Day 1 :
Keynote Forum
Hrvoje Lalic
Health Centre Rijeka and Medical Faculty University Rijeka, Croatia
Keynote: The key role of occupational medicine specialist as an expert witness in national and international law suites
Biography:
Hrvoje Lalic has completed his Medical degree at University of Rijeka in 1983 and worked as the General Practitioner in the Health Center Rijeka for ten years.He did Specialization in Occupational Medicine in Zagreb, Croatia, in internationally famous School “Andrija Štampar” that is under the WHO patronage and partially in Bologna, Italy at “Policlinic S´Orsola Malpighi, OM school for specialization. Currently, he is working at the Department of OM Medicine Rijeka as a specialist in Occupational Medicine and Sports Medicine and Regular Professor of OM at Medical School University of Rijeka, Croatia. In 2018, he received the permanent title of Regular Professor
Abstract:
The occupational medicine specialist has a key role in assessment of one’s capacity to work, as well as their incapacity,
temporary or permanent. This assessment is a very responsible task and there is always an unsatisfied party, the patient
or the authorities, as well as the lawyers. The aim of this paper is to demonstrate the importance of the expert witnesses’
complete neutrality. They have to assess the patient’s work capacity completely objectively and in doing so have to cancel
out their emotions and the potential uncomfortable feeling whilst confronting the team of experts representing Croatian
Institute for Health or Pension Insurance. Here are presented four cases of expert witnessing where unsatisfied patients
pressed charges against the Croatian Institute for Pension Insurance. The first is the case of a person with dual nationality
Bosnian and Herzegovinian and Croatian, resident of Austria, who sued Croatian Institute for not being granted pension
for the disabled. The second is a 37 years old woman, a shop assistant who suffers from lumbar disc hernia and claim she
cannot lift weight in the grocery shop. The third is the case of a 27 years old woman who has no forearm and two toes on
each foot but was proclaimed capable of independent living. The fourth is the case of a fashion tailor who suffers from
a severe case of epidermolysis bullosa hereditaria, she states she is fighting for her life, but was proclaimed capable of
working. They too sued the authorities. In the first two cases the expert witness for occupational medicine decided that
the Croatian Institute made a correct decision and the last two cases were won by the patients. Such law battles are fought
daily and courts are overburdened by them. On one side the patients (the claimants) are too subjective and think that
their state is the heaviest and on the other side the Croatian Institute for Pension and Health Insurance with very limited
means, is laden with applications for the pension for the disabled. However, the limited means must not be the reason for
a truly ill disabled person who cannot work anymore, not to be able to retire. On the other side those who can still work or would like to gain undeserved benefits, must be refused their applications. Incomplete medical examinations are another frequent cause for such claims being rejected by the Croatian Pension and Health Institute. To conclude, the occupational medicine specialist as an expert witness successfully solves all the unclear cases of work in/capacity. The occupational medicine experts should be included in Croatian Institute for Pension teams in order to avoid unnecessary court expense and to adequately assess the patients.
Keynote Forum
Anna Tompa
Semmelweis University Department of Public Health, Hungary
Keynote: Cytogenetic and immunotoxic effects caused by occupational formaldehyde exposure among pathologists and their assistances
Biography:
Anna Tompa has completed her PhD at Semmelweis University, Budapest. She was the Head of the Department of Public Health Institute and National Institute of Chemical Safety, a premier research organization. She has published more than 135 papers in reputed journals and has been serving as an Editorial Board Member of several repute Hungarian and international journals. Currently, she is the Research Director at Semmelweis University Department of Public Health and Professor Emeritus.
