Posttraumatic Stress Disorder and Associated Functional Impairments During Pregnancy: Some Consequences of Violence Against Women

Despite the high prevalence of violence in the lives of women of reproductive age, and the adverse consequences posed to pregnant women suffering from PTSD, few studies have examined violence-related trauma and PTSD among pregnant women. A structured research interview was administered to a convenience sample of 85 prenatal care women to collect information regarding their experiences of violence victimization, PTSD symptoms related to violence-related traumatic events, and whether these symptoms impaired various aspects of the women's daily functioning. Results indicated that 69% of the women experienced a violent traumatic event, with the majority of events occurring before the current pregnancy and being perpetrated by the women's intimate partners. The traumatized women evidenced high levels of PTSD symptoms during pregnancy, with 58% of the women meeting criteria for a PTSD diagnosis. Moreover, many of the women with PTSD symptoms reported that the symptoms adversely affected aspects of their daily functioning.     

Parental refusals of medical treatment: the harm principle as threshold for state intervention

Minors are generally considered incompetent to provide legally binding decisions regarding their health care, and parents or guardians are empowered to make those decisions on their behalf. Parental authority is not absolute, however, and when a parent acts contrary to the best interests of a child, the state may intervene. The best interests standard is the threshold most frequently employed in challenging a parent's refusal to provide consent for a child's medical care. In this paper, I will argue that the best interest standard provides insufficient guidance for decision-making regarding children and does not reflect the actual standard used by medical providers and courts. Rather, I will suggest that the Harm Principle provides a more appropriate threshold for state intervention than the Best Interest standard. Finally, I will suggest a series of criteria that can be used in deciding whether the state should intervene in a parent's decision to refuse medical care on behalf of a child.     

Pregnancy as an Opportunity for Trauma-Intervention Among Women Who Are Addicted to Substances

Victims of violence come from various backgrounds; however, the intersection of gender combined with poverty, belonging to a racial minority, [dis]ability, and youth, put women at greater risk for experiencing violence and trauma. Many of these features are also high-risk markers for women who experience addictions to substances. Considering the risk factors and prevalence of violence and addictions experienced by young women, it is important to consider the comorbidity of complex trauma and substance use disorder and their combined effects on women’s reproductive health. The experience of pregnancy, combined with the experience of past trauma and addictions, presents a complex and compelling situation in which women struggle to balance their intentions to maintain a healthy pregnancy, with the drive to use substances as a way to cope with unresolved past traumatic experiences. By reviewing the literature regarding addictions, pregnancy, and complex trauma, this article aims to demonstrate that pregnancy presents a unique opportunity for trauma intervention among addicted women, and to establish how a missed opportunity for trauma-focused intervention can contribute to intergenerational trauma, creating a cycle of harm for women and their children.     

Sleep in Women: A Review

Sleep complaints are common in women, and women are more likely to suffer from insomnia than men. Multiple factors across a woman's lifespan, including hormonal changes, age‐related physiological changes, psychosocial factors, the presence of sleep disorders, and physical and mental health conditions, can contribute to complaints of poor sleep in women. This article reviews the literature on the characteristics of, and contributing factors to, subjectively and objectively measured sleep during the menstrual cycle, pregnancy, and post‐partum period, as well as the menopausal transition and postmenopause. Evidence from both subjective and objective measurements supports the presence of chronic sleep fragmentation associated with pregnancy, acute sleep deprivation during labour and the immediate post‐partum periods, as well as disrupted sleep during the first few months after childbirth. While there is evidence for menstrual cycle and menopause related sleep disturbance based on women's self report, findings from objectively measured sleep have been mixed. Observational and intervention studies on the relationship between sleep and women's psychological well‐being suggest that underlying causes of sleep disturbance across a woman's lifespan are often multi‐factorial. Comprehensive assessments and targeted interventions are needed in managing sleep problems in women. Cognitive behavioural interventions have been shown to reduce sleep complaints during the perinatal and menopausal periods, and improvements in sleep are likely to lead to improvements in women's overall well‐being.     

Attitudes to Genetic Testing for Deafness: The Importance of Informed Choice

With recent progress in the identification of genes for deafness, it is highly likely that genetic testing, including pre-natal testing, for deafness will become more widely available. In a context where there are concerns about pre-natal testing, and where many in the Deaf community contest the understanding of deafness as a disability, it is important to examine the attitudes of Deaf/deaf people toward genetic testing. This qualitative study employed in-depth interviews to investigate the views about genetic testing for deafness of 19 participants, who were identified as functionally deaf or hearing impaired, or as belonging to the Deaf community. The key findings are that participants were generally supportive of genetic testing for deafness but only when full information about all relevant aspects of deafness is given to prospective users of genetics services. Participants emphasized informed choice, stating that information about medical and technological options for deaf people should be provided, together with information about communication, education, and the experience of being deaf. Although there was less support for pre-natal diagnosis and termination of pregnancy for deafness, most participants nonetheless felt that individual choice was important and that pre-natal diagnosis should be made available to those who wanted to use it.     

Attack by female mice on “Strangers”

In this study the aggressive responses directed by small groups of female mice towards virgin, pregnant, and lactating female strangers, which were individually introduced into their cages, were compared. The results obtained show that, except when lactating, pregnant females are neither attacked much more often nor any more severely than virgin mice. It is suggested that only the state of lactation favors the production of stimuli (olfactory) which release attack by female mice.     

美国SPIRIT干预模式研究及对我国的启示

预立医疗照护计划是保障患者医疗自主权、提高患者临终质量的重要举措,分享患者意愿以增强信任（sharing patient's illness representation to increase trust,SPIRIT）干预是美国预立医疗照护计划干预研究最成功的项目之一。通过系统综述SPIRIT干预的发展概况及特点,重点探讨了SPIRIT干预的优势与不足。研究发现,SPIRIT干预能够实现长时间的临床实践在于其形成了完整的干预体系。基于此,提出以社会文化背景为基础构建预立医疗照护计划干预体系,以全面且广泛的评估视角评价预立医疗照护计划干预体系,以持续质量改进为目标应用预立医疗照护计划干预体系。

     

重复异位妊娠的临床处理策略

为了探讨重复异位妊娠适宜的临床治疗方案,对2006年1月至2006年12月我科收治的251例异位妊娠中42例重复异位妊娠患者的资料进行回顾性分析,资料显示:重复异位妊娠的发病率为16.7%(42/251),平均发病年龄30.7岁,42例患者中异位妊娠部位与上次发生在同侧输卵管12例,对侧输卵管30例,两次异位妊娠发生间隔的时间最短为2个月,最长为9年,平均3.2年。其中10例为第3次异位妊娠。此次患病手术治疗25例,包括切除输卵管13例,保守性手术12例。因盆腔炎症和保守性手术是重复异位妊娠的危险因素,预防和彻底治疗盆腔炎症是降低重复异位妊娠发生的重要手段,采取保守性治疗或保守性手术时应慎重考虑其对患者将来生育和心理的影响。