Current practices regarding newborn intracranial haemorrhage and obstetrical care and mode of delivery of pregnant haemophilia carriers: a survey of obstetricians, neonatologists and haematologists in the United States, on behalf of the National Hemophilia Foundation's Medical and Scientific Advisory Council.

We undertook this survey to determine institutional practices of obstetricians, neonatologists and haematologists regarding care of pregnant haemophilia carriers and newborns with haemophilia and intracranial haemorrhage (ICH). Our purpose was also to determine whether institutions had written guidelines to manage such patients. Questionnaires were sent to 1000 obstetricians and through the Haemophilia Treatment Centres (HTC) to 180 paediatric haematologists and 180 neonatologists, each representing an institution. Twenty-three per cent of obstetricians, 22% of neonatologists and 16% of paediatric haematologists returned completed surveys. Over 94% of the respondents had no written guidelines for management of pregnant haemophilia carriers or their newborns or for neurologic assessment of newborns. For known haemophilia carriers, 57% of the obstetricians routinely preferred vaginal delivery and 11% preferred caesarean section. Availability of perinatal services influenced prenatal management (P < 0.05). In term newborns with documented ICH, only 23% of neonatologists would evaluate for haemophilia, whereas in pre-term newborns with ICH, this number dropped even further to 3%. For all newborns with haemophilia, 40% preferred routine administration of clotting factor concentrates (CFC) immediately following birth to offset the trauma of delivery and 89% of paediatric haematologists favoured early prophylaxis with CFC. Guidelines are needed for management of pregnant haemophilia carriers as well as newborns with haemophilia. Physicians need to be made aware that ICH may be a presenting sign of haemophilia in both term as well as pre-term newborns, so that appropriate therapy can be instituted early in the event of a bleed.

Rewards and incentives for nonsalaried clinical faculty who teach medical students.

We surveyed the clerkship administrators of pediatrics, family medicine, and internal medicine at U.S. medical schools, and of pediatrics at Canadian medical schools to determine what rewards and incentives are being offered to nonsalaried faculty for office-based teaching. Monetary payment was offered by 13% to 22% of the programs. Nonmonetary rewards like educational opportunities were offered by 70% to 89%; academic appointments by 90% to 95%; special recognition events by 62% to 79%; and appreciation letters by 74% to 84% of programs. Only 3 of 338 responders offered no rewards or incentives.

Biosocial variances and infant survival: a path analysis approach.

This study used path analysis to assess the chances of survival of babies in a neonatal intensive care unit in Lansing, Michigan, USA. Two paths to neonatal survival were identified and the variables accounted for 20% of the variance in gestational age. The first path showed that prior infant losses were negatively correlated with gestational age while in the second path, gestational age showed negative relationships with pre-pregnancy weight and household job worries.

Physicians' preferences for adoption, abortion, and keeping a child among adolescents.

PIP: January-March 1985 data from 118 physicians practicing in 2 US midwestern states were analyzed to determine their preferences for adolescents who must make decisions about their pregnancies. They limited the pregnancy outcomes to abortion, adoption, and keeping a child. Overall, physicians ranked adoption as the preferred option in all 3 vignettes. Age did not affect their preferences greatly. They were more likely to rank adoption as their 1st preference when the fictional circumstances included a 15-year old girl (gestation age 6 weeks), uninformed parents, child's father not revealed, no desire to contact the father, not ready for parenthood, and wants to have the child adopted. General practitioners ranked abortion 1st followed by adoption and keeping the child. Family practitioners, obstetrician- gynecologists, and pediatricians ranked adoption 1st then abortion and keeping the child. Yet most pregnant 15-19 year old adolescents (93% in 1982) keep their children. This disjunction between physicians' preferences and patients' actual choices indicated that the physicians counseling was not effective in affecting adolescents' choices. Other research with adolescent mothers showed that most mothers did not seriously think about putting their children up for adoption at any time during their pregnancies. They tend to make a decision on what to do with the child either before pregnancy or very early in pregnancy. So adolescent mothers may not take physician advice for adoption seriously. They also tend to be more concerned about powerful sources of influence including the adolescent's mother, her partner, her future plans, or other goals for herself and her child than considering the physicians' advice. Due to the apparent limited influence physicians have on adolescent patients, they should provide them with counseling on prenatal care and parenting.^ieng

Sex in transition, 1900-1980.

