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By B. Ivan. Villanova University.

Subjects nary syndrome to see their effectiveness in relation to conventional who answered a questionnaire about sexual activity at start point cardiac programs (8–12 weeks) of longer duration rabeprazole 20mg discount diet gastritis adalah. Information on socio- an acute coronary syndrome discount rabeprazole 10 mg on-line gastritis from ibuprofen, referred to a cardiac rehabilitation demographic characteristics and cardiac function obtained at start program between 2009 and 2014 cheap 20 mg rabeprazole visa gastritis symptoms vs gallbladder. The data was ana- 6 sessions of physical training and assistance to health education lyzed through Independent t-test to compare between the groups order rabeprazole 10 mg online gastritis diet . Material and Methods: A one-day Car- Thomas1 diac Rehabilitation Awareness Workshop was held in Hospital 1 Rehabilitasi Cheras on the 8/6/2015. Cardiac rehabili- such as indications for cardiac rehabilitation, benefts of exercise, tation enrollment data were available in 303 patients. However, not many factors, comorbidity index, self-reported medical status, perceived understood the components of healthy diet and energy conser- health patient and patient health questionnaire score were recorded. Results: Eighty three per cent of responders re- Rehabilitation Awareness Workshop may be used as a tool to in- ported a musculoskeletal disorder at the time of hospital discharge. More focus should be given on healthy diet was reported to limit the ability to do moderate exercise in 57% of the and energy conservation techniques to healthcare providers espe- patients. Abdul Latif 1University Malaya, Rehabilitation Medicine- Faculty of Medicine, dysfunction and strong predictors for mortality of cardiovascular disease. Material and Methods: In a prospec- sess the autonomic response to graded physiological stress. There was no signif- J Rehabil Med Suppl 55 Poster Abstracts 183 icant difference with regards to mortality or major adverse cardiac nal chest wall might provide autonomy and greater compliance. Conclusion: This cardiac rehabilitation program proved to compared safety and effcacy of a mechanical chest percussor de- be effective in improving patient’s exercise capacity. There Department of Rehabilitation Medicine, The Second Affliated Hos- were no signifcant difference in adverse events and majority of pital of Chongqing Medical University, Chongqing, China patients were willing to use the device by themselves. A random effects analysis was applied on account element of care for people with cystic fbrosis. There was no techniques, physical exercise and inhalation therapy are part of evidence of signifcant publication bias (Begg’s p=0. Our objective was to evaluate the effciency of aerobic exercises combined with airway clearance techniques. Material and Meth- tation Centre Hospital, Jakarta, Indonesia ods: 34 individuals with kyphotic posture (20 individuals without respiratory problems and 14 individuals with respiratory problems) Introduction/Background: Chronic obstructive pulmonary disease who has the average of 49. Many factors contribute to the reduction of functional tion tests, the datas recorded prior to kinesiologic taping, after and exercise capacity and balance impairment. The obtained datas were compared to appropriate of physical activity, lower extremity muscle weakness and inspira- statistical analysis. Results: When pulmonary function parameters tory muscle weakness have been associated with both problems. So, that obtained prior to kinesiologic taping and after kinesiologic tap- purpose this study To analyse the relationship between functional ing are compared with the parameters that obtained after a week, in exercise capacity and balance. Pearson’s nesiologic taping that applied on thoracic spine with functional cor- correlations examined relationships between functional exercise rection taping method in individuals with kyphotic posture reduces capacity and balance. There were negative correlations between predicted problems and in individuals with respiratory problems. Conclusion: There is a signifcant relation- ship between functional exercise capacity and balance. Material and