Abstract:
Formaldehyde (FA) is a widely used chemical, what is classified by IARC, as a human carcinogen based on several sufficient scientific evidences. Several studies concluded FA is mutagenic and genotoxic in different experimental settings and also cause cancer to human during long term occupational exposure. In our study we have examined 73 individuals (59 women and 14 men) worked for the pathology department in different hospitals as a pathologist or
histological assistants. FA ambient air concentration level was measured in only in one unit of four, what was ranged from
0.4 mg/m3 to 1.1 mg/m3, with a mean formaldehyde level of 0.9 mg/m3. The average exposure time varied between 12-20 yrs. Blood samples were collected by venipuncture. The donors took part in a routine clinical laboratory check-up and were interviewed by a physician to take up an anamnesis data sheet on age, medication, smoking, drinking habits, medical and working histories. The end-points of the genotoxicology monitor included the determination of the frequencies of chromosome aberrations (CA) and sister-chromatid exchanges (SCE), and the measurement of UV-induced unscheduled DNA repair synthesis (UDS). The percentages of premature centromere separation (PCD) and high-frequency SCEs
(HF/SCE) were also scored. Apoptosis, immune-phenotype and cell proliferation parameters were determined by flow cytometry. The average age of exposed donors was 43 yrs, compared to 146 (34 years old) historical controls and 86 industrial controls (34 yrs old). In the exposed groups the results showed elevation in chromosomal aberrations, DNA repair and SCE value, although the apoptotic rate of peripheral blood lymphocytes was decreased especially among men, after in vitro PHA stimulation of PBL cells. Immuno toxic effect of FA was also demonstrated and immune suppression
varied on cytotoxic T cells and NK cells in different rate of exposed groups. In our study demonstrated the early genotoxic and immuno toxic effect on different occupationally FA exposed groups, giving an evidence for intervention and improve the working conditions. Based on our study we are going on to force the Hungarian hospital managements to replace theFA with other less harmful fixative in pathology units.
Keynote Forum
Hazem Gallagher-Alagha
University of Glasgow, Scotland
Keynote: Are the outcomes of health surveillance predictive of development of new cases of hand arm vibration syndrome?
Biography:
Hazem Gallagher-Alagha has completed his Membership of the Faculty of Occupational Medicne at the Royal College of Physicians of London in 2015. He is the Head of the Department of Occupational Medicine in Qatar Airways Clinic in Doha. He is an Honorary Clinical Lecturer at the University of Glasgow.
Abstract:
This study aimed to establish whether the results of repeat Health Surveillance (HS) for Hand Arm Vibration Syndrome (HAVS) are predictive of the development of new cases and the progression of existing cases of HAVS amongst exposed employees. A secondary objective is to evaluate the effectiveness of control measures for Hand Transmitted Vibration (HTV) exposure. The study describes and analyses trends of HS scores over 10 years. The use of previous HS records allows for the retrospective analysis trends of annual HS results and scores. The aim of this presentation is to demonstrate
that the number of new cases of HAVS in the exposed population declined sharply between 2003 and 2007 and continued to decline, albeit it at a lesser rate between 2007 and 2012, Using HS scores as a linear function of time, the results suggest that scores consistently decreased over time and that the influence of time on the scores was highly significant in all cases.Annual HS for HAVS is, to an extent, predictive of the development of new cases and the progression of existing ones amongst exposed employees. Furthermore, it can be demonstrated that control measures are relatively effective for Hand
Transmitted Vibration exposure.
Keynote Forum
Victor Songmene
University of Quebec, Montreal, Canada
Keynote: Progress on fine and ultrafine particles emision, dispersion and control during machining: Cases of metals, composite, woods and granite
Biography:
Victor Songmene has obtained his PhD from École Polytechnique de Montréal, Canada, in 2001. He has been with the Industrial Research and Development Institute (IRDI), Toronto, Canada, from 1995 -2001. He is currently a Full Professor at University of Quebec, École de Technologie Supérieure (ÉTS), Montréal, Canada. Since joining the university he has put his expertise on developping sustainable and safe machining practices for industry. His expertise includes metal cutting, fine and nanoparticle control, optimisation and environmentally conscious manufacturing. He is the Director of the Product, Processes and Systems Engineering Laboratory (P2SEL). He has published more than 150 papers in reputed journals and has produced more than 50 technical reports for North American industries
Abstract:
Machining is necessary to shape parts but it is also an important source of pollution (such as dust and aerosols) and this constitutes hazards for machine-tools operators. The emission of dust and the overall shop floor air quality are of great concern when shaping dusty materials such as granite (containing silica) but also woods products, composites materials and metals. In recent times, the occupational health and safety regulations have become more severe. To quickly comply with new regulations, engineers and researchers must help industries in developing strategies to limit workers risk
of exposure to these hazards. This keynote presentation will addres progress on fine and ultrafine particle emission during machining and polishing of granite, metals, woods and composites. The focus will be on OHS aspects but also on the effects of machining conditions on machining shop floor air quality and means of reducing at the sources of these hazards without sacrifying the productivity and the machined part quality.
