By C. Lisk. Benedictine College.
A partial Horner’s syndrome (minor degree of ptosis and meiosis) propecia 1mg overnight delivery, transient or permanent order 1 mg propecia visa, may persist between attacks order propecia 1mg without prescription. If the condition is expected to last for a few weeks discount 5mg propecia, corticosteroids can be used. Treatment of an attack may involve oxygen (100%, 7-12 litres/minute: vasoconstrictive effect and reduces release of calcitonin gene-related peptide), sumatriptan (subcutaneous [6 mg] or nasal), zolmitriptan (nasal or oral), dihydroergotamine, nasal lidocaine, corticosteroids, and various other procedures, e. Percutaneous radiofrequency trigeminal rhizotomy may be useful for chronic intractable cluster headache. Also, stimulation of the occipital nerves with electrodes implanted in the suboccipital region may be useful for chronic intractable cases. A family history, aura, photophobia or phonophobia, nausea or vomiting will favour migraine. Of course there is nothing to stop someone with one of these headache types having, say, a tumour. Secondary (symptomatic) cluster headache can be due to many intracranial disorders, e. The diagnosis should be considered if there is no periodicity to the attacks, if there is some headache between attacks, if response to treatment is unsatisfactory, and if there are neurological signs (apart from miosis and ptosis). There may be a dull, tight or cramping sensation in the occiput or generally, building in severity until orgasm or abruptly starting with orgasm. Uncommonly, vascular complications may result from hypertension during intercourse (such as subarachnoid bleeding). Medications and illicit substances associated with sex-related headaches (examples) Amyl nitrate Phosphodiesterase-5 inhibitors Contraceptive pill Amiodarone Cannabis Amphetamines Cocaine The pregnant headache sufferer with acute migraine may initially try paracetamol followed by ibuprofen if inadequate relief ensues. Peri-menstrual exacerbation of migraine may respond to simple painkillers but may require triptans such as sumatriptan. The American expansion of treatment was 3141 paralleled by an increase in the number of stimulant prescriptions, leading to organised protest meetings. However, geography played a limited role in explaining variability, the main contribution coming from methodological factors: diagnostic criteria, information source, and requirement of impairment. Mcardle ea, (2002) in their study of children in Newcastle upon Tyne, concluded that while conduct disorder occurs against a background of family conflict and poor child-care, hyperactivity, by contributing to a pattern of confrontation-punishment, is sometimes complicated by disturbed social conduct. Hudziak ea (2005) reported that genetic analysis yielded a model that included genetic dominance (48%), additive genetic factors (30%), and unique environmental factors (22%). He lists other factors as cigarette or alcohol exposure, low birth weight, and psychosocial adversity. In normal development increased dimensions of right frontal and left occipital cortex emerge in the adult from the reversed pattern of cortical asymmetries in the child. There seem to be deficits in executive function related to spatial working memory but unrelated to age or symptoms. Although such girls may be less likely to have comorbid conduct disorder than such boys, the risk of psychiatric admission in adulthood is greatly increased by its presence. The Utah criteria (Wender, 1995; Ward ea, 1993) include inability to relax, dysphoria when inactive, restlessness, distractibility and non-completion of tasks, labile mood, impulsivity, transient temper outbursts, excessive or inappropriate reactions to mundane events, and problems in any life area. Similar doses have similar effects on cognition and behaviour in normal boys, hyperactive boys and healthy adults. Novartis circulated a warning in the same year to avoid stimulants in the presence of structural heart abnormalities or severe hypertension. Atomoxetine is excreted primarily as 4-hydroxyatomoxetine-O-glucuronide, mainly in the urine. Fluoxetine may help impulsiveness and aggression if the dose is increased very slowly. Lithium may be used for severe emotional lability or in cases with bipolar affective disorder. Bupropion carries a risk of seizures but does not interact with asthma medications. Behaviour therapy employing contingency principles based on learning theory is advocated although effects may not be sustained once therapy ceases and generalization of learning to new setting may not occur. The family might require assistance in changing communication patterns and improving functioning (Barkley ea, 1992) although gains are relatively modest. An autosomal dominant gene with incomplete but high penetrance is possible in some cases. Robertson ea (2008) observed 