADE intervention against usual care. We will recruit 144 independently living adult participants, absent of tissue-healing comorbidities, who have undergone surgical stabilisation of isolated Weber B ankle fractures. The EMADE intervention consists of a non-weight-bearing progressive home exercise programme, complemented with manual therapy and education. Usual care consists of immobilisation in a non-weight-bearing below-knee cast. The intervention period is between week 2 and week 6 post surgery. The primary outcome is the Olerud and Molander Ankle Score (OMAS) patient-reported outcome measure (PROM) at 12 weeks post surgery. Secondary PROMs include the EQ-5D-5 L questionnaire, return to work and return to driving, with objective outcomes including ankle range of motion. Analysis will be on an intention-to-treat basis. An economic evaluation will be included. Discussion: The EMADE intervention is a package of care designed to address the detrimental effects of disuse atrophy and joint stiffness. An advantage of the OMAS is the potential of meta-analysis with other designs. Within the economic evaluation, the cost-utility analysis, may be used by commissioners, while the use of patient-relevant outcomes, such as return to work and driving, will ensure that the study remains pertinent to patients and their families. As it is being conducted in the clinical environment, this p-RCT has high external validity. Accordingly, if significant clinical benefits and cost-effectiveness are demonstrated, EMADE should become a worthwhile treatment option. A larger-scale, multicentre trial may be required to influence national guidelines. Trial registration: ISRCTN, ID: ISRCTN11212729. Registered retrospectively on 20 March 2017

Immediate continuous passive motion after internal fixation of an ankle fracture

Surgical treatment is usually mandatory in displaced bimalleolar and trimalleolar fractures. Some authors have recommended early mobilization of the ankle joint after surgical treatment of these lesions. In this study, we evaluate the effect of immediate postoperative continuous passive motion in the management of displaced bimalleolar and trimalleolar fractures treated surgically