Medical students' attitudes towards abortion: a UK study

BACKGROUND

There is little research into medical students' or doctors' attitudes to abortion, yet knowing this is important, as policy makers should be aware of the views held by professionals directly involved in abortion provision and changing views may have practical implications for the provision of abortion in the future.

METHODS

We surveyed 300 medical students about their views on abortion, their beliefs about the status of the fetus and the rights of the mother, their attitude towards UK law and their willingness to be involved in abortion provision as qualified doctors.

RESULTS

62% of medical students were pro-choice, 33% pro-life and 7% undecided. Students' views correlated with gender, year of study and holding a religious belief. Their beliefs about abortion, the status of the fetus and the rights of women significantly correlated with their attitudes towards the UK law and their willingness to be involved in abortion provision. Students' willingness to be involved in abortion provision was related to their views on abortion, the extent of participation required, the circumstances of the pregnancy and the stage of pregnancy.

CONCLUSIONS

The percentage of pro-choice students was lower than that found in research on general practitioners' attitudes to abortion. It is unclear whether this is because students become more pro-choice as they progress through their medical career or because there is genuinely a change in attitudes to abortion.

Broken bones and fractures - an audit of patients' perceptions

INTRODUCTION

'Have I got a fracture or a break doctor?' remains a commonly posed question in fracture clinics, suggesting that patients frequently feel a 'fracture' and a 'break' are two separate entities. This apparent misconception amongst fracture clinic patients may result in confusion and occasionally anger that doctors appear to have inconsistent views on the severity of their injury. Compliance and outcome of patient care can also be affected by poor communication.

PATIENTS AND METHODS

Our questionnaire-based study was conducted in two stages. The initial objective was to establish whether this misconception surrounding the words 'fracture' and 'break' is commonly held amongst our out-patient trauma patients. The second stage of the audit was to determine whether a patient information leaflet on fractures/broken bones could help reduce this misconception.

RESULTS

The preliminary audit involving 50 new patients attending our fracture clinic showed that 84% thought there was a difference between a 'fracture' and a 'break', with 68% believing a 'break' to be worse than a 'fracture'. Following the introduction of an information leaflet, a re-audit of 61 new patients took place. This time 67% felt there was a difference between a 'fracture' and a 'break', with 65% believing a 'break' to be worse than a 'fracture'. Only 21% had read the supplied information leaflet, and 69% of those still believed there was a difference between a 'fracture' and a 'break'.

CONCLUSIONS

The majority of patients believed that there was a difference between a 'fracture' and a 'break'. Access to information leaflets did not appear to alter this misconception. Verbal communication and explanation may be more beneficial and practical than visual aids and leaflets in overcoming this problem.

Perinatal factors influencing survival in extremely low-birthweight infants

The majority of deaths in normally formed infants occur in extremely low birth weight infants (< 1000 g). Survival rates for these infants have improved greatly but still vary from centre to centre and accurate local outcome figures are important for counselling parents and upholding standards of care. In the Rotunda Hospital, Dublin, over the 6 year period from 1 January 1990 to 31 December 1995, there were 34 474 deliveries over 500 g birthweight. One hundred and twenty-six of these were normally formed infants between 500 g and 999 g. Our objective was to analyse the factors influencing survival in these extremely low birthweight (ELBW) infants. Overall survival in the group was 63%. The most significant factors influencing survival to 28 days were gestation and birthweight. Survival increased from 33% at 24 weeks to 100% at 28 weeks' gestation and from 29% at 500-599 g to 87% at 900-999 g birthweight. Having controlled for gestational age, none of the following variables had a significant effect on survival: year of birth; gender; multiple pregnancy; 1-minute Apgar score; maternal age; parity; use of antenatal steroids; a history of antepartum haemorrhage, pre-eclamptic toxaemia or prolonged rupture of membranes. A 5-min Apgar score > 5 increased the chance of survival by 3.97 (95% CI: 1.46- 10). Both mode of delivery and incidence of chorioamnionitis had an influence on survival which varied according to the gestational age. A larger cohort of survivors would illustrate the effect of these variables more clearly.

Clinical and serological associations of anti-Ku antibody

OBJECTIVE

To ascertain the clinical and serological associations of anti-Ku antibody.

METHODS

Twenty-seven patients over a 7 year period (1987-1996) had anti-Ku antibody detected by counterimmunoelectrophoresis (CIEP). Nineteen patients were available for clinical review. Five patients were assessed by chart review. Serum was taken at review for repeat antibody analysis. Patients were assigned to diagnostic groups based on the American College of Rheumatology criteria.

