Understanding Uncertainties in Medical Evidence: Professional and Public Responsibilities

1994 ◽  
Author(s):  
Valerie Mike
Keyword(s):  
Young Women ◽  
Behavioral Problems ◽  
Fetal Brain ◽  
Clear Cell Adenocarcinoma ◽  
Major Theme ◽  
Increased Risk ◽  
The Family ◽  
Practice Of Medicine ◽  
Fetal Brain Development ◽  
The Subject

The case of Linda Loerch and her son Peter presented to the Minnesota Supreme Court raises the question of whether legal liability can extend beyond the second generation. During the pregnancy leading to Linda's birth, her mother had taken the synthetic hormone diethylstilbestrol, commonly known as DES. Linda herself has a deformed uterus, and her son Peter, born twelve weeks prematurely, is a quadriplegic afflicted with cerebral palsy. The family is seeking damages for the child's condition from Abbott Laboratories, the manufacturer of the drug taken forty years earlier by his grandmother (MacNeil/Lehrer 1988). The claims of this lawsuit hinge on the evidence available when the drug was prescribed. The case illustrates, with some new ramifications, the interrelated issues of ethics and evidence surrounding the practice of medicine, a major theme of this chapter. The DES story first became national news at a time that marked the rise of the new field of bioethics. The Food and Drug Administration (FDA) issued a drug alert in 1971 to all physicians concerning the use of DES by pregnant women, as an association had been found between the occurrence of a rare form of cancer of the vagina in young women and their mothers' exposure to DES. The drug had been prescribed widely since the 1940s for a variety of medical conditions, including the prevention of miscarriages. It is estimated that during this period four to six million individuals, mothers and their offspring, were exposed to DES during the mothers' pregnancy. The full dimensions of the medical disaster, the subject of continued controversy, have yet to be firmly established. DES daughters are at risk of developing clear cell adenocarcinoma of the vagina, the risk estimated to be one per one thousand by age twenty-four. Ninety percent have a benign vaginal condition called adenosis, and many have other genital abnormalities. They are at higher risk of pregnancy loss and infertility. DES mothers also may be at a higher risk for breast and gynecological cancers, and DES sons may be at an increased risk of genitourinary abnormalities, infertility, and testicular cancer. DES may, as well, have affected fetal brain development, leading to behavioral problems and learning disabilities.

scholarly journals Prenatal maternal immune disruption and sex-dependent risk for psychoses

2014 ◽  
Vol 44 (15) ◽  
pp. 3249-3261 ◽  
Author(s):  
J. M Goldstein ◽  
S. Cherkerzian ◽  
L. J. Seidman ◽  
J.-A. L. Donatelli ◽  
A. G. Remington ◽  
...  
Keyword(s):  
Brain Development ◽  
Fetal Brain ◽  
Estimating Equation ◽  
Generalized Estimating Equation ◽  
Increased Risk ◽  
Offspring Sex ◽  
Subgroup Analyses ◽  
Fetal Brain Development ◽  
Nested Case Control ◽  
Necrosis Factor

Background.Previous studies suggest that abnormalities in maternal immune activity during pregnancy alter the offspring's brain development and are associated with increased risk for schizophrenia (SCZ) dependent on sex.Method.Using a nested case–control design and prospectively collected prenatal maternal sera from which interleukin (IL)-1β, IL-8, IL-6, tumor necrosis factor (TNF)-α and IL-10 were assayed, we investigated sex-dependent associations between these cytokines and 88 psychotic cases [SCZ = 44; affective psychoses (AP) = 44] and 100 healthy controls from a pregnancy cohort followed for > 40 years. Analyses included sex-stratified non-parametric tests adjusted for multiple comparisons to screen cytokines associated with SCZ risk, followed by deviant subgroup analyses using generalized estimating equation (GEE) models.Results.There were higher prenatal IL-6 levels among male SCZ than male controls, and lower TNF-α levels among female SCZ than female controls. The results were supported by deviant subgroup analyses with significantly more SCZ males with high IL-6 levels (>highest quartile) compared with controls [odd ratio (OR)75 = 3.33, 95% confidence interval (CI) 1.13–9.82], and greater prevalence of low TNF-α levels (<lowest quartile) among SCZ females compared with their controls (OR25 = 6.30, 95% CI 1.20–33.04) and SCZ males. Higher levels of IL-6 were only found among SCZ compared with AP cases. Lower TNF-α levels (non-significant) also characterized female AP cases versus controls, although the prevalence of the lowest levels was higher in SCZ than AP females (70% v. 40%), with no effect in SCZ or AP males.Conclusions.The results underscore the importance of immunologic processes affecting fetal brain development and differential risk for psychoses depending on psychosis subtype and offspring sex.