Keynote Forum
Rosa Maria Orriols
Bellvitge university hospital, Spain
Keynote: Evaluation methodology of medical safety device
Biography:
Rosa M. Orriols, PhD, received her BSChE from Barcelona University in Barcelona, Ph.D. from Suffolk University in Boston and her Master from the Universitat Politecnica Catalunya in Barcelona. Currently, she is Director of Occupational Hygienist Health Safety in Hospital Universitari Bellvitge Institut Catala de la Salut the main health institution in Spain. Her research and work focus on preventing harmful exposures and creating healthy environments at work. She is on Board on International Commission Occupational Health (ICOH) from WHO. She also Profesor in Master of Occupational Health at Deusto University. Previous, Rosa was Technical Officer Occupational Health and Safety in National Occupational Safety and Health (INSHT) at the Spanish Government.
Abstract:
evaluating safety medical devices. We chose to do the presentation in two parts: Technical report on Needle stick and cutting material in ICS. Territorial Program to monitor the SMD. The First part was developed with a multidisciplinary team from different hospitals and primary care from Institut Català de la Salut. The Methodology was published in NTP 875 Biological risk: methodology for the evaluation of sharp and cutting equipments with built-in biosafety devices. Spanish Government and WHO Manual on Selection and Evaluation Medical Safety Device.
Results: 61 products have been evaluated, 11 wasn’t accepted, 13 past only the first phase, 12 Not guaranteed safety in
the event of human error and safety in the event of foreseeable misuse, is partially guaranteed; 21 was in the category of
very good, and 4 safety medical device guaranteed the safety user during all life product. In the analysis of all material
use in Institut Català de la Salut 40’63 % was needlestick; 14, 53 % was scalpel, any was in safety medical device category.
32, 29 % was catheter and 12, 90 % was in safety medical device category; any trocar (5,21 % material) was in the safety
medical device; 4,17% of all material was lancets, and 50% was safety medical device. Syringes with needles was 3,13% ,
any syringes was in safety medical device category.
Keynote Forum
Marian Gugushvili
David Tvildiani Medical University, Gerogia
Keynote: Risk factors of functional hyperandrogenesis: Case control study
Biography:
Abstract:
- Occupational Health and Risk Management | Occupational Public Health | Occupational Health and Industrial Hygiene | Occupational Health and Mental Health | Occupational Health Psychology and Work Environment
Location: Sylt 1-2
Session Introduction
Marian Gugushvili
David Tvildiani Medical University, Gerogia
Title: Risk factors of functional hyperandrogenesis: Case control study
Biography:
Mariam Gugushvili has experience of working since 5 year up to present working in Medical corporation Evex as Medical doctor in obstetrics and gynaecology department. 2015 up to present-working in David Tvildian medical university as assistant in Obstetrics and Gynaecologic department. 2015 up to present visiting Lecturer in David Tvildiani Medical University –Anatomy and pathology subjects. In 2018 she become a member of The European MD/PhD Association, in 2018 she Become a board member and Georgian representative in EUROPAG. she was working on this subject “hirsutism in Georgian population “with professor Besarion Tkeshelashvili for 2016 year. Research gives us more information how to make management of patients who has functional hirsutism, nowadays she is working on her PhD program
Abstract:
Objective: The purpose of this study was to establish risk-factors of functional hyperandrogenism (FH) in ethnically Georgian adolescents with polycystic ovary syndrome (PCOS). Material and Methods: 286 female adolescents (14-20 years) randomly selected for case-control study. Anthropometric measurements including waist, height, weight and body mass index were evaluated. Transabdominal ovary ultrasonography was performed for all subjects in days 7-14 of menstrual cycle. Blood fasting samples were collected
to measure serum levels of free testosterone, total testosterone, DHEA-S, androstenedione, 17-hydroxyprogesterone, FSH, LH, SHBG, prolactine, cortisol, TSH. PCOS was defined by the diagnostic criteria of Androgen Excess and PCOS Society. Following risk factors were studied: sleep disorder (late bedtime habits or night deprivation or short
sleeping time); rare meal intake habits (<3) and/or breakfast skipping; sugar-rich and/or protein-lack diet.