RESULTS

There were 22 women and 5 men. The duration of symptoms ranged from one year to 28 years. Nine patients fulfilled criteria for systemic lupus erythematosus (SLE), 4 scleroderma, 3 rheumatoid arthritis (RA), one discoid lupus, and 7 had an undifferentiated connective tissue disease. There was a low incidence of renal (2/24) and central nervous system involvement (1/24); 19/24 had Raynaud's phenomenon, 15/24 had inflammatory arthritis but only one had erosions on radiograph; 11/24 reported esophageal reflux symptoms. Three of 24 patients had myositis. All patients had anti-nuclear antibody using indirect immunofluorescence of > 640 titer with a speckled and nucleolar pattern. Anti-Ku antibody was detected on CIEP in 15/19 sera available for repeat testing. Three patients had anti-Ro antibody, 2 had anti-U1RNP antibody, one patient had anti-topoisomerase-1 and anti-Ro.

CONCLUSION

Anti-Ku antibody is found in a wide variety of connective tissue syndromes. While several patients fulfilled diagnostic criteria for SLE, scleroderma, and RA, their clinical features were usually mild and did not form a distinctive clinical pattern. Common features associated with anti-Ku were Raynaud's phenomenon, arthralgia, skin thickening, and esophageal reflux. Few patients had associated autoantibody specificities found in SLE or scleroderma.

Latex allergy and latex sensitization in children and adolescents with meningomyelocele

BACKGROUND

The high prevalence of clinical latex allergy and latex sensitization in children with meningomyelocele has been widely reported. It has also been noted that these same children have a higher than expected prevalence of atopic disease. It would be useful to have a safe, sensitive, and specific skin test to detect latex sensitivity and to know how well this test compares with available in vitro tests. It would likewise be helpful to know as fully as possible the characteristics of the individual and to evaluate the relative importance of factors suspected to contribute to clinical latex allergy and latex sensitization in this population.

METHODS

A group of 116 children and adolescents 1 to 20 years of age were recruited for the study. An extensive history of latex allergy, atopic diseases, and surgical procedures was taken on all subjects. Each subject had either a latex skin test or an in vitro study for latex-specific IgE, and 67 subjects had both tests simultaneously. Eighty-five subjects had epicutaneous skin tests to a panel of environmental allergens.

RESULTS

Overall, 25 of 116 (21.5%) subjects had a history of clinical latex allergy, and 51 of 116 (44%) were sensitized to latex. The sensitivity and specificity of skin tests for clinical latex allergy were slightly greater than for the in vitro test (100% vs 95.8% and 82.3% vs 68.9%, respectively). The positive predictive value and negative predictive value of skin testing for clinical latex allergy were also greater (67.6% vs 50% and 100% vs 98.1%, respectively). Age was found to be a significant variable for both latex allergy and latex sensitization. The number of surgical procedures undergone and the presence of positive skin test responses to environmental allergens were significantly correlated with latex sensitization but not with clinical allergy to latex.

CONCLUSIONS

A sensitive, specific, and safe skin test for latex sensitivity appears superior to in vitro testing for latex allergy. Age, number of surgical procedures, and the presence of positive allergen skin test responses are significantly correlated with latex sensitization. Age alone is significantly correlated with clinical allergy to latex.

The prevalence of chemical substance and alcohol abuse in an obstetric population in Dublin

OBJECTIVE

To determine the prevalence of illicit drug abuse and alcohol use in an obstetric population based in an urban maternity hospital.

SETTING

A collaborative study between the Rotunda Hospital, Dublin and the Irish National Drug Advisory & Treatment Centre.

DESIGN

A prospective study consisting of anonymous, unlinked urine testing of 504 'first visit' antenatal patients and a separate group of 515 patients six weeks after delivery.

METHODS & OUTCOME MEASURES

Toxicological screening using enzyme-linked immunoassay techniques, with all positive samples being reanalysed. Drug histories were taken and samples were tested for alcohol and six of the most commonly abused drugs. The pre- and postnatal prevalence of abuse was matched with demographic data.

RESULTS

The prevalence of chemical substance misuse in the antenatal population was 2.8% and 5.6% in the postnatal population. Substances identified included benzodiazepines, cannabis, amphetamines, opiates and cocaine. Less than 2% of samples tested positive for alcohol. None of the women yielding positive samples had been pre-identified on the basis of history. A significant proportion of the women were in the high risk categories with regard to age and socio-economic status.

CONCLUSION

The prevalence of drug misuse antenatally was nearly 3% and postnatally almost 6%. Substance abusers in pregnancy are more likely to be single, unemployed, and to have had a previous pregnancy.