5 factors in symptom data from 410 cases: socially inappropriate behaviours and other complex vocal tics; complex motor tics; simple tics; compulsive behaviours; and touching self. Exacerbation of tics may follow stress, as when someone relaxes after work or school. Factors that may reduce their intensity include sexual arousal or preoccupation with emotionally neutral material. Some authors, however, believe that stimulant-induced tic exacerbation is unlikely. Most individuals with tics lead reasonably normal lives, and the tics tend to improve during the teens. Deep brain stimulation (electrodes placed in midline thalamus, nucleus accumbens, or globus pallidus interna) has been used for severe, intractable tics. Ackermans ea, 2008) Other treatment approaches include vocal cord injections of botulinum toxin (Porta ea, 2004) for vocal tics and coprolalia. The patient uses competing responses (such as isometric contraction of opposing musculature) when the urge to tic occurs. Although it has since been diagnosed in man, it was originally described in monkeys following bilateral temporal lobe destruction. Features include the examination of all available objects with the mouth, licking and biting, hypermetamorphosis (nothing ignored and constant exploration), always exploring), placidity, hyperphagia, and hypersexuality (including homosexuality and sexual intercourse with other species). There is psychic blindness (responds in a similar manner to an orange as to a charging bull - able to see but he is unable to meaningfully discriminate between objects). Again, parts of the syndrome may occur early in the course of frontotemporal dementia. Diogenes or Plyushkin’s syndrome3168 Diogenes syndrome is named for Diogenes of Sinope,(Wrigley & Cooney, 1992; O’Shea & Falvey, 1997; 3169 Cooney, 1997) a Greek cynic philosopher. Affected persons often refuse help from professionals and they collect all sorts of rubbish (syllogomania). About 50% have a formal psychiatric illness at the time of examination, but far fewer have been admitted to psychiatric care. The death of a close relative may be a precipitating factor in those with no psychiatric illness. Cole ea, 1992) Diogenes syndrome represents a dilemma for psychiatry and for society. Do we let patients live and squalor in case we infringe 3170 human rights (‘rotting with their rights on’)? The stables, unclean and housing many cattle, were cleaned by Heracles (Hercules) who achieved his task in a single day by rerouting rivers. A beggar who admired pverty and decried human achievements, he lived in an Athenian tub and ate onions. The key to diagnosis is the almost simultaneous development of roughly the same symptoms by a number of people inhabiting the same building. Gulf War syndrome (cognitive difficulties, fibromyalgia, depression, anxiety, respiratory problems and chronic fatigue) is not unique to that conflict. Ismail ea (2002) felt that psychiatric disorders did not fully explain self reports of ill health in people with Gulf War syndrome but there is no evidence that it is caused by neurological problems. Examples of the latter include improving ventilation systems and reducing any contaminant exposure. The patient may need counselling, medication, career guidance/change/retirement – or whatever is appropriate, keeping in mind the necessity of non-reinforcement. Humidifier fever is due to contamination of humidifying systems in air conditioners in factories and office blocks with bacteria, thermoactinomyces or amoebae. It may present with the symptoms of extrinsic allergic alveolitis: fever, cough, dyspnoea etc. The head is suddenly and unexpectedly jolted whilst the head moves freely, as when one car hits another from behind. Claims for persistent symptoms make up a large percentage of all personal injury claims. Are these people physically injured, psychologically traumatised, or ‘on the make’? In the Karlsborg ea (1997) series of 39 patients there are 6 cases of whiplash in females for every 4 cases in males.
For reasons best known to the journalists involved buy 1mg propecia fast delivery, none of them appear to have turned to sociologists or statisticians for an analysis of the survey results purchase propecia 5 mg. It was the journalists purchase propecia 5mg, inside and outside the medical press 5mg propecia for sale, either members or fellow travellers of the Campaign Against Health Fraud, who really put the boot in. They were at the ideological sharp end of publicising the report, and many of them did nothing at all to make palatable the bitter pill which the report was intended to be. Some, like James Le Fanu, a member of the Campaign Against Health Fraud, actually revelled in the results, writing an 24 opening paragraph in The Times, of which any orthodox doctor could have been proud. Apart from the various specialists and those whose partisan opinions defended