scholarly journals DINÁMICA FAMILIAR EN EL ABORTO INDUCIDO EN ADOLESCENTES EN EL DISTRITO DE SALUD DE JIPIJAPA

2019 ◽  
Vol 4 (4) ◽  
pp. 103
Author(s):  
Lizette Annabell Pincay López ◽  
Juana Dolores Sarmiento Cueva
Keyword(s):  
Young Women ◽  
Early Pregnancy ◽  
Family Dynamics ◽  
Induced Abortion ◽  
Social Phenomenon ◽  
Original Design ◽  
First Child ◽  
Palabras Clave ◽  
The Family ◽  
The Subject

La presente investigación pretende identificar las causas por las cuales las adolescentes recurren al aborto inducido, las actitudes que asumen sus padres, y el apoyo que reciben de ellos, es decir las dinámicas familiares generadas por esta experiencia. Se planteó las preguntas: ¿Existe relación en el tipo de la dinámica familiar con la búsqueda del aborto inducido? Y ¿de qué forma influye la dinámica familiar en la decisión de practicarse un aborto inducido? Se utilizó literatura sobre el tema que permite comprender de mejor manera la investigación, para en lo posterior aplicar encuestas a 100 jóvenes embarazadas y a 38 padres de familia, quienes de manera voluntaria y con conocimiento accedieron colaborar llenando las encuestas. El diseño original contempló encuestar a todas las adolescentes en embarazo precoz, que llegaban al Distrito, al igual que a sus padres, sin embargo, en el transcurso del estudio se presentaron dificultades dadas por las características del embarazo, tales como que sus padres aún no lo sabían, incluyendo el caso en que las adolescentes no quisieron participar en el estudio. El presente estudio es de carácter cuantitativo, transversal y de tipo descriptivo, buscando una perspectiva comprehensiva de este fenómeno social, que es una realidad compleja. De acuerdo a los resultados, las jóvenes encuestadas provienen de hogares mayoritariamente legalizados, están casados civilmente los padres, en la mayoría de hogares hay violencia familiar; y en alto porcentaje los padres tuvieron su primer hijo antes de los 20 años. PALABRAS CLAVE: Embarazo precoz; adolescencia; aborto inducido; dinámica familiar. FAMILY DYNAMICS IN ABDUCTION INDUCED IN ADOLESCENTS FROM THE JIPIJAPA HEALTH DISTRICT ABSTRACT The present research aims to identify the causes by which adolescents resort to induced abortion, the attitudes assumed by their parents, and the support they receive from them, that is, the family dynamics generated by this experience. The questions were posed: Is there a relationship in the type of family dynamics with the search for induced abortion? And in what way does family dynamics influence the decision to perform an induced abortion? Literature on the subject was used to better understand the research, and later on, to apply surveys to 100 pregnant girls and 38 parents, who voluntarily and knowingly agreed to collaborate by completing the surveys. The original design contemplated surveying all adolescents in early pregnancy, who arrived at the District, as well as their parents, however, in the course of the study there were difficulties given by the characteristics of pregnancy, such as that their parents have not yet they knew it, including the case in which the adolescents did not want to participate in the study. The present study is of a quantitative, transversal and descriptive nature, looking for a comprehensive perspective of this social phenomenon, which is a complex reality. According to the results, the young women surveyed come from mostly legalized homes, the parents are married civilly, in most homes there is family violence; and in high percentage the parents had their first child before the age of 20. KEYWORDS: Precocious pregnancy; adolescence; induced abortion; family dynamics.