Methods: A retrospec- ability such as mobility in bed and in sitting were limited. Physical therapy intervention may improve the mobility months pulmonary rehabilitation program between Jan to Jun 2015. Tambunan1 1 634 Faculty of Medicine, Physical Medicine and Rehabilitation De- partment of Dr. Results: A to- mum expiratory and inspiratory pressure, mobility of the diaphragm tal of 12 patients, mean age of 53 years with a female predomi- and diaphragmatic thickness were evaluated by ultrasound. Urodynamic studies have revealed abnormalities in 8 tory pressure, diaphragm thickness rate, and mobility increased by patients. Inappropriate used of antibiotic in the treatment admitted to our clinic complaining of drop foot for two weeks. Also, he complaint This study was to determine the common pathogen associated with the nausea and vomiting in this time. Material and Methods: This retrospective the sprain of him right foot two weeks ago. After this injury, he observational study was conducted from Sep 2012 to Sep 2014. How- cal examination, they were determined that minimal steppage gait, ever patient with other concurrent infection has been excluded. The weakness of the right foot and toe dorsifexors, and paresthesia of target sample size calculated using was 63 subjects. The fnal sample size was 22 in the tibialis anterior and extensor digitorum brevis and gastrocne- patients. The high- and electroneuromyographic fndings were consistent with a right est isolated bacteria in these patient were E. Gynecology Department and pelvic foor muscle exercise training This study showed our practice in antibiotic usage concordance to at the Rehabilitation Medicine outpatient clinic in the frst visit. The pelvic foor muscle endurance after 6 weeks biofeedback method of pelvic foor muscle exercise between Network, Rehabilitation Medicine, Liverpool, United Kingdom groups were the same and not signifcantly different (10 second, Introduction/Background: Urinary tract infections are a common p=0. Conclusion: Biofeedback method of pelvic foor muscle problem in rehabilitation units as many patients have impaired exercise for 6 weeks can improve pelvic foor muscle endurance in mobility, neurologically conditions, catheterised and constipated. Circumferential measurements were performed 639 from specifc anatomic landmarks before and after the treatment (wrist, mid forearm, elbow, mid upper arm, axilla). Each participant underwent physi- life by reducing pain and sensation of heaviness. J Rehabil Med Suppl 55 Poster Abstracts 187 641 quent metastatic sites include the pleura, brain, and skin. The aim of this study was to evaluate the these impairments and their effect on the life quality. Material and Meth- 1Baskent University, Physical Medicine and Rehabilitation, Adana, ods: The study included 100 patients (age:55±10. Patients were screened and examined for the presence of upper extremity Introduction/Background: In this study, it was aimed to determine impairments such as motion restrictions, lymphedema, pain, numb- whether there is a correlation between the serum level of vitamin D ness and loss of strength. Lymphedema was noted as in three stages and lymphedema in patients with malignancy. Fifty-fve patients had moder- affected and unaffected extremities, the volumetric differences be- ate to severe upper extremity lymphedema. Weight gain after the tween affected and unaffected extremities, range of motion and mo- disease was common and forty-six patients were obese. It was evaluated the correlations patients reported moderate-severe deconditioning. Beck Depression Scale scores showed that 59 one patient had endometrial carcinoma. Only, seven patients tients had stage 1 lymphedema while fve patients had stage 2, the did not report fatigue. There was low statistically in patients with moderate to severe fatigue or lymphedema. Also, low level of this vitamin can be precipitate the pain and decreased of the quality of life. Doruk Analan1 Introduction/Background: Etiologies of traumatic, compressive, 1Baskent University, Physical Medicine and Rehabilitation, Adana, ischemic, neoplastic, or idiopathic etiologies may cause sciatica. Turkey Most common cause of sciatica is spinal disc herniation pressing on the lumbar or sacral nerve roots.

