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In this second part of the review the roles that copper and dietary carbohydrate play in the cardiovascular system, pregnancy and lactation, haemopoiesis, and in male and female animals, are summarised. The mechanisms that may contribute to the exacerbation of copper deficiency when simple sugars are consumed are discussed.

Purpose: Miscarriage is commonly understood as an involuntary, grieve-able pregnancy outcome. Abortion is commonly understood as a voluntary, if stigmatized, pregnancy outcome that people do not typically grieve. This chapter examines a nexus of the involuntary and voluntary: how people who chose abortion following observation of a serious fetal health issue make sense of their experience and process associated emotions.

Design: The author draws on semi-structured interviews with cisgender women who had an observed serious fetal health issue and chose to terminate their pregnancy.

Findings: Findings highlight an initial prioritization of medical knowledge in pregnancy decision-making giving way, in the face of the inherent limits of medical knowability, to a focus on personal and familial values. Abortion represented a way to lessen the prospective suffering of their fetus, for many, and felt like an explicitly moral decision. Respondents felt relief after the abortion as well as a sense of loss. They processed their post-abortion emotions, including grief, in multiple ways, including through viewing – or intentionally not viewing – the remains, community rituals, private actions, and no formalized activity. Throughout respondents’ experiences, the stigmatization of abortion negatively affected their ability to obtain the care they desired and, for some, to emotionally process the overall experience.

Originality/Value: This chapter offers insight into the understudied experience of how people make sense of a serious fetal health issue and illustrates an additional facet of the stigmatization of abortion, namely how stigmatization may complicate people’s pregnancy decision-making process and their post-abortion processing.

The study of birth defects has increased in importance in recent years because the rate of infant mortality due to other causes (such as infection and nutritional disease) has decreased more quickly than has the rate of deaths due to birth defects. Today, abnormalities are detected in approximately 3 percent of newborn humans, and twice as many prenatally acquired defects are found in children after infancy as are discovered at birth. In addition, many of the more than 500,000 miscarriages and stillbirths that occur each year in the United States are due to abnormal fetal development.

In healthcare, there is limited knowledge of and experience with patient choice management. The purpose of this paper is to focus on patient choice, apply and test demand-supply-based operating (DSO) logic integrated with clinical setting in clarifying choice contexts, investigate patient’s choice-making at different contexts and suggest context-based choice architectures to manage and develop patient choice.

Prenatal screening and testing in the Helsinki and Uusimaa Hospital District (HUS), Finland, was taken as an example. Choice points were contextualized by using the DSO framework. Women’s reflections, behaviors and experience at different choice contexts were studied by interviewing women participating in prenatal screening and testing. Semi-structured interview data were processed by thematic analysis.

By applying DSO logic, four choice contexts (prevention, cure, electives and continuous care) were relevant in the prenatal screening and testing episode. Women had different choice-making in prevention and cure mode contexts regarding choice activeness, information needs, social influence, preferences, emotion status and choice-making difficulty. Default choice was widely accepted by women in prevention mode and individual counseling can help women make informed choice in cure mode.

The authors apply the DSO model to contextualize the patient choice in one care episode and compare patient choice-making at different contexts. The authors also suggest the possible context-based choice architectures to manage and promote patient choice

Prenatal genetic testing is fast becoming standard practice in the medicalized arena of pregnancy in American health care provision. The interest of this paper, using empirical research data from participant observation and semistructured interviews of genetic counselors, geneticists, perinatologists, and obstetricians, is to explicate the provision of genetic care by the care-givers themselves, paying close attention to the ways they deal with the inherent uncertainties and ambiguities in medical genetics, especially prenatal genetic testing. Ambiguity and uncertainty are omnipresent in prenatal genetic testing, most obviously through the absence of an individual to examine in conjunction with test results. The test is for fetal abnormalities. Rarely are test results able to be interpreted with a clear, straightforward definition of what type of individual the fetus could eventually be. Through analysis of genetic intake meetings, departmental meetings, and quarterly interdepartmental meetings, the way providers order their work is elucidated; it reveals two work ideologies implemented to handle ambiguity and uncertainty: assessing the patient and tailoring the information to the patient. These work ideologies are examined through a social worlds/arenas theory and a sociology of work lens informed by symbolic interactionism. Analyzing providers' interpretations of their clinical practices allows an explication of their (re)construction of genetic medical knowledges through the individual providers' social worlds.

Prenatal comes from the Latin words ‘prae’ and ‘natalis’ meaning ‘before’ and ‘to be born’, respectively (Concise Oxford Dictionary, 1995). This word is semiotically loaded because ‘prenatal’ connotes the time before being born. The word itself signifies the foetus (who is ‘before being born’) not the pregnant body within whom the foetus grows. If medical experts working within the discipline of reproductive medicine concentrate more on the foetus and its health than the pregnant woman, they take this meaning to heart. Experts argue that ‘a multidisciplinary approach to the foetus is essential part of antenatal screening’ (Malone, 1996, p. 157), a view suggesting that the foetus, more than a pregnant woman, is the physician's main focus during the prenatal period.

The progress of genetic medicine has given rise to recent changes in the field of health care, such as expected benefits and potential risks for patients and their relatives. Individual genetic information can unlock many secrets within the genetic family and, sometimes the community to which he or she belongs. Therefore, the traditional duty of confidentiality owed by a health care professional to a patient has been challenged by the more serious discussions based on new genetics. Clinical geneticists providing genetic services must be aware of such complicated situations and whenever possible offer support to the patient (client) and their family members. Excluding eugenics and nonscientific perspectives, the Japanese government renamed and reworked “The Eugenic Protection Act” into the “Maternal Heath Protection Act” in 1996. From 1995 to 2003, the Japanese Society of Human Genetics (JSHG) revised guidelines for genetic testing three times. This process attempted to clarify indications for genetic testing, to focus on protection of individual genetic privacy and to deepen respect for familial relationships and responsibilities. The survey involving 221 JSHG approved clinical geneticist (response rate 54%) revealed that during last 5 years the number trying to do “non-directive” rather than “directive” counseling increased significantly. Although there is still in confusion on certain issues, such as data disclosure to relatives, the global bioethical view of new genetics is gaining Japanese geneticists’ acceptance.

Figures published by the Department of Health and Social Security show that in the UK during 1977 5,958 babies were born dead; 5,984 died in the neonatal period; 4,949 died under the age of one month; and 8,845 died in the first year. In addition to these losses various reports suggest that between 6% and 10% of all children, that means between 35,000 and 60,000 in the UK, have some handicap at the age of 5 years and it is reported that each year 18,000 infants enter special schools or institutional care. Amongst ‘normal’ children nowadays many suffer from hyperactivity, learning difficulties or allergic syndromes.