vested interests, there were those who commented on the Bristol research from sheer vindictive 25 ignorance. Writing in the Observer, Richard Ingrams took the opportunity of his column to support the results of the Bristol survey. This he did without the slightest pretence that he knew anything about the subject. None of the major media reports drew attention to the fact that the big pharmaceutical companies back cancer research and there is a history of internecine struggle between these companies and the proponents of alternative cancer treatments. Nor did any journalists declare their own interests in the pharmaceutical or chemical industry. In the medical press such matters were not in contention because it is known that the majority of the media is subsidised by drug company advertising. For these reasons, it was hardly surprising to find the real ideological cutting edge of the 26 Bristol study articulated in the medical papers. The survey results might, the writer bemoaned, have driven cancer patients into the hands of much greater charlatans. The logic of this editorial is, like the study itself, deeply flawed; the insinuation, however, is clear. Those working at Bristol were charlatans but not extreme ones, the latest findings wreck the reputation of complementary cancer care. The mildness of the Bristol therapy was and still is attractive to patients with cancer. Now they are asked to believe that a vegan diet, the laying on of hands, relaxation classes and positive thinking are far from benign but indeed dangerous. This gives a golden opportunity to charlatans peddling more aggressive and more harmful "cures". It was not the results of the survey which angered Tobias nor even the charlatans in alternative medicine, it was the attitude of the Bristol workers. Why had they not immediately conceded defeat and admitted that their work was of no value? Such statements contain the classic signs of criminalisation, when even to speak critically of orthodoxy earns punitive condemnation. In the last part of his full-page article, Dr Tobias claims that conventional doctors have been happily flexible about the treatments they have handed out, willing to change their practices when they do not suit the patient, asserting as Baum frequently does that only orthodox doctors really care about their patients. It was so explicit one wonders why she went to the trouble of writing the article beneath it. This review never once questioned the statistical basis of the Lancet paper and used completely inappropriate words to describe the study. The writers of the report were asked by different journalists to illustrate and amplify it. This they did with an endless series of quotes which showed they had no doubts at all about their own abilities or the validity of the results. There was to be much speculation in the coming months as to what part Professor Tim McElwain had actually played in the disaster of the post-press conference publicity. For a start of the 334 so-called breast cancer patients of the Bristol Centre studied, no fewer than 112 attended for one day only. Although the critical riposte to the publication of the interim results actually began immediately, its effect was slow. The response was uncoordinated and perhaps more important, it lacked the popularist brevity and media-speak which the results themselves had conjured up. Critical responses were couched with caution in the language of statistics or sociological methodology, some were conservative enough to confound the understanding of lay observers. It staggered as if from a knock-out blow, reeled and appeared to have serious doubts about rejoining the fight. It could have been the case that the attack opened up wounds of self-doubt, subconscious uncertainties about the academic standing of the work which was taking place at Bristol. Working on the periphery in any field is hard, working on the periphery in a field where the opposition can accuse you of bringing about the death of cancer patients demands superhuman stoicism. All the vast resources of the media disappear when people try to propound theories about such things as marginalised religions, fringe politics, animal liberation or alternative medicine. Within a day of the press conference, Professor Karol Sikora, a long-time friend of Bristol and a leading London oncologist, had marshalled a statement critical of the study and faxed it to Bristol. Secondly, there seems to be some discrepancy between the Cox model coefficient (0. Given the forces which were ranged against them and the multiplicity of their vested interests, this was a fatal mistake. Their opponents had a history of street fighting, and had set themselves the task of destroying the Bristol Cancer Help Centre. The letter hinted at the basic faults with the research, from a methodological and statistical point of view. Sheard did articulate