Methamphetamine Consumption during Pregnancy – Effects on Child Health

2017 ◽  
Vol 50 (03) ◽  
pp. 107-113 ◽  
Author(s):  
Jürgen Dinger ◽  
Patricia Hinner ◽  
Jörg Reichert ◽  
Mario Rüdiger
Keyword(s):  
Social Support ◽  
Health Care ◽  
Pregnant Women ◽  
Behavioral Problems ◽  
Health Care Professionals ◽  
Psychiatric Treatment ◽  
Perinatal Care ◽  
Fetal Brain ◽  
Current Evidence ◽  
Increased Risk

AbstractMethamphetamine abuse during pregnancy represents an emerging health care problem. The consequences are not only of relevance to the pregnant women, but also their unborn child. It is associated with an increased risk of preeclampsia and hypertension, fetal demise, preterm delivery, and intrauterine growth restriction. The deleterious effects of prenatal methamphetamine exposure on the developing fetal brain may lead to long-term neuro-developmental and behavioral problems.Given the current evidence, abuse of methamphetamine during pregnancy must be of utmost concern to health care professionals and to policy-makers. As it has been described for neonatal abstinence syndrome, a multi-professional team is required to improve care of affected women and families. A multi-disciplinary approach is needed, including good prenatal care of pregnant women, perinatal care by specialized obstetricians and neonatologists, and psychiatric treatment by an addiction specialist. Furthermore, families should be integrated into appropriate social support networks.For the development of a structured support program for pregnant women with methamphetamine consumption, methamphetamine use disorder should be considered as a disease that requires medical treatment as well as psychological and social support. The pregnancy should be considered as a window of opportunity to provide the required help.

scholarly journals Diet during pregnancy and the risk of cerebral palsy

1998 ◽  
Vol 79 (5) ◽  
pp. 407-412 ◽  
Author(s):  
Eleni Petridou ◽  
Mary Koussouri ◽  
Nektaria Toupadaki ◽  
Sotiris Youroukos ◽  
Antigoni Papavassiliou ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Dietary Intake ◽  
Brain Development ◽  
Neurological Diseases ◽  
Maternal Diet ◽  
Fetal Brain ◽  
Food Groups ◽  
Increased Risk ◽  
Nutritional Influences ◽  
Fetal Brain Development

The role of maternal diet in the development of the fetal brain has not been adequately explored. Marine n-3 fatty acids have, however, been proposed to be important for brain development. The present case–control study aimed to investigate the relationship between dietary intake during pregnancy and the occurrence of cerebral palsy (CP) in the offspring. Children with CP (n 109), born between 1984 and 1988 to mothers residing in the Greater Athens area, were identified at any time in 1991 or 1992 through institutions delivering care and rehabilitation. Successful nutritional interviews were conducted with ninety-one of these children. Controls were chosen among the neighbours of the CP cases or were healthy siblings of children with neurological diseases other than CP, seen by the same neurologists as the children with CP. A total of 278 control children were chosen, and 246 of them were included in the nutritional study. Guardians of all children were interviewed in person on the basis of a questionnaire covering obstetric, perinatal socioeconomic and environmental variables. A validated semiquantitative food-frequency questionnaire of 111 food items was used to estimate maternal dietary intake during pregnancy. Statistical analysis was done by modelling the data through logistic regression. Food groups controlling for energy intake were alternatively and simultaneously introduced in a core model containing non-nutritional confounding variables. Consumption of cereals (mostly bread) and fish intake were inversely associated with CP (P < 0·05 and P < 0·09 respectively) whereas consumption of meat was associated with increased risk (P < 0·02). A protective effect of fish consumption and a detrimental effect of meat intake have been suggested on the basis of earlier work and appear to be biologically plausible. If corroborated by other studies, these results could contribute to our understanding of the nutritional influences on fetal brain development.