Changes in the proportion of college-aged males and females participating in coital relationships are analyzed through a review of 35 studies conducted between 1903 and 1980. Two major trends are apparent: there has been a major increase in the proportion of young people reporting intercourse, and the proportion of females reporting coital involvement has increased more rapidly than the proportion of males, although the initial base for males is greater. Prior to 1970, about twice as many college men as women reported having had intercourse; since 1970, the proportions of men and women reporting coital involvement are nearly equal. These changes are seen as supportive of major shifts in the standards governing sexual behavior from the double standard to the single standard of permissiveness with affection [Reiss, I. F. (1967).The Social Context of Premarital Sexual Permissiveness, Rinehart and Winston, New York] to the current standard of intercourse being appropriate in love relationships (without the requirement of progression toward marriage) and permissible in causal relationships without exploitation.

Medical practice and genetics in the mid-Michigan area.

In this report the authors provide information on the knowledge of and attitudes on genetics of allopathic and osteopathic physicians of the Mid-Michigan area. The type of degree (M.D. or D.O.) made no difference with respect to physicians' knowledge of genetics, while their specialty and year of graduation from medical school each had a significant impact on the physicians' genetic performance. Although there are important differences by specialty area, the average score on a multiple-choice genetic knowledge test was approximately 50 percent correct. Respondents were more likely to indicate a lack of knowledge than to choose an incorrect answer, but the overall level of knowledge was low. Ninety-two percent of the respondents stated that their present knowledge was inadequate and preferred continuing medical education courses and case-related conferences to increase their knowledge.

Talking about sex revisited.

Friends and others are told of 1st intercourse under different conditions. The conditions under which 1st intercourse is reported are related to the scripts which govern the transition from virgin to nonvirgin. This study compares the reporting of 1st intercourse by a group of college students in 1976 with that for a group studied in 1967. The earlier analysis found dramatic gender differences in reporting that interacted with the timing of 1st intercourse and relationship with the 1st partner, suggesting different scripts for men and women. Analysis of the current data suggests a simpler model in which males and females behave in similar ways, and in which only relationship with the partner influences the speed of reporting. The present study suggests that males and females now share a single script and a single standard of behavior for 1st intercourse.

Nutrition and social correlates in iron deficiency anemia.

This study was designed to ascertain some nutrition and nutrition related social factors in the environment of the child with anemia. In this study, it was found that the child with iron deficiency anemia consumed less iron per kilogram per day, drank more milk, was less likely to have been given supplemental iron, was introduced to strained foods at an older age, and had a greater number of siblings. The mother was more likely to be separated or divorced, view the child as having more feeding problems and be an inappropriate weight for age, have somewhat different expectations of his ability to perform certain tasks, and be, in general, less satisfied with the child. The family group spent less per capita on food and cared for the child in the home more of the time. A better understanding of these factors, important in the development of iron deficiency anemia, may eventually lead to amelioration of the problem.

Nutrición, desarrollo y comportamiento social

EL PRESENTE VOLUMEN CONTIENEN LAS ACTAS RESUMIDAS DE LA CONFERENCIA SOBRE LA EVALUACION DE LAS PRUEBAS DEL COMPORTAMIENTO DERIVADAS DE ESTUDIOS SOBRE NUTRICION EN EL HEMISFERIO OCCIDENTAL, CELEBRADA EN MAYAGUEZ, PUERTO RICO, DEL 20 AL 23 DE OCTUBRE DE 1970. LA CONFERENCIA SE ORIENTO HACIA A LOS PROBLEMAS METODOLOGICOS DE LOS ESTUDIOS PRACTICOS SOBRE NUTRICION Y DESARROLLO MENTAL, LAS CARACTERISTICAS SOCIALES DE LA DESNUTRICION QUE A SU VEZ REPERCUTEN EN EL DESARROLLO INTELECTUAL Y LA POSIBLE RELACION ENTRE LA DESNUTRICION Y EL DESARROLLO SOCIAL O LA COMPETENCIA FUNCIONAL