one of the most most fundamental criticisms of the Bristol sample — that it was composed of people who had attended the Centre, but had often stayed no longer than a day and had not returned for treatment. By September 18th, ten days after the press conference, there was the first glimmer of public criticism of the paper. Dr Jean Monro and Hospital Doctor magazine were both being quoted in the national press. This letter appeared in the issue of September 22nd: it fleshed out in some detail the general methodological and statistical errors in the original Chilvers paper. With her more combative approach, Dr Monro appeared to see something which other experts failed to see. As long as the experts slugged it out in a scientific ghetto, the vested interests would inevitably win because they had already made a massive public exhibition of their results. With this in mind, Dr Monro and Dr Payne contacted the papers when their letter 35 was due to appear in the Lancet. Monro and Payne were also the first to make it publicly clear that the Bristol sample had all been treated primarily with orthodox medicine. Breast cancer before age 55 usually has a worse prognosis, 38 and to ignore the difference in age distribution is not acceptable. Like was not compared with like, and there was a difficulty in attributing the worse outcome of Bristol cases to any aspect of the Bristol therapy. The Bristol cases included those who had not actually taken up any therapy and the paper made no comment on the numbers that had actually continued with the therapy or advice offered by Bristol. The letter concluded with the statement that a meeting of the British Sociological Association regretted that the interim findings had been published when they had. This damning letter, signed by 54 qualified peers of the authors of the study itself, should have been sufficient for the authors to make a public apology and withdraw the paper. It appeared, however, like the rest of the criticism which was surfacing, to have little effect. The editorial in the Hospital Doctor on 13th September by Stephen Pinn was one of the most ideologically combative statements issued in response to the Lancet paper. Instead of nit-picking with statistics, Pinn came right out and said it — the paper was a fraud. In an article that argued for the Bristol therapy, he laid bare the issues behind the paper. That includes drugs used to treat cancer, most of which have not been proved to save lives but which sometimes cause terrible side effects. The media response to the Lancet paper showed the press up for what it all too often is, the messenger for vested interests. It would be diplomatic, no doubt, to say that many journalists do not understand that they are writing for vested interests. A number of the journalists who wrote about the Bristol Cancer Help Centre were not innocents but parties to the attack. Some had previously had contact with the Campaign Against Health Fraud and were active members of the Medical Journalists Association, or had contact with the Media Resources Service at the Ciba Foundation.
Demonstrations of specimens purchase propecia 1mg on line, photographs purchase 5mg propecia, and slides of both dead bodies and living people 5mg propecia amex. Demonstrations of specimens propecia 5 mg with visa, photographs, and slides of both dead bodies and living people. Types of mechanical asphyxia- hanging, ligature strangulation and manual strangulation – general and type characteristics, manner of death. Other types of mechanical asphyxia - drowning, airway obstruction, postural asphyxia, asphyxia due to exhaustion or displacement of environmental oxygen. Medicolegal autopsy in cases of traumatic injuries, postmortem changes, diagnosis of death. Introduction and preparing a specific Forensic Medical Expert Examination for a particular case. Practical introduction of the methods of chemical examination of biological materials. Basics of legal proceedings in Forensic Medicine in the Republic of Bulgaria (Penal Procedure Code and Code of Civil Practice). Blunt force trauma – definition, types, mechanism of causation, morphological characteristics of the injuries. Abrasions – definition, mechanism of causation, morphological characteristics, medicolegal importance. Bruises – definition, mechanism of causation, morphological characteristics, medicolegal importance. Lacerations - definition, mechanism of causation, morphological characteristics, medicolegal importance. Motor vehicle trauma – definition, classification, major issues concerning Forensic Medical Expert Examinations. Common morphological characteristics in cases of death caused by mechanical asphyxia-postmortem appearances. Airway obstruction, postural asphyxia, asphyxia due to exhaustion or displacement of environmental oxygen. Major issues of Forensic Medical Expert Examination in cases of mechanical