Analisis Perbandingan Manajemen Keuangan Ojek Online Dan Ojek Reguler Studi Kasus Kecamatan Duren Sawit Jakarta Timur

Liquidity ◽  
2018 ◽  
Vol 7 (1) ◽  
pp. 41-52
Author(s):  
M. Koesmawan ◽  
Darwin Erhandy ◽  
Dede Dahlan
Keyword(s):  
Financial Management ◽  
Average Income ◽  
Savings And Loans ◽  
Financial Difficulties ◽  
The Family ◽  
Family Finances ◽  
The Subject ◽  
Almost All

In order to meet the needs of living which consists of primary as well as secondary needs, human can work in either a formal or an informal job. One of the informal jobs that is became the subject of this research was to become an ojek driver. Ojek is a ranting motorcycle.  Revenue of ojek drivers, accordingly, should be well managed following the concept of financial management. This research was conducted for the driver of the online motorcycle drivers as well as the regular motorcycle drivers they are called “The Ojek”. Ojek’s location is in Kecamatan (subdistrict) Duren Sawit, East Jakarta with 70 drivers of ojeks. The online ojeks earn an average of Rp 100,000 per day, can save Rp 11,000 to 21,000 per day, while, the regular ojek has an average income per day slightly lower amounted to Rp 78,500, this kind of ojeks generally have other businesses and always record the outflow of theirs money. Both the online and regular ojeks feel a tight competition in getting passengers, but their income can help the family finances and both ojeks want a cooperative especially savings and loans, especially to overcome the urgent financial difficulties. Almost all rivers, do not dare to borrow money. They are afraid of can not refund the money as scheduled.

CEREBRAL PALSY:A CLINICAL OVERVIEW

2020 ◽  
Vol 3 (1) ◽  
pp. 54-59
Author(s):  
Nargiza Ergasheva ◽  
◽  
Sardor Anorboev ◽  
Gavkhar Kendjaeva ◽  
Keyword(s):  
Brain Area ◽  
Fetal Brain ◽  
Clinical History ◽  
Screening Tests ◽  
Spastic Diplegia ◽  
Team Approach ◽  
Birth Process ◽  
Increased Risk ◽  
Spastic Quadriplegia ◽  
Magnetic Resonance Imaging Mri

Cerebral palsy (CP) is a disorder characterized by abnormal tone, posture and movement. The incidence of CP is 2–4 per 1,000 live births in the world. Prematurityand low birth weight are important risk factors for CP; however, multiple other factors have been associated with an increased risk for CP, including maternal infections and diseases, and abnormal birth process. In most cases of CP the initial injury to the brain occurs during early fetal brain development, later a brain area that is injured cannot function properly in the future. CP is classified clinically based on the predominant motor syndrome—spastic hemiplegia, spastic diplegia, spastic quadriplegia, ataxic and dyskinetic cerebral palsies. The diagnosis of CPis based on a combination of clinical history, use of standardized neuromotor assessment and findings on magnetic resonance imaging (MRI). If there is a suspicionof genetic or inborn metabolic disorders, screening tests should be provided additionally. Because CP is associated with multiple associated and secondary medical conditions, its management requires a multidisciplinary team approach

New normal range of fetal cavum septum pellucidum in the second trimester of gestation

2020 ◽  
Author(s):  
M.V. Medvedev, O.I. Kozlova, À.Yu. Romanova
Keyword(s):  
Brain Development ◽  
Reference Range ◽  
Fetal Brain ◽  
Septum Pellucidum ◽  
Second Trimester ◽  
Normal Range ◽  
Cavum Septum Pellucidum ◽  
New Normal ◽  
Biparietal Diameter ◽  
Fetal Brain Development

Fetal brain was retrospectively evaluated in 418 normal fetuses at 16–28 weeks of gestation. The multiplanar mode to obtain the axial cerebral plane and measured the width of the cavum septum pellucidum (CSP) and biparietal diameter (BD). All measurements of CSP were done from as the widest diameter across both borders in an inter-to inter fashion. The CSP width is increasing at second trimester of gestation. Normal range plotted on the reference range (mean, 5th and 95th percentiles) of fetal width CSP by measuring of its size may be useful for assessment of fetal brain development in the second trimester of gestation.