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As primary roots are resorbed it is often preferable to leave small fragments in situ if the root fractures purchase 10mg rabeprazole otc gastritis chronic diarrhea. Blind investigation of primary sockets should not be performed as there is a danger of damaging the underlying permanent successor cheap rabeprazole 10 mg with mastercard gastritis kronis adalah. Similarly discount rabeprazole 20 mg fast delivery gastritis migraine, blind investigation of the distal root socket of first permanent molar teeth must not be carried out in children with unerupted second molars cheap rabeprazole 10mg on-line gastritis diet , as unintentional elevation of the second molar can occur. Problems peculiar to the child patient A number of problems peculiar to the child patient will affect the way in which extractions are carried out. The following should be considered: (1) natal and neonatal teeth; (2) infraocclusion of teeth; (3) fusion/gemination of two teeth; (4) damage to the permanent successor; (5) dislocation of the mandible. Elevators are usually employed, with or without tooth division and bone removal, to effect extraction. This is because the articular eminence is not as pronounced in young patients as in adults. It is essential to verify that dislocation has not occurred before the patient is allowed to regain consciousness. When removing teeth from the lower right the right- handed operator stands behind the patient with the chair as low as possible to allow good vision. Once again, lower right teeth are removed from behind, with all others being extracted by the operator standing in front of the patient. It does save time during general anaesthesia if teeth can be removed ambidextrously as all teeth can be extracted with the operator standing in front of the patient. The removal of primary teeth with the non-dominant hand is not difficult to master and is a useful skill to acquire. It provides resistance to the extraction force on the mandible to prevent dislocation. Order of extraction When performing multiple extractions in all quadrants of the mouth (especially if under general anaesthesia) the order of extraction is as follows: 1. Lower teeth are extracted before upper teeth (to eliminate bleeding interfering with the surgical field). If there are symptomatic teeth in all quadrants right-handed operators should begin with lower right extractions. This minimizes the number of changes of position of the surgeon, which will reduce general anaesthetic time. In older children some additional buccal expansion may be required for the removal of the permanent upper canine. When removing primary upper anteriors, upper primary anterior or upper primary root forceps are used; for the permanent maxillary anteriors upper straight forceps are employed. Malpositioned permanent upper anteriors are frequently encountered and modifications to technique must be employed. Labially placed upper lateral incisors and canines have very little buccal support and are easily removed, either by using straight forceps applied mesially and distally and using a slight rotatory movement as described earlier or by the use of elevators. The most useful elevators under these circumstances are the straight and curved Warwick James and Couplands. The straight elevators are applied along the length of the mesial and distal surfaces of the root and directed in a rotatory manner towards the apex (Fig. The mesiobuccal and distobuccal surfaces are used alternately, although in many instances the tooth will be elevated after application to only one of these surfaces. When the curved Warwick James elevators are used, the right-sided Warwick James is positioned on the mesiobuccal surface of upper right teeth and the distobuccal surface of upper left teeth, and then rotated towards the mid-line of the tooth. The left-sided instrument is used on the opposite root surface in a similar fashion. Palatally positioned lateral incisors and canines are usually not accessible with forceps and thus elevators are used as described above, with the exception that they are applied on the palatomesial and palatodistal surfaces. When the curved elevators are used the right-sided instrument is applied distally on the right side and mesially on the left side. The initial movement after application of the forceps is palatal, to expand the socket in this direction. The tooth is then subjected to a continuous bucally directed force, which results in delivery. Occasionally, buccal movement is not adequately obtained due to gross caries on the palatal aspect causing slippage of the forceps beak on the palatal side during buccal expansion. This may be overcome by completing the extraction by continued palatal expansion, the elastic bone of younger patients allowing this to be performed. The upper second premolar is often single rooted and, although buccal expansion with premolar forceps should be attempted in the first instance, this tooth can also be subjected to a rotation about its long axis to effect delivery. The use of elevators in a manner similar to that described for palatally placed canines is preferred. Following application of the forceps to the roots of the tooth (the pointed beak being driven towards the buccal root bifurcation) the tooth is delivered by expanding the socket in a buccal direction. The use of palatal expansion is not as successful in the removal of permanent molars, but