asphyxias. Major issues concerning Forensic Medical Expert Examination in cases of electrical injuries and lightning stroke. The impairment of health and death caused by the effect of chemical agents (Forensic Toxicology). Medium bodily injury - legal and medical criteria (article 129 from Criminal Code) 31. Severe bodily injury - legal and medical criteria (article 128 from Criminal Code) 32. Fornication (act for the purpose of arousing or satisfying sexual desire, without copulation - articles 149 and 150 from Criminal Code). Homosexual acts (sexual intercourse or acts of sexual satisfaction with a person of the same sex - article 157 from Criminal Code). Rape (sexual intercourse with a person of the female sex - 329 article 152 from Criminal Code). Short summary for different types of examination- genetic and serological methods. Forensic Medical Expert Examination of dead body in cases of sudden natural death. Early postmortem changes –changes in the skin, changes in the eye, livor mortis, algor mortis and rigor mortis. Application of medical methods for diagnosis and treatment leading to a temporary change in consciousness. Score assessment Participation in seminars, weekly tests, essay preparation and presentation Semester exam: Yes / written and oral examination State Exam Yes Lecturer Full Professor from the Department of Epidemiology Department: Epidemiology and medicine of disastrous events. Methodology and methods of epidemiology of infectious diseases and their application in the study of massive, socially significant diseases. Epidemiologic characteristics, prevention, surveillance and control of infectious diseases. Teoretical and practical training in the field of epidemiology as a essential medical discipline. Knowledge about the mode of transmition and distribution of infectious diseases and the system of measures for prevention and control them. Knowledge of basic epidemiological characteristics of chronic mass non communicable diseases and their prevention and control. Knowledge of basic epidemiologic characteristics of non communicable diseases with massive infectious etiology and their prevention and control. Skills such as physicians to participate in solving practical problems limiting, reducing economic and social losses, elimination and eradication of infectious diseases. Theoretical knowledge about the epidemiologic features characteristic of mass non communicable diseases with such infectious etiology. Technical means and methods - autoclave, desinfection chamber - evaluation effienciency of prevention and control. Practical skills: - To make the epidemiologic history of different infectious diseases. Subject, theory and methods of epidemiology of infectious diseases and epidemiology of mass non-infectious diseases. Definition, the aim, the main tasks of epidemiology of infectious diseases and epidemiology of mass non-infectious diseases. Theory of epidemiology of infectious diseases: theory of epidemic process, epidemiologic aspects of infectious process, epidemiologic aspects of epizootic process, socio – ecosystemic dependency of diseases, molecular-genetic processes in microbial populations. Methods of epidemiology: descriptive-evalutional, observation, experimental, analysis and synthesis, molecular-genetic, molecular-biologic. Source of infection: definition of source of infection and a reservoir, a animal reservoirs, non animal reservoirs. Transmission of infectious diseases: direct and indirect contact, air born, fecal oral, blood, vector-borne transmission, derma, factors for transmition. Human behavior among family members among family members, school, work, different groups etc. Natural factors of epidemic process : geographic-climatic-meteorological and cosmic influences depending the place and time. Non infectious diseases: environmental factors, social factors, life-style related factors, iatrogenic factors. Criteria for elimination and eradication: economic considerations , social and political. Epidemiology of air born infections: Diphtheria, Scarlet fever, Meningococcial infection, Pertussis. Definition, Etiology- antigens and resistance in environment , Incubation period, Entry site, Dischrage site, Contagious index, Source of infection, Mode of transmission, Immunity after disease,Characteristics of epidemiological process: Lethality, Seasonal features, Age, Morbidity. Definition, Etiology- antigens and resistance in environment , Incubation period, Entry site, Dischrage site, Contagious index, Source of infection, Mechanism of transmission, Immunity after disease, Characteristics of epidemiological process: Lethality, Seasonal features, Age, Morbidity. Definition, Etiology- antigens and resistance in environment , Incubation period, Entry site, Dischrage site, Contagious index, Source of infection, Mechanism of transmission, Immunity after disease,Characteristics of epidemiological