Genetic testing for children and adolescents.
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Adolescent↗
Biomedical subjects
B M Burke
Publications and source records attributed to B M Burke.
Directiveness in prenatal genetic counseling.
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Decision Making↗
Deciding about the unknown: perceptions of risk of women who have prenatal diagnosis.
This paper examines the risk perceptions of women who undergo two prenatal diagnostic procedures, amniocentesis and CVS (chorionic villus sampling). Data were collected from a survey of clinic patients in suburban Washington, D.C. and in San Diego (N = 120). The survey was supplemented by in-depth interviews with prenatal diagnosis users and genetic counselors. Women with more education, as well as those who had CVS rather than amniocentesis, were more likely to view their risk as low. This contradicts the accepted view that users are aware of the higher risks of CVS. Rather, it seems that risk perceptions are socially constructed to achieve cognitive consistency with the action undertaken. Qualitative data suggest that perceptions of risk appear to be influenced not only by the users' demographic characteristics but by the salience and severity of the event in question and by the user's perceived control over it.
Amniocentesis↗
Genetic counselor attitudes towards fetal sex identification and selective abortion.
Thirty-four prenatal genetic counselors (all but one non-M.D.s) in seven American cities were interviewed on attitudes which might plausibly affect counselor-client interchanges. They overwhelmingly endorse both non-directive counseling and the pro-choice ethos which supports a woman's absolute right to abortion in the early stages of pregnancy. However, they also overwhelmingly condemn using prenatal diagnosis for sex selection purposes. Therefore, counselors experience continual stress from clients who evoke the conflict inherent between these two stances. Counselors use a variety of coping mechanisms to minimize this cognitive dissonance. Avoidance through out-referral or invoking institutional policies forbidding prenatal diagnosis for sex selection purposes is a diminishing option and not possible with clients who have or offer a medical indication. More common is the use of psychological coping mechanisms. By elevating the ideals of non-directiveness and female autonomy counselors better tolerate client values in conflict with their own. Some redefine the category of 'unwanted pregnancy' to include fetuses of the 'wrong sex'; others redefine the problem as their own ethnocentricism. Empowering counselors to set the protocols they use to screen applicants for prenatal diagnosis would not remove these conflicts. Many counselors believe a ban on releasing fetal sex information while abortion is still a legal option would be organizationally or legally unacceptable, or a violation of patient automony. A complicating factor is that 60% of the counselors interviewed would prefer to know fetal sex in their own pregnancies. Counselors reflect the ambivalence of American society in balancing conflicting social goals.(ABSTRACT TRUNCATED AT 250 WORDS)
Abortion, Legal↗
Microwave sterilization: a method for home sterilization of urinary catheters.
A standard microwave oven has been used to sterilize catheters used for intermittent self-catheterization. Catheters were incubated for 60 minutes in a suspension of microorganisms isolated from the urine of patients with urinary tract infections. Each catheter was removed from the suspension, placed in a paper bag and microwaved for 0 to 30 minutes. A control catheter was not microwaved. We tested 42 strains of microorganisms to determine the minimum microwaving time needed to sterilize the catheters. Representative urinary isolates of Escherichia coli, and Klebsiella, Proteus, Enterobacter, Pseudomonas, Staphylococcus, Streptococcus and Candida species were tested. Mean sterilization time for all strains was 13.0 minutes (standard deviation +/- 5.7 minutes), with a range of 4.0 to 28.6 minutes. Repeat sterilization in the microwave oven did not affect the integrity of the catheter. A water heat sink of constant volume was required. A home microwave oven may be used as a method to sterilize red rubber catheters for reuse. This technique makes aseptic intermittent self-catheterization a practical possibility.
Cooking and Eating Utensils↗
A comparison of cefmetazole, and cefoxitin for the treatment of patients hospitalized with acute urinary tract infections.
This study evaluates the safety and efficacy of cefmetazole in comparison with cefoxitin in the parenteral treatment of patients hospitalized with acute urinary tract infections. Of the 49 evaluable patients, 27 were randomized to cefmetazole and 22 to cefoxitin. There was clinical success in 26 (96%) patients and bacteriological cure in 22 (81%) patients receiving cefmetazole. This compares with clinical success in 21 (95%) patients and bacteriological cure in 17 (77%) patients randomized to cefoxitin. There were no adverse reactions associated with either antibiotic. This study indicates that the clinical and bacteriological outcome was similar.
