Pregnancy hormone levels signal trisomy 21, improved screening, lower costs possible

Article Abstract:

Prenatal screening is becoming faster and easier because of advances in biochemistry. An analysis of substances in the mother's blood, when considered with age-related risk, can more accurately detect the genetic defect that causes Down's syndrome. These substances are the hormones human chorionic gonadotropin and unconjugated estriol, and the protein alpha-fetoprotein (AFP). The blood test, performed during the second three months of pregnancy, can then be followed by amniocentesis if the result indicates a risk of the genetic defect, an additional 21st chromosome. Maternal age is a poor indication of risk, and fewer than one-fourth of the cases of Down's syndrome are identified when only older women are tested. Physicians have previously used AFP alone to determine risk among younger women, but this method has detected only about one-fifth of the cases of Down's syndrome among this population. The high detection rate of the new test make it cost-effective because unnecessary amniocentesis would be avoided. The technique is expected to detect 67 percent of the 5,000 affected fetuses born each year, a considerable advantage over the current 40 percent detection rate. For older women, who are at much greater risk of having a child with Down's syndrome, the new method would fail to detect 10 percent of affected fetuses, and it does not detect other chromosomal abnormalities, which are more common among the fetuses of older mothers. For these women, amniocentesis is probably the better choice, but their doctors should also advise them of the new test. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Diagnosis, Testing, Pregnant women, Down syndrome, Prenatal diagnosis

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Domestic violence intervention calls for more than treating injuries

Article Abstract:

The leading cause of injury to women is physical violence (battering) at the hands of their spouses or by others with whom they are intimately involved. Research has shown that physicians, nurses, and other members of the clinical team often fail to report these cases to the police or to explore the reason for the violence with the patient. Despite the fact that physicians would not consider discharging a sick patient requiring support without making adequate arrangements for the protection of the patient, abused women are usually discharged back into the same environment that produced the battery. The detached medical model, and even the language that is used to discuss cases and record medical history, may remove physicians from their feelings when dealing with abused women. When clinicians avoid confronting the patient with the evidence of abuse, an important opportunity for change is lost. The patient's feelings of self-worth can be further impaired, leading to more isolation. Physicians satisfy what they believe to be their medical obligation, and do not consider the implications of the physical injuries that they treat. Physicians can help by identifying the problem and getting the patient to recognize this serious and possibly life-threatening circumstance. The woman's safety, and the safety of her children must be assessed. Information regarding all options should be presented, and the patient's decision should be supported. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Health aspects, Care and treatment, Injuries, Wife abuse, Conjugal violence

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Domestic violence hot line's demise: what's next?

Article Abstract:

The national domestic violence hotline was discontinued after funding ended in Jun 1992. The funding for this hotline was provided by a private grant. Individuals who ran the hotline tried to find a new source of funding for the hotline without success. Many individuals in the community did not know about the problems with continuing funding for the hotline until it was too late. Many programs for battered women continued to post the number throughout the community. The medical community also published the number in a directory on domestic violence used by thousands of physicians. Many members of the medical community are concerned about battered women who may need emergency services such as a hotline. The board of directors of the Texas Council on Family Violence has voted to nationalize its statewide hotline, and hopes to raise money from public and private sources.

Finance, Services, Hotlines (Counseling)

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