Case group: n=71 adolescents with PCOS, corresponding control group - n=215. For the evaluation of quality of life standard questionnaire EQ-5D-5L created by the EuroQol Group has been used.
Results: From sleep disorders sleep deprivation in PCOS adolescents was revealed more frequently than in controls (44,79% vs. 39.01%; OR=1.2679, 95%CI – 1.0632 to 1.5120, p=0.0082). Same association was in case of rare eating habits or skipping breakfast – odds ratio for this factor is higher in case group vs. controls (43,04% vs. 38.49%; OR=1.2079, 95%CI – 1.0122 to 1.4415, p=0.0362).
Our results revealed a significant difference for sugar-rich/protein-lack diet between PCOS adolescents vs. controls (57,25% vs. 50.47%; OR=1.3139, 95%CI – 1.0123 to 1.5661, p=0.0023). The value of quality of life in investigated PCOS (76.66 ± 12.73) (77.75 ± 11.79) group was significantly
lower than in control group (87.02 ± 12.03).
Conclusion: Stress conditions such as sleep disorders, reduced frequency rate of meal intake and/or breakfast skipping,sugar-rich and/or protein-lack diet is accompanied by the development of an FH and PCOS.
Shayesteh Jahanfar
Central Michigan University, USA
Title: Age of menarche heritability and birth weight
Biography:
Shayesteh Jahanfar is a Reproductive Epidemiologist with grounding in public health and biostatistics. Her research focuses on reproductive health, women
and children health and genetic versus environment studies. She has worked with a number of twin studies in Australia, Iran, Malaysia and Canada. She has
conducted several epidemiological studies and produced over 15 systematic reviews in the areas of HIV/AIDS, domestic violence, family planning, ultrasound screening and breast-feeding. She is an International Cochrane Trainer who has conducted over 20 Cochrane workshops/webinar series on standard author training and trained over 400 clinicians and scientists. She has over 60 peer-reviewed publications including Nature Perinatology, Fertility & Sterility, Cochrane Library and Journal of Fetal and Maternal Medicine. She is currently working towards conducting several twin studies, a randomized controlled trial and a longitudinal study all related to reproductive health and reproductive behavior at national and international levels. She is interested to work with interested students and researchers for potential collaboration.
Abstract:
Background: Genetic and environmental factors both influence on age of menarche. However, it is not clear how much of intra-uterine environmental factors particularly sex discordance and birth weight affects the onset of
menarche.
Method: To investigate the genetic and environmental contributions to the association between birth weights with onset of menarche, we studied twins registered at State Washington Twin Registry. A group of female-female
monozygotic (n=994, 497 pairs), female-female dizygotic (n=296, 148 pairs) and females from opposite sex twin sets (n=168) replied to a reproductive health questionnaire. The primary goal of this study was to use a modern
maximum likelihood quantitative genetic method to estimate the heritability (h(2)) of age at menarche. The second goal was to study the role of sex discordance and birth weight on onset of menarche.
Result: After adjusting for birthweight, the monozygotic correlation for age of menarche (0.59) was about 4.21 times the dizygotic correlation (0.14). Birth weight was positively associated with age of menarche (r=0.07, p<0.01) but
not sex discordant.