Adolescent↗
Topical azelaic acid and the treatment of acne: a clinical and laboratory comparison with oral tetracycline.
Topical azelaic acid and oral tetracycline were compared in a 6-month double-blind study for treatment of acne vulgaris in 45 male subjects with clinical acne. Their acne was graded, inflamed or non-inflamed, lesions were counted and the density of their skin microflora was measured. Both treatments were of benefit and produced only a few minor side-effects. Although oral tetracycline was more effective than azelaic acid, the differences were only just significant. The average reduction in numbers of cutaneous micrococcaceae and Propionibacterium sp. with azelaic acid treatment was 224 and 30-fold, respectively. In a separate group of 11 male subjects with physiological acne the effect of azelaic acid on sebum excretion rate was assessed, and little change was detected.
Acne Vulgaris↗
Single-dose ceftriaxone treatment of urinary tract infections.
Single-dose antibiotic therapy for urinary tract infections in which no underlying structural or neurologic lesions are present holds the promise of greater patient compliance and convenience. We present the results of a study comparing a single intramuscular dose of a long-acting, third-generation cephalosporin, ceftriaxone, with a standard, five-day regimen of trimethoprim-sulfamethoxazole (TMS). Fifty-two patients were entered into the study. After randomization, 26 were assigned to the TMS group and 26 were assigned to the ceftriaxone group. Of the patients who completed the study, 13 of the TMS group had positive cultures at the time of initial presentation, and 20 of the ceftriaxone group had positive cultures. There was no statistical difference between the groups in symptoms of dysuria, hematuria, frequency, flank pain, and nocturia (alpha = .05). The physical parameters of age, blood pressure, pulse, and temperature were similar in the two groups (alpha = .05), as were the types of infecting organisms (alpha = .05). When comparing the two regimens, the ceftriaxone group cure rate (18 of 20, 90%) was not found to be significantly different from that of the TMS-treated control group (13 of 13) (alpha = .05).
Administration, Oral↗
Oral spironolactone therapy for female patients with acne, hirsutism or androgenic alopecia.
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Acne Vulgaris↗
The assessment of acne vulgaris--the Leeds technique.
We describe two simple, reproducible scoring systems for assessing acne severity, and we emphasize the technical problems which could invalidate either technique. Constant baseline data is desirable for any clinical trial, and our data clearly show that acne patients should ideally be off all treatment for at least 2 months before the start of a therapeutic trial.
Acne Vulgaris↗
Clients undergoing chorionic villus sampling versus amniocentesis: contrasting attitudes toward pregnancy.
We analyzed interview data from 44 primarily white, middle-class women who had used the prenatal diagnostic technique of chorionic villus sampling (CVS: n = 24) or amniocentesis (n = 20). CVS provides earlier results but carries a somewhat higher risk of miscarriage. Amniocentesis clients were highly committed to the pregnancy and expressed considerable anxiety over the possibility of having to terminate it should an abnormality be diagnosed. CVS clients seemed less bonded to the fetus and less concerned about losing a pregnancy several termed "replaceable." Thus, with its first-trimester abortion decision, CVS redefines prenatal diagnostic issues for women.
Abortion, Therapeutic↗
Grieving the wanted child: ramifications of abortion after prenatal diagnosis of abnormality.
Prenatal diagnosis is increasingly common. Whereas amniocentesis is typically performed in the second trimester, chorionic villus sampling (CVS) is a first-trimester procedure, which makes an earlier, safer abortion possible. However, CVS carries a slightly higher risk of miscarriage and other complications. In choosing a procedure, couples (with the aid of genetic counseling) must weigh the risks of miscarriage against the odds and implications of an abnormal diagnosis. Interviews with women who decided on abortions after amniocentesis or CVS and meetings with genetic counselors indicate that both types of abortion are more traumatic than is commonly realized. Both dash dreams and hopes. Termination after amniocentesis also forces the mother to take an active part in the life and death of a nearly viable fetus. Yet, because abortions for fetal abnormality are statistically rare, there is little societal understanding and minimal support for those who experience them. This is true of health care workers as well as for the couple's primary support group.
Abortion, Therapeutic↗