Perireceptor mechanisms sustaining olfaction at low salinities: insight from the euryhaline blue crab Callinectes sapidus

As the blue crab Callinectes sapidus moves from sea water to fresh water, the 'exposed' chemosensory dendrites in the olfactory sensilla (aesthetascs) undergo changes in length that are positively correlated with environmental salinity. In this study, we demonstrate the following. (1) The responses of the olfactory receptor cells of freshwater-acclimated crabs are reduced relative to those of seawater-acclimated animals, but increase with a time course comparable to the increase in dendrite length when these crabs are transferred to sea water. (2) The olfactory response of seawater-acclimated crabs is lost and the chemosensory dendrites osmotically ablated if the aesthetascs are acutely exposed to low salinity. However, maintaining iso-osmotic conditions with mannitol preserves both the physiological response and the structural integrity of the dendrites. (3) The flux of [14C]thiocyanate and 22Na between the hemolymph and sensillar lymph of the aesthetascs indicates continuity between these fluid compartments. (4) There is a net efflux of Na+ from the hemolymph through the aesthetascs in freshwater-acclimated crabs, and measurements of electrical potential across the antennules suggest that this efflux largely derives from passive diffusion. (5) Dendrites in the aesthetascs of crabs acclimated to brackish water are intermediate in length between those of freshwater- and seawater-acclimated animals. Together, our findings suggest that, at low salinities, the efflux of Na+ (and probably other ions) from the hemolymph generates an ionic/osmotic microenvironment within the aesthetascs that sustains the structural and functional integrity of the olfactory dendrites. We propose that the length of these dendrites, and consequently the olfactory response, is constrained by the distance over which this microenvironment can be effectively maintained.

HELLP syndrome: a condition of varied presentation

Three cases of HELLP syndrome are presented which illustrate its varied clinical presentation, the difficulty in making a diagnosis and the management problems. The cases varied in severity; all showed thrombocytopenia and abnormal liver function tests, but in one case the blood pressure remained within "normal limits" whereas another patient suffered grand mal seizures due to hypertensive encephalopathy.

Maternal and neonatal hyponatraemia: a comparison of Hartmanns solution with 5% dextrose for the delivery of oxytocin in labour

We performed a randomised controlled trial to compare the effect on neonatal and maternal serum sodium of using oxytocin in Hartmanns solution compared to the standard 5% Dextrose regimen for induction or augmentation in labour. We found significantly decreased maternal and neonatal serum sodium concentrations in the 5% Dextrose group compared to the Hartmanns group.

Limited role of fetal blood sampling in prediction of outcome in intrauterine growth retardation

Fetal acid-base status was evaluated on 66 blood samples taken for rapid karyotyping from 58 growth-retarded fetuses. Before blood sampling, doppler blood flow studies of the umbilical artery showed end-diastolic frequencies to be absent in 32 fetuses (group 1) and present in 26 (group 2). Fetuses with chromosomal (n = 4) or structural (n = 8) abnormalities were excluded from subsequent analysis. Gestational age at blood sampling (27.8 [95% CI 26.5-29.1] vs 32.2 [30.4-34.1] weeks) and time from sampling to delivery (median 2 (range 0-35] vs 14 [0-77] days) were significantly lower in group 1 than group 2. There were no perinatal deaths in group 2 whereas mortality in group 1 was 65.4%. There were significant differences between the groups at blood sampling in pH, pO2, pCO2, base equivalents, and nucleated-red-cell count, but within group 1 these measurements were similar in surviving fetuses and those who died perinatally. Since acid-base determination does not predict perinatal outcome in growth-retarded fetuses, fetal blood sampling has a limited role in monitoring fetal wellbeing.

Induction of labour postdates in primiparae using vaginal prostaglandin tablets

The management of pregnancy after 40 completed weeks remains controversial because induction of labour has been, in the past, associated with an increase in the incidence of caesarean section. This study examined the use of vaginal prostaglandin tablets for the induction of labour in selected primiparae after forty one weeks of pregnancy. The outcome of prostaglandin induction in 118 consecutive patients was compared with the outcome in 90 consecutive patients who went into labour spontaneously at the same gestation before induction could be undertaken. The active management of labour was applied in both groups and, therefore, the management of labour was strictly standardised. There was no difference between the two groups in the mode of delivery. Nor was prostaglandin induction associated with an increased incidence of prolonged labour. In selected primiparae, the cautious use of vaginal prostaglandin tablets can induce labour successfully postdates without increasing the complications of labour. A larger study is required to examine the effects of the induction of labour at this gestation on the fetal outcome.