process: Lethality, Season, Age, Morbidity. Definition, Etiology- antigens and resistance in environment , Incubation period, Entry site, Dischrage site, Contagious index, Source of infection, Mechanism of transmission, 340 Immunity after disease,Characteristics of epidemiological process: Lethality, Seasonal features, Age, Morbidity. Definition, Etiology- antigens and resistance in environment , Incubation period, Entry site, Dischrage site, Contagious index, Source of infection, Mechanism of transmission, Immunity after disease,Characteristics of epidemiological process: Lethality, Seasonal features, Age, Morbidity. Definition, Etiology- antigens and resistance in environment , Incubation period, Entry site, Dischrage site, Contagious index, Source of infection, Mechanism of transmission, Immunity after disease,Characteristics of epidemiologic process: Lethality, Seasonal features Age, Morbidity. Epidemiology of tick borne infections: Congo-Crimean fever, Q – rickettsiosis, Mediterranean Spotted fever, Lyme disease. Definition, Etiology- antigens and resistance in environment , Incubation period, Entry site, Dischrage site, Contagious index, Source of infection, Mechanism of transmission, Immunity after disease,Characteristics of epidemiological process: Lethality, Seasonal features, Age, Morbidity. Definition, Etiology- antigens and resistance in environment , Incubation period, Entry site, Dischrage site, Contagious index, Source of infection, Mechanism of transmission, Immunity after disease,Characteristics of epidemiological process: Lethality, Seasonal features, Age, Morbidity. Normative documents to HealthCare Ministry –notification,Note Book for registration of infectious sicks and Note Book of contacts of sicks. Prove about careerness-indications,mode to collect samples,storage and transport of materials for laboratory examination.
Shakespeare tries to steer a middle course between the polarities of denial of the limita- tions of very severe disability propecia 1 mg line, on the one hand purchase 5 mg propecia fast delivery, or else fearful pity and dread about very severe disability cheap propecia 1mg with mastercard, on the other buy propecia 1 mg. Attempts to analyse maternal–fetal relations and prenatal decisions are trapped in another powerfully dismissive demarcation: pro-life versus pro- choice. Yet decisions about a greatly desired though impaired pregnancy illuminate the complications in right-to-life arguments versus women’s actual right to choose freely when they want neither available option – neither a severely impaired child nor an abortion. Ramazanoglu (1989) argues that feminist research is a matter of examining and holding together contradictions instead of futile attempts to ignore or resolve them superWcially, and this links to concepts of ‘maternal holding on’ watching and waiting (Ruddick, 1990) in contrast to ‘masculinist’ decisive rapid intervention which prenatal counselling tends to facilitate. Prenatal counselling and images of disability 201 Research with disabled people During a European project (see Acknowledgements) researchers investigated the views on prenatal screening of physicians, midwives, pregnant women, the general public, experts and reports in the mass media and professional journals. The Wrst, through general questions about their family and friends, education and work, problems, enjoyments and aims, built up a picture of interviewees’ views on the quality and value, and the possible suVering and costly dependence of their lives. As reviews of Medline and other website data-sets show, the medical literature on these conditions is mainly drawn from medical records and research about associated pathology, and from quantitative psychologi- cal surveys of anxiety, depression, intelligence and quality of life. In contrast, we used qualitative methods, a less formal interview style, and open questions asking for detailed replies; we looked for variety instead of measuring common factors. We contacted small groups of people through informal networks in order, we hoped, to avoid seeming perhaps intimidat- ingly professional, and to stress that we saw them as persons rather than patients. Everyone was sent a leaXet before they agreed to take part about the topics we would raise, and about their rights: to consent or refuse; to withdraw or withhold information; and to maintain conWdentiality. We were worried at Wrst about whether we should risk asking questions that might be painfully probing, but we were soon reassured by the responses; almost everyone talked calmly and frankly as if they were used to discussing issues such as screening for their condition. The 50 interviewees Cystic Sickle Spina Down’s Conditions Thalassaemia Wbrosis cell biWda syndrome Interviewees 10 10 10 5 5 Men 5 2 6 1 4 W om e n Age range 26–39 17–30 21–33 18–33 20–43 Median age 33 24 29 26 30 Mainstream