it may be worth attempting if buccal expansion fails to deliver the tooth. The problem with palatal expansion when extracting permanent molars is that it can cause fracture of the palatal root, which is usually the most closely associated with the maxillary antrum. The most effective method of removal is to apply lower root forceps and expand the socket labially. Permanent lower canines may be delivered by a rotatory movement about the long axis or by buccal expansion. Labially displaced lower canines are removed in a manner similar to that described for buccally placed upper anteriors. The position of lingually placed lower anteriors normally precludes the use of forceps and straight elevators applied mesially and distally should be employed. They can be extracted using either lower primary molar or lower primary root forceps. Lower primary root forceps are used by applying the beaks to the mesial root of the primary molar. Lower first primary molars are usually more easily removed with lower primary root forceps. After application of the forceps a small lingual movement is followed by a continuous buccal force, which delivers the tooth. Malpositioned lower second premolars are normally lingually positioned and can be difficult to remove with lower forceps. When lingually placed, lower premolars may be extracted using straight elevators applied mesially, lingually, and distally. Alternatively, it is often possible to apply the beaks of upper fine root forceps mesially and distally to the crown of the lingually placed tooth when the forceps are directed from the opposite side of the jaw. The lower molar forceps have two pointed beaks that are applied in the region of the bifurcation buccally and lingually. Once applied the forceps are used to move the tooth in a buccal direction to expand the buccal cortical plate. When buccal expansion is not sufficient to deliver the tooth then the forceps should be moved in a figure-of-eight fashion to expand the socket lingually as well as buccally, and this is generally successful. The points are applied to the bifurcation of the lower molar in a manner identical to that described above. The next movement is to squeeze the forceps handles together, which results in the beaks approaching one another at the base of the bifurcation. The only way the beaks can approach each other is by displacing the tooth in an occlusal direction resulting in extraction of the tooth.

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You can see this starting with the symmetrical distribu- tion containing the scores 1 purchase rabeprazole 10 mg with mastercard gastritis symptoms in spanish, 2 quality 20mg rabeprazole acute gastritis symptoms uk, 2 discount 20mg rabeprazole with visa gastritis diet oatmeal, 2 generic rabeprazole 10 mg mastercard gastritis emedicine, and 3. As this illustrates, although the mean is always at the mathematical center, in a skewed distribution, that center is not where most of the scores are located. In both graphs, the mean is pulled toward the extreme tail and is not where most scores are located. The mode is toward the side away from the extreme tail and so the distri- bution is not centered here either. Thus, of the three measures, the median most accu- rately reflects the central tendency—the overall address—of a skewed distribution. It is for the above reasons that the government uses the median to summarize such skewed distributions as yearly income or the price of houses. But a relatively small number of corporate executives, movie stars, professional athletes, and the like make millions! However, this is misleading because most people do not earn at or near this higher figure. In sum, the first step in summarizing data is to compute a measure of central tendency to describe the score around which the distribution tends to be located. High scores scores Deviations Around the Mean 69 Most often the data in behavioral research are summarized using the mean. This is because most often we measure variables using interval or ratio scores and most often with such scores, “mother nature” produces a reasonably normal distribution. Because the mean is used so extensively, we will delve further into its characteristics and uses in the following sections. The simplest transformation is to add, sub- tract, multiply, or divide each score by a constant. If we add a constant 1K2 to each raw score in a sample, the new mean of the trans- formed scores will equal the old mean of the raw scores plus K. In essence, using a con- stant merely changes the location of each score on the variable by K points, so we also move the “address” of the distribution by the same amount. The mean is the center score because it is just as far from the scores above it as it is from the scores below it. That is, the total distance that some scores lie above the mean equals the total distance that other scores lie below the mean. The distance separating a score from the mean is called the score’s deviation, indi- cating the amount the score “deviates” from the mean. A score’s deviation is equal to the score minus the mean, or in symbols: The formula for computing a score’s deviation is X – X Thus, if the sample mean is 47, a score of 50 deviates by 13, because 50 2 47 is 1 3. Thus, you can see that a posi- tive deviation indicates that the raw score is larger than the mean and graphed to the right of the mean. A negative deviation indicates that the score is less