Biomedical subjects
A Lippman
Publications and source records attributed to A Lippman.
Choice in prenatal testing.
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Indications for transfer for childbirth in Inuit women at the Innuulisivik Maternity.
The Innuulisivik Maternity is a northern-based service in Povungnituk, Quebec, which serves the Inuit women of the Hudson Coast. Although most women stay in the North for childbirth, others are transferred south. This paper will describe the experience of the Innuulisivik Maternity, which uses committee-based risk assessment for transfer decisions. Data for the three-year period 1989-1991 were examined. Descriptive statistics were used to compare the observed differences in the distribution of several variables according to birthplace. Data were available for 411 women. Three hundred fifty (85.2%) of the births occurred at Innuulisivik: 44 (10.7%) women were transferred and 17 (4.1%) were nursing station births. In 80% of transfers, clinical conditions were identified which in themselves usually require transfer. Premature labor was prevalent in the transfer group. The data demonstrate that risk scoring by consensus is a viable option for northern birthing units. Finally, logistical and cultural factors should be included for meaningful risk assessment in the North.
Nonconsensual participation in genetic studies.
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"Everything you need to know": how women's magazines structure prenatal diagnosis for women over 35.
The use of biomedical testing and genetic counselling is usually framed as something an individual woman chooses, with little consideration given to the context in which women make these choices. In order to understand something of the context in which women (35 and over) undergo prenatal diagnostic tests, we have surveyed the contents of 10 major women's magazines. We found that the stories told about the "older" pregnant woman and the risks attached to her pregnancy are highly selective. The dominant rhetoric used in these narratives suggests that women "need" to be informed of the facts of being pregnant when older (through reading magazine articles), that this need incurs a further need to find out the state of the fetus (through biomedical intervention), and that the pregnant woman can meet these needs by "choosing" prenatal diagnosis. These results illustrate how a "need" for prenatal testing gets created and suggest that to "choose" to be tested may be to partake of, not challenge, the mainstream biomedical assumptions about how the "older" pregnant woman will and should behave.
Intraoperative cardiac output monitoring: comparison of impedance cardiography and thermodilution.
Impedance cardiography (IC) is a noninvasive, simple to use method of cardiac output (CO) determination. A prospective evaluation of IC monitoring was performed in 50 patients undergoing noncardiac surgery. IC CO measurements (NC-COM3-Revision 7, BoMed Manufacturing) were compared to simultaneous measurements of thermodilution (TD) CO to assess the validity of this technique for intraoperative cardiac monitoring. Adequate impedance signals could not be obtained in 7 of the 50 patients. IC CO measurements were highly correlated to TD CO (P < .005), with a correlation coefficient r = 0.84. Bias analysis, however, indicated clinically significant disagreement between the two techniques. IC CO tended to underestimate TD CO (mean bias = -0.41 L/min) and the SD of the bias was 1.0 L/min (95% level of agreement 1.6 to -2.4 L/min). Trending data showed IC to accurately track the direction of TD CO changes but to underestimate their magnitude (r = 0.60, intercept -0.7 L/min, slope 0.47). Factors that may have impaired the performance of IC in this study include the high prevalence of cardiac disease in the study population and electrical noise in the operative setting. Further development of IC appears warranted if it is to prove useful as an intraoperative cardiac monitor.
Screening for genetic disease.
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Prenatal genetic testing and geneticization: mother matters for all.
Prenatal genetic testing represents the most widespread human application of reproductive technology, and its use is necessarily gendered. Moreover, its application both reflects and generates the process of 'geneticization' that increasingly orients contemporary western-world stories of health and disease. Taking a woman-centered approach, this paper examines some of the stories being told about testing; questions their themes of 'reassurance' and 'choice', their construction of 'risk', and their assumptions about disability; and explores the 'life-style' testing creates for (pregnant) women. Testing itself, and its power to control how we live and the children we bear, raises complex and troubling matters that require continued and fresh examination.
Re: "The 'fourth disease' of childhood: reevaluation of a nonexistent disease".
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Canadian multicentre randomized clinical trial of chorion villus sampling and amniocentesis. Final report.
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Familial chromosomal aberrations and metabolic disorders.
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Led (astray) by genetic maps: the cartography of the human genome and health care.
Advocates of projects to map the human genome claim that the information produced will illuminate the causes of human disease, improve treatment and, in general, increase our health and well-being. While concerns about the costs of mapping and the possible discriminatory and eugenic applications of the information it will provide have received some attention, assumptions implicit in the biomedical discourse in which its 'benefits' are proposed and which are shaping definitions of illness and health, normality and abnormality, have not yet been adequately analyzed. This paper examines how the genetic stories about mapping and its potential products being told in the biomedical (and popular) literature continue a tradition of reductionism and determinism. This new 'cartography', by adopting the blueprint as a metaphor for genes, leads to restricted conceptions of health and illness, reinforces inequities in the distribution of health and, by privatizing and individualizing responsibility for health, creates and legitimizes a new arena for social control.
Prenatal diagnosis: can what counts be counted?
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Twice-told tales: stories about genetic disorders.
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Conflicts, ethics, and the genome.
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Research studies in applied human genetics: a quantitative analysis and critical review of recent literature.
To determine the extent to which speculations about the social, legal, and ethical implications of genetic counseling, screening, and prenatal diagnosis are being studied empirically, the substantive contents of major genetics (N = 5) and obstetrics journals (N = 2) from the years 1985-1989 were reviewed. Among the approximately 9,000 articles published, only 58 containing relevant substantive data could be identified. Data collected in a single study were reported in more than one article in at least ten cases so that these articles actually represent only 45 distinct studies. Most described investigations of the attitudes and reactions of individuals or couples who had had or been referred for genetic counseling or prenatal diagnosis. These observational studies generally employed study-specific questionnaires, many of which were apparently self-administered by respondents, to obtain data. This survey and analysis of the recent literature suggests that despite frequent editorials and other commentaries underlining the problematic nature of developments in medical genetics and calling for their investigation, the "gate-keepers" to this service continue to pay scant attention to these issues in their reported research. Innovative and interdisciplinary studies that will provide information to close the many gaps in our understanding of the consequences of developments in applied human genetics are recommended for the future.
Prenatal genetic testing and screening: constructing needs and reinforcing inequities.
This Article considers the influence and implications of the application of genetic technologies to definitions of disease and to the treatment of illness. The concept of "geneticization" is introduced to emphasize the dominant discourse in today's stories of health and disease and the social construction of biological phenomenon is described. The reassurance, choice and control supposedly provided by prenatal genetic testing and screening are critically examined, and their role in constructing the need for such technology is addressed. Using the stories told about prenatal diagnosis as a focus, the consequences of a genetic perspective for and on women and their health care needs are explored.
Genetics and public health: means, ends, and justices.
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