school 10 9. This worked very well, as the previous discussion had helped to order and clarify their views, and the sheets gave them some editorial control over how we would use their views. In contrast to mainstream medical and psychological traditions, our ap- proach, methods and language yield diVerent and, we would argue, more realistic insights into the daily lives of people with serious congenital condi- tions. Among the people with Down’s syndrome, for example, one helped to run a youth club, one taught on courses about empowerment, assertion and safer sex for people with learning diYculties and was an artist, and two were actors who shared in creating plays about disability and genetics. Qualitative research such as this study cannot produce measurable, generalizable Wndings about the abilities and experiences of these Wve groups of people. Yet the study can challenge general assumptions, by showing how these interviewees did not Wt the negative images propounded in the prenatal medical literature. I was worried when he showed me into the family living room where his sister and girlfriend were already sitting, as I expected that their presence would inhibit him. I avoid the standard research practice of asking families to regroup to allow for a private interview, partly because their decisions and family dynamics are such useful data and partly because I would assert a potentially inhibiting power balance. During the interview he spoke about his shorter life expectancy, and when the young women objected he said that they always avoided the subject, but he wanted to talk about it with them. Like other interviewees he tried to make his employment record at least as good as that of his colleagues, to prevent his condition being used as an excuse to dismiss him. Like many of the interviewees, when asked about his hopes and aims, Tim spoke freely about being a partner and becoming a parent, spontaneously raising these issues and relieving me of the worry that I might upset or embarrass him by introducing them. Jane was delighted to return to work and to caring fully for her family after her recent heart transplant, but others were frustrated at not being able to Wnd suitable work. Having returned to live with her parents, she would ‘like to be able to do things more spontaneously, have more energy, spend less time with my parents and have more self-identity, be stronger and more conWdent’. Jenny said that she would love to be married and have children but felt that no one would want to take on the responsibility of caring for her and that she was not strong enough to have a child. It has stopped me from making plans and getting on with my life, like going to university or doing things which might be boring for a few years but lead on to something better’. Asked what he might want to change about himself, again like some of the others Rob replied, ‘I’m happy with my character, I’m very happy with what’s happening in my life at the moment’, and he was more keen to talk about how to change society. For example, one man with Down’s syndrome described being pushed and shoved in the street by his neighbours, and another was fed up with being Prenatal counselling and images of disability 205 treated by new work colleagues as if he were stupid, though he added, ‘They learn in the end, and then they realize that are the ones who look silly’. Their conditions did not appear to dominate their lives in most cases, and much time was spent talking about the many things they had in common with their ‘ordinary’ peers: work or unemployment, income, housing, relationships, leisure activities and ambitions. The other more disabled people with spina biWda included a young single mother who was also a college student, and Richard and Vivian who both used wheelchairs. He enjoyed going to city clubs with friends, and could haul himself in his chair up and down stairs, so he used underground trains despite oYcials trying to stop him. He said that when he joined mainstream secondary school, the wheelchair users were all taught mobility and coping with stairs and pave- ment kerbs, which helped him to become very Wt. You do feel low and in pain and angry with people and it is important to have friends and to go out for a drink’, and she talked enthusiastically about her many interests. Vivian was planning to have a baby and she talked of her mixed feelings about taking folic acid to reduce the risk of the baby having spina biWda, yet ‘being proud that I have spina biWda’ because it had given her such experience, knowledge and opportunities she would not otherwise have had. They also tended to say that they would respect any decision made by prospective parents after being properly informed, whether to continue or end a pregnancy aVected by their condition, though they hoped the pregnancy would continue and some had mixed feelings. For example, two