Conclusion: Age of menarche is genetically determined. From the potential intra-uterine environmental factors, birth weight seems to be related to age of menarche but not sex discordance.
Masahiro Onuma
President of Trisguide ltd, Japan
Title: Electronic water can reduce oxidative stress in PCOS patients for 3 weeks drinking
Biography:
Masahiro Onuma has expertise in oxidative disease prevention to use non-medical product based on GSK’s experience of Allopurinol which is the strongest antioxidant efficacy in this world. He creates new indication of Allopurinol for stomatitis induced by cancer treatment which was approved by the Japanese Cancer treatment committee to propose new mechanism of Allopurinol for anti-oxidant. And now, there are so many new research papers of Allopurinol in the world.
Abstract:
Oxidative stress means a state there is imbalance between the oxidizing action and the reducing action due to reactive oxygen species (ROS) in a living body, resulting in the oxidizing action becoming dominant. Oxidative stress arises as the balance between production and removal is disrupted through excessive production of ROS and impairment of the antioxidant system. Oxidative stress has been reported to be involved in the onset and progress of various diseases. Characteristics of Type 2 diabetes are insulin secretion failure and insulin resistance, but it seems that oxidative stress is greatly involved in insulin secretion failure. Oxidative stress (OS) has received extensive attention in the last two decades, because of the discovery that abnormal oxidation status was related to patients with chronic diseases, such as diabetes, cardiovascular, polycystic ovary syndrome (PCOS), cancer, and neurological diseases. OS is considered as a potential inducing factor in the pathogenesis of PCOS, which is one of the most common complex endocrine disorders and a leading cause of female infertility, affecting 4%–12% of women in the world, as OS has close interactions with PCOS characteristics, just as insulin resistance (IR), hyperandrogenemia, and chronic inflammation. Electronic water, which was developed to generate electron in water, was consumed for three weeks, after meals, between meals and before sleeping 6 times a day, and according to the test subjects' possible time periods. The amount of drinking water was 750-1000 mL, and BAP and d-ROMs checks for all cases were carried out at 4:30 pm. The results of cancer patients and diabetes patients were seen as attached. As a result, the d-ROMs value in the degree of oxidative stress has reduced, and the BAP value, which is an indicator of plasma antioxidant capacity, has improved significantly.
Shayesteh Jahanfar
Central Michigan University, USA
Title: Age of menarche, heritability and birth weight
Biography:
Shayesteh Jahanfar is a Reproductive Epidemiologist with grounding in public health and biostatistics. Her research focuses on reproductive health, women
and children health and genetic versus environment studies. She has worked with a number of twin studies in Australia, Iran, Malaysia and Canada. She has
conducted several epidemiological studies and produced over 15 systematic reviews in the areas of HIV/AIDS, domestic violence, family planning, ultrasound screening and breast-feeding. She is an International Cochrane Trainer who has conducted over 20 Cochrane workshops/webinar series on standard author training and trained over 400 clinicians and scientists. She has over 60 peer-reviewed publications including Nature Perinatology, Fertility & Sterility, Cochrane Library and Journal of Fetal and Maternal Medicine. She is currently working towards conducting several twin studies, a randomized controlled trial and a longitudinal study all related to reproductive health and reproductive behavior at national and international levels. She is interested to work with interested students and researchers for potential collaboration.
Abstract:
Background: Genetic and environmental factors both influence on age of menarche. However, it is not clear how much of intra-uterine environmental factors particularly sex discordance and birth weight affects the onset of
menarche.
Method: To investigate the genetic and environmental contributions to the association between birth weights with onset of menarche, we studied twins registered at State Washington Twin Registry. A group of female-female
monozygotic (n=994, 497 pairs), female-female dizygotic (n=296, 148 pairs) and females from opposite sex twin sets (n=168) replied to a reproductive health questionnaire. The primary goal of this study was to use a modern
maximum likelihood quantitative genetic method to estimate the heritability (h(2)) of age at menarche. The second goal was to study the role of sex discordance and birth weight on onset of menarche.
