Physician recommendation for invasive prenatal testing: the case of the 'precious baby'

Do clinicians manage pregnancies conceived by assisted reproductive technologies (ART) differently from spontaneous pregnancies?

Clinicians decisions about prenatal testing during pregnancy depend, at least partially, on the method of conception.

Research thus far has shown that patients decisions regarding prenatal screening are different in ART pregnancies compared with spontaneous ones, such that ART pregnancies may be considered more valuable or precious than pregnancies conceived without treatment.

In this cross-sectional study, preformed during the year 2011, 163 obstetricians and gynecologists in Israel completed an anonymous online questionnaire.

Clinicians were randomly assigned to read one of two versions of a vignette describing the case of a pregnant woman. The two versions differed only with regard to the method of conception (ART; n 78 versus spontaneous; n 85). Clinicians were asked to provide their recommendations regarding amniocentesis.

The response rate among all clinicians invited to complete the questionnaire was 16.7. Of the 85 clinicians presented with the spontaneous pregnancy scenario, 37 (43.5) recommended amniocentesis. In contrast, of the 78 clinicians presented with the ART pregnancy scenario, only 15 (19.2) recommended the test. Clinicians were 3.2 (95 confidence interval [CI]: 1.66.6) times more likely to recommend amniocentesis for a spontaneous pregnancy than for an ART pregnancy.

The study is limited by a low response rate, the relatively small sample and the hypothetical nature of the decision, as clinician recommendations may have differed in an actual clinical setting.

Our findings show that fertility history and use of ART may affect clinicians recommendations regarding amniocentesis following receipt of screening test results. This raises the question of how subjective factors influence clinicians decisions regarding other aspects of pregnancy management.

There was no funding source to this study. The authors declare no conflicts of interest.

Is a single item stress measure independently associated with subsequent severe injury: a prospective cohort study of 16,385 forest industry employees

Background: A previous review showed that high stress increases the risk of occupational injury by three- to five-fold. However, most of the prior studies have relied on short follow-ups. In this prospective cohort study we examined the effect of stress on recorded hospitalised injuries in an 8-year follow-up.
Methods: A total of 16,385 employees of a Finnish forest company responded to the questionnaire. Perceived stress was measured with a validated single-item measure, and analysed in relation recorded hospitalised injuries from 1986 to 2008. We used Cox proportional hazard regression models to examine the prospective associations between work stress, injuries and confounding factors.
Results: Highly stressed participants were approximately 40% more likely to be hospitalised due to injury over the follow-up period than participants with low stress. This association remained significant after adjustment for age, gender, marital status, occupational status, educational level, and physical work environment.
Conclusions: High stress is associated with an increased risk of severe injury.

Late-Glacial and early Holocene marine 14C reservoir ages off North Iceland (16-9 cal kyr BP)

Tephrochronological age models and 48 14C age determinations on molluscs and foraminifera (planktonic and benthic) are applied for the calculation of marine 14C reservoir age variability during a time period covering the Heinrich event H1 to early Holocene (16–9 cal kyr BP). Our data source consists of four high-resolution marine sediment cores (HM107-04, HM107-05, MD99-2271, MD99-2275) from the North Icelandic shelf. The marine reservoir age (ΔR) is found to be extremely variable, ranging from 385 to 1065 14C years. Extreme ΔR values occur at the end of H1, with values around 1000 14C years (~15 cal kyr BP), probably due to reduced northward flow of well-ventilated subtropical surface waters and a southward expansion of polar waters, as well as an expansion of sea ice limiting air-sea gas exchange. With the onset of the Bølling-Allerød interstadial, the ΔR values decrease towards 0 14C years suggesting a more vigorous North Atlantic Current and an active meridional overturning circulation system. During the Younger Dryas stadial, ΔR values are consistently around 700 14C years suggesting e renewed expansion of polar waters and a weakened meridional overtuning circulation. Interestingly, ΔR values remain high (~200 14C years) at the onset of the Holocene suggesting continued high influence of polar waters. Subsequently, ΔR values rapidly decrease to ~¬ 250 14C years around 11 cal kyr BP, indicating increased air-sea CO2 exchange with the coeval atmosphere. The ΔR values average around 0 14C years from around 10.5 to 9.0 cal kyr BP.