men with Down’s syn- drome, who had been talking intently about their acting, suddenly looked very sad when asked about screening, and said they did not want to talk about it, as if the subject was too painful. However, the interviewees had far more similarities than diVerences, including the ways they reXected on their lives, and their belief that they suVered from the general stigma of disability more than from their actual condition. This raises questions about why the prenatal literature, policy makers and counsellors make so little mention of the potential range of each condi- tion from mild to severe, of the increasingly eVective treatments which Jenny mentioned, and of the possibility that some therapeutic abortions may prevent potentially rewarding lives. A further complication for prenatal predictions is the mismatch, shown particularly by the people with spina biWda, between the degree of severity of physical disability and the way people value and enjoy their lives. Prenatal counselling and images of disability 207 The implications of the interviews for prenatal counselling and maternal–fetal relations The overall impression given by the interviewees was of very interesting, thoughtful and pleasant people. Most of them appeared to value and enjoy their lives, sometimes despite pain and serious illness, as much as any average group of 40 young adults might say they do. One man with sickle cell anaemia was in such pain that his interview took place over three separate visits, but this was because he was so keen to take part. Their friends appeared to value them, and so did their families, with one exception as might be expected in any group of 40 adults (her mother had died and her father had remarried). Most interviewees had far more in common with their ‘ordinary’ peers than diVerences, and none showed any clear reason why their life would have been better prevented. Even allowing for the artiWcial nature of the research interview, and the way our methods partly shape the evidence, as is inevitable in every type of research, the interviewees provide compelling evidence for questioning the assumptions on which prenatal policies and counselling are based – that it is reasonable to prevent such lives. The interviewees challenge the view that it is kinder to terminate any aVected pregnancy, however mildly the fetus might be aVected, because life is so awful for the severest cases. Repeatedly, interviewees spoke of the crucial importance to them of being involved in mainstream society – schools and colleges, homes and jobs, clubs and pubs and friendships. They tended to stress their need to see beyond their condition as a personal predicament, and to press for greater inclusion by challenging negative attitudes in society, and by showing how they could be involved. They were grateful to parents who encouraged them to be strong and who, as one woman with Down’s syndrome said of her mother, were ready to ‘Wght for my rights [even through] the High Court, the High Court of Justice! Some of them helped to train medical students, and they criticized inaccurate medical images of disability, such as the sickly child advertisements that raise funds for medical research. Richard was referring to a theme that ran through the interviews – of adaptation, ingenuity and a resilience that grows through accepting and surmounting diYculties. This is in contrast to prenatal screening policies which propose eVorts to prevent and avoid diYculties, as if human beings cannot or should not have to experience them, and as if disability is not inevitable for most human beings, at least at the beginning and end of life. The interviewees quoted earlier suggest that this approach is unrealistic, because ordinary people’s lives so often involve problems – such as with relationships, loss, frustrating limitations or poverty. Fearful avoidance of disability, rather than promoting ways to support disabled people’s lives, is liable to diminish people rather than freeing them into new achievement and conWdence. The diYculty in these criteria is the current limitations in predicting how severe an impairment might be or might become, how much it may be ameliorated by social or medical support, and how the aVected person and family may experience similar diYculties either as hardship and suVering or as part of a worthwhile rewarding life. Some parents value their Prenatal counselling and images of disability 209 child’s very short life far more than no life at all (Delight and Goodall, 1990). Unawareness may include unawareness of suVering, which would obviate the criterion of suVering, and uncertainty again prevails over the diagnosis and prognosis of unawareness. Children who have been dismissed as ‘vegetables’ are perceived by others to experience profound feelings, such as by the researcher who commented, ‘Cabbages do not cry’ (Oswin, 1971).