Result: After adjusting for birthweight, the monozygotic correlation for age of menarche (0.59) was about 4.21 times
the dizygotic correlation (0.14). Birth weight was positively associated with age of menarche (r=0.07, p<0.01) but
not sex discordant.
Conclusion: Age of menarche is genetically determined. From the potential intra-uterine environmental factors, birth weight seems to be related to age of menarche but not sex discordance
Maria do Carmo Baracho de Alencar
Federal University of Sao Paulo, Brazil
Title: The suffering of nutrition attendants of a public hospital affected by RSI/WRMSD
Biography:
Maria do Carmo Baracho de Alencar has completed her PhD at Federal University of Santa Catarina, Brazil. She is the Associated Professor and Member of Health, Education and Society Department, Institute of Health and Society of the Federal University of Sao Paulo (UNIFESP), Brazil.
Abstract:
The aim of this study was to understand the relationship between aspects of the work organization and the health of nutrition workers affected by RSI/WRMSD. Throughout the process, absenteeism statistics related to RSI/WRMSD were obtained from a Public Hospital in Porto Alegre/Brazil, from 06/01/2015 to 06/30/2016, and a section of such hospital was selected for further study. A selection of the food distribution section and its nutrition attendants for the research occurred because of having a high absenteeism level related to the sickness of RSI/WRMSD. A structured questionnaire with sociodemographic and professional data and the Self-Reporting Questionnaire (SRQ-20) were used to investigate the prevalence of common mental disorders (CMD), and collective interviews were conducted with nutrition attendants affected by RSI/WRMSD, recorded and transcribed for content analyses, and using the theoretical reference of the work psychodynamics. Participated in the questionnaires and SRQ-20 application 113 nutrition attendants, most of the female gender (97.3%) and 74.3% aged above 40 years and 48.6% with a common mental disorder (CMD). The low back pain was the most common body region affected (62.8%), among others. Results include the collective interviews a total of 19 nutrition attendants participated in eight meetings. Qualitative results obtained pointed to ways of organizing and managing work which included excessive pressure, moral harassment and lack of recognition, generating suffering and influencing the processes of illness
Biography:
Rebecca Purc-Stephenson is an Associate Professor of Psychology in the Augustana Faculty at the University of Alberta. She has completed her Graduation at the University of Windsor from the Applied Social Psychology program. She maintains an active research program, and her research interests include health, illness, work and access to services for the socially disadvantaged. Her most recently funded research program examines how individuals with a physically disability find and maintain stable employment. She has published over 20 papers in scholarly journals, presented over 30 papers at national or international conferences, and serves as an Editorial Board Member for one academic journal.
Abstract:
Disclosing a disability to an employer is usually necessary to receive workplace accommodations. However, many employees consider disclosure a risky action that could result in lowered supervisor expectations, fewer
promotional opportunities, segregation from co-workers, and increased likelihood of termination. Much of the existing research exploring the reasons for disclosure focus on employee characteristics and/or their relationship
with their supervisor. Recent research shows that several employer practices, ranging from having accessible physical environments to including a message of disability inclusiveness on the organization’s website, may be important
cues that an organization is “disability friendly” and therefore encourage disability disclosure. The purpose of this study was to determine what employer practices or workplace characteristics contribute to a “disability-friendly” organizational culture, and how this relates to employee disclosure decisions. Using survey methodology, data were collected from a convenience sample of 350 employees to develop a new 25 item assessment tool, called the Inclusive Workplace Survey (IWS), that measures the perceived disability inclusiveness of an organization. A second sample of 128 employees with physical disabilities was collected to test the new survey and hierarchical regression was used to determine what factors predict disability disclosure. In addition to employee health status, the strongest predictors of disability disclosure were having control and flexibility at work, feeling supported by co-workers and supervisor, and working in a visibly diverse workplace. This presentation will describe the new IWS tool and summarize the relationship between employer practices, organizational culture, and disability-disclosure decisions. Understanding how employees make decisions about disclosure in the workplace may inform organizational policies, practices and programs to improve the experiences of individuals living with a disability.