The stability of alcohol consumption between age 16 and 26: Evidence from a National Birth Cohort Study

This study examined the association between moderate drinking at age 16 (adolescence) and alcohol consumption at age 26 (young adulthood), whilst controlling for possible confounding effects at the individual and family level (assessed at birth and age 10). Using the British Cohort Study (BCS70), 6515 respondents provided data on their adolescent alcohol consumption and other behaviours. Of these, 4392 also completed the survey at age 26. Consumption patterns established in adolescence persisted, to a large degree, into early adulthood. Those adolescents who drank moderately in adolescence drank significantly less in adulthood than those adolescents who drank to heavy or hazardous levels. Implications for health promotion strategies and guidance are discussed.

Early assessment of visual acuity after cataract surgery in rural Indonesia.

BACKGROUND: The accuracy and impact on service uptake of early examination after cataract surgery is not known. DESIGN:   Prospective cohort study. PARTICIPANTS: Cataract patients in rural Indonesia. METHODS: Visual acuity was measured preoperatively, 1day, 1-3, 4-6 and >12weeks after surgery, and 6-8months postoperatively at an outreach examination. Acceptance of second-eye surgery and spectacles was evaluated. MAIN OUTCOME MEASURE: Presenting visual acuity in the operated eye. RESULTS: Among 241 subjects (extracapsular surgery 84%), examinations at 1day, 1-3, 4-6 and >12weeks and 6-8months were completed for 100% (241), 90.9% (219), 67.6% (163), 22.0% (53) and 80.0% (193), respectively. Among subjects at the final examination (mean age 65.8±10.6years, 51.8% male), 73.6% had bilateral preoperative presenting visual acuity≤6/60. By 4-6weeks, the proportion with good (≥6/18) or poor (≤6/60) visual acuity did not differ significantly from the final examination. Among 49 persons accepting free second-eye surgery, 69.4% (34) and 16.3% (8) returned to clinic at 4-6 and >12weeks, respectively. Among 131 patients (67.9%) paying US$7 for glasses, 94 (71.8%) and 30 (22.9%) attended 4- to 6- and >12-week examinations, respectively. CONCLUSION: Even with large-incision surgery, early assessment of postoperative vision is representative of final vision, and may help deliver postoperative services to more of those needing them. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.

Los pueblos indios en sus mitos 16: Quichuas amazonicos del Aguarico y San Miguel

La región del Napo tiene una posición geografica peculiar, que ha influido mucho en la historia de su gente. Por ella ha entrado Francisco de Orellana desde Quito al Amazonas y por ella, desde Belém do Pará, ha subido Pedro de Texeira hasta Quito. La facllidad de acceso desde los Andes y el hecho de tener ríos navegables ha permitido al Napo conocer fenómenos casi inexistentes en otras provincias orientales ecuatorianos, como por ejemplo el establecerse de haciendas desde tiempos relativamente remotos, con la consecuente conversión de la población indígena en personaje sometido. En la época funesta del auge cauchero el Napo fue la única provincia ecuatoriana seberamente afectada por el fenómeno, que determinó la reubicación forzada de muchas poblaciones Sin duda, de toda la Amazonía ecuatoriana, el Napo es la región cuya población, especalmente en el último siglo, ha sido mós diezmada, sometida, literalmente zarandeada. Es también la que ha recibido un rnayor aporte de migración serrana y costeña, aún antes del descubrimiento del petróleo, hasta el punto que hoy se está hablando de su subdiuisión en dos o tres provincias.

Estágios curriculares do bacharelato em Engenharia Mecânica

Os planos curriculares da globalidade dos cursos de Bacharelato ministrados na Escola Superior de Tecnologia (EST) contêm uma disciplina designada por Estágio, de carácter obrigatório, a qual se desenvolve, em geral, no período compreendido entre o final do 2º semestre e o início do 1º semestre do ano lectivo seguinte. O seu objectivo primordial é o de permitir a integração dos alunos em situações de actividade profissional concretas, num ambiente real e externo à Escola, como complemento da sua formação académica.