Dramatis Personae

2018 ◽  
Author(s):  
Susan Mitchell Sommers
Keyword(s):  
Birth Order ◽  
Formal Education ◽  
The Family ◽  
The Subject ◽  
The Voice ◽  
Official Records

This chapter introduces the family: father Edmund, a shoemaker turned bookseller, and his three or four wives, their social and religious status, questions of literacy and formal education. The children are introduced more or less in their birth order: Kezia, Ebenezer, Manoah, Job, and Charity. The difficulties of tracing women is discussed. Particular attention is paid to Kezia, who was the subject of one of Ebenezer’s astrological cases, and Charity, who left a decades-long trail through official records, marking her as one of the most economically savvy members of the family. Since many of the Sibly men took shorthand, there is a brief discussion of contemporary shorthand uses, accuracy, and to what extent shorthand takers preserved the voice of the speaker. Ebenezer’s daughter Urania is also introduced, though like Ebenezer and Manoah, she has her own chapter later in the work

scholarly journals CB1 antagonism increases excitatory synaptogenesis in a cortical spheroid model of fetal brain development

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alexis Papariello ◽  
David Taylor ◽  
Ken Soderstrom ◽  
Karen Litwa
Keyword(s):  
Brain Development ◽  
Spontaneous Activity ◽  
Microelectrode Array ◽  
Cannabinoid Receptor ◽  
Fetal Brain ◽  
Endocannabinoid System ◽  
Autism Spectrum ◽  
Nervous System Development ◽  
Inhibitory Synapses ◽  
Fetal Brain Development

AbstractThe endocannabinoid system (ECS) plays a complex role in the development of neural circuitry during fetal brain development. The cannabinoid receptor type 1 (CB1) controls synaptic strength at both excitatory and inhibitory synapses and thus contributes to the balance of excitatory and inhibitory signaling. Imbalances in the ratio of excitatory to inhibitory synapses have been implicated in various neuropsychiatric disorders associated with dysregulated central nervous system development including autism spectrum disorder, epilepsy, and schizophrenia. The role of CB1 in human brain development has been difficult to study but advances in induced pluripotent stem cell technology have allowed us to model the fetal brain environment. Cortical spheroids resemble the cortex of the dorsal telencephalon during mid-fetal gestation and possess functional synapses, spontaneous activity, an astrocyte population, and pseudo-laminar organization. We first characterized the ECS using STORM microscopy and observed synaptic localization of components similar to that which is observed in the fetal brain. Next, using the CB1-selective antagonist SR141716A, we observed an increase in excitatory, and to a lesser extent, inhibitory synaptogenesis as measured by confocal image analysis. Further, CB1 antagonism increased the variability of spontaneous activity within developing neural networks, as measured by microelectrode array. Overall, we have established that cortical spheroids express ECS components and are thus a useful model for exploring endocannabinoid mediation of childhood neuropsychiatric disease.

scholarly journals Neuroplacentology in congenital heart disease: placental connections to neurodevelopmental outcomes

2021 ◽  
Author(s):  
Rachel L. Leon ◽  
Imran N. Mir ◽  
Christina L. Herrera ◽  
Kavita Sharma ◽  
Catherine Y. Spong ◽  
...  
Keyword(s):  
Brain Development ◽  
Congenital Heart ◽  
Fetal Brain ◽  
In Utero ◽  
Structure And Function ◽  
Brain Growth ◽  
Neurodevelopmental Outcomes ◽  
Fetal Brain Development ◽  
And Function

Abstract Children with congenital heart disease (CHD) are living longer due to effective medical and surgical management. However, the majority have neurodevelopmental delays or disorders. The role of the placenta in fetal brain development is unclear and is the focus of an emerging field known as neuroplacentology. In this review, we summarize neurodevelopmental outcomes in CHD and their brain imaging correlates both in utero and postnatally. We review differences in the structure and function of the placenta in pregnancies complicated by fetal CHD and introduce the concept of a placental inefficiency phenotype that occurs in severe forms of fetal CHD, characterized by a myriad of pathologies. We propose that in CHD placental dysfunction contributes to decreased fetal cerebral oxygen delivery resulting in poor brain growth, brain abnormalities, and impaired neurodevelopment. We conclude the review with key areas for future research in neuroplacentology in the fetal CHD population, including (1) differences in structure and function of the CHD placenta, (2) modifiable and nonmodifiable factors that impact the hemodynamic balance between placental and cerebral circulations, (3) interventions to improve placental function and protect brain development in utero, and (4) the role of genetic and epigenetic influences on the placenta–heart–brain connection. Impact Neuroplacentology seeks to understand placental connections to fetal brain development. In fetuses with CHD, brain growth abnormalities begin in utero. Placental microstructure as well as perfusion and function are abnormal in fetal CHD.

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