Emmanouella Chatzidaki
Institute of Molecular Biotechnology, Vienna, Austria
Title: Ovulation suppression prevents the increase in egg aneuploidy with maternal age
Biography:
Dr. Emmanouella Chatzidaki has completed his PhD at the age of 26 years from the Univeristy of Cambridge, UK and postdoctoral studies from Karolinska Isntitute, Sweden
Abstract:
The frequency of egg aneuploidy and trisomic pregnancies increases with maternal age. Since multiple causes contribute to egg aneuploidy, it is likely challenging to prevent the “maternal age effect” using a single approach. To test our hypothesis that ovulations contribute to oocyte ageing and chromosome missegregation, we used genetics, hormonal contraception and successive pregnancies to reduce ovulations. We observed that ovulation reduction is sufficient to prevent egg aneuploidy and age associated errors during meiosis I division of the oocyte, in aged mice. By interrupting ovulations with successive pregnancies, we discovered that eggs from aged mated females display lower aneuploidy and reduced precociously separated sister centromeres compared to those from aged virgin females. When putting mice on hormonal contraception we find a near 2 fold reduction in aneuploidy incidence. To reduce ovulations further, we generated Gpr54 knockout mice, which remain in a pre-pubescent state. Remarkably, aneuploidy is reduced 3-fold in eggs from Gpr54-/- versus Gpr54+/+ aged females. These data suggest protection is due to reduced ovulations. We further observed that ovulations contribute to loss of Rec8-cohesin, which is essential for sister chromatid cohesion in meiosis. Single-nucleus Hi-C revealed a deterioration of 3D chromatin organization that depends on ovulation frequency and Rec8, which restricts loops extrusion. We conclude that ovulation suppression leads to retention of Rec8, which maintains chromatin structure and promotes chromosome segregation and production of euploid eggs. Our work implies that hormonal contraception can reduce the risk of Down’s syndrome pregnancies at advanced maternal age.
Marlee Madora
Montefiore Medical Center, USA
Title: Peripartum ethical considerations in a pregnant psychotic patient
Biography:
Marlee Madora completed her medical degree at Sidney Kimmel Medical College of Thomas Jefferson University. She is a second year resident in psychiatry at Montefiore Medical Center and is particularly interested in womens mental health. Rachel Noone completed her medical degree at Penn State University and is a graduate of Montefiore Medical Center’s Psychiatry Residency. She specializes in the treatment of patients with serious mental illness and works at the Inpatient Psychiatry Unit at Montefiore Wakefield Campus.
Abstract:
CM is a 41yo G2P1 domiciled in supportive housing with supraventricular tachycardia, chlamydia and chronic severe schizoaffective disorder who presented to the hospital during her second trimester with worsening psychosis. She expressed the delusion that the father of her child was a celebrity who was not giving her money for food. She was involuntarily hospitalized for decompensated psychosis and refused antipsychotics due to paranoia. She was taken to court for treatment over objection and was court ordered for treatment with olanzapine. Despite receiving a maximum daily dose of olanzapine, the patient continued to be paranoid, delusional, isolative and unable to care for herself throughout her entire pregnancy. She had a C-section at term, and was subsequently monitored on the cardiology unit for tachycardia. After medical stabilization, she was transferred back to psychiatry for management of persistent psychosis. Child Protective Services (CPS) was called and the baby was remanded due to the patient’s severe psychosis with inability to care for herself or the child. The patient then requested to visit her child and breastfeed while her baby was in the neonatal intensive care unit for respiratory issues. Using a relational ethics framework, the multidisciplinary team decided that the risk of disrupting the mother’s psychiatric treatment, exposing her to psychological harm due to increasing attachment before remanding the child, and risk to child due to potential unpredictable dangerous behavior driven by psychosis outweighed the benefits of visitation and breastfeeding in this challenging clinical case.