than the mean and graphed to the left of the mean. The size of the deviation (regardless of its sign) in- dicates the distance the raw score lies from the mean: the larger the deviation, the farther into the tail the score is from the mean. If we add together all of the positive deviations we have the total distance that some scores are above the mean. Adding all of the negative deviations, we have the total distance that other scores are below the mean. If we add all of the positive and negative deviations together, we have what is called the sum of the deviations around the mean. Thus, the mean is the center of a distribution because, in total, it is an equal distance form the scores above and below it. Therefore, the half of the distribution that is below the mean balances with the half of the distribution that is above the mean. The sum of the deviations around the mean always equals zero, regardless of the shape of the distribution. For example, in the skewed sample of 4, 5, 7 and 20, the mean is 9, which produces deviations of 25, 24, 22, and 111, respectively. Some of the formulas you will see in later chapters involve something similar to computing the sum of the deviations around the mean. The statistical code for finding the sum of the deviations around the mean is Σ1X 2 X2. The Σ indicates to then find the sum The mean is subtracted from each score, of the deviations. Therefore, we think of the mean as the typical score be- cause it more or less describes everyone’s score, with the same amounts of more and less. Using the Mean to Predict Scores Recall that a goal of behavioral science is to predict a behavior in a particular situation. When we don’t know anything else, the mean is our best prediction about the score that any individual ob- tains. Because it is the central, typical score, we act as if all the scores were the mean score, and so we predict that score every time. This is why, if the class average on an exam is 80, you would predict that each student’s grade is 80. Further, for any students who were absent, you’d predict that they will score an 80 as well. Likewise, if your friend has a B average in college, you would predict that he or she received a B in every course. However, not every score in a sample will equal the mean, so our predictions will sometimes be wrong. To measure the amount of our error when predicting unknown scores, we measure how well we can predict the known scores in our data. The amount of error in any single prediction is the difference between what someone actually gets 1X2 and what we predict he or she gets 1X2. We’ve seen that this is called a deviation, but alter your perspective here: In this context, a de- viation is the amount of error we have when we predict the mean as someone’s score. If we determine the amount of error in every prediction, our total error is equal to the sum of the deviations. Thus, by predicting the mean score every time, the errors in our predictions will, over the long run, cancel out to equal zero. One student scored the 70, but we would predict he scored 80, so we would be wrong by 210. But, another student scored the 90; by predicting an 80 for her, we would be off by 110. In the same way, our errors for the sample will cancel out so that the total error is zero. Likewise, we assume that other participants will behave similarly to those in our sample, so that using the mean to predict any unknown scores should also result in a total error of zero. If we predict any score other than the mean, the total error will be greater than zero. A total error of zero means that, over the long run, we overestimate by the same amount that we underestimate. A basic rule of statistics is that if we can’t perfectly describe every score, then the next best thing is to have our errors balance out. One hits 1 foot to the left of the target, and the other hits 1 foot to the right. Of course, although our total error will equal zero, any individual prediction may be very wrong. By saying that Σ1X 2 X2 5 0, you are saying that the mean is located ____ relative to the scores in a sample. Therefore, scores above 30 that when predicting someone’s score is the mean, will produce positive deviations which will cancel out our errors ____.

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This test is used to examine whether there is a trend for an outcome to increase or decrease across the categories of the ordered variable order 10 mg rabeprazole with mastercard gastritis or gallbladder. This association is equivalent to testing whether the slope of a regression through the estimates is different from zero buy discount rabeprazole 20 mg on line diet in gastritis. Linear mixed model A statistical model that includes both fixed and random effects order rabeprazole 10 mg with amex gastritis diet . This model is commonly used to analyse data when there are repeated or multiple measurements on participants purchase rabeprazole 20mg with amex gastritis gerd. Log rank test This test can be used to examine whether there is a statistically significant difference between the survival curves of two or more groups. This tests that there is no difference in the probability of an event at any time between the groups. Logistic regression Logistic regression is used to predict a categorical outcome vari- able from a set of explanatory variables. When the outcome variable is binary, this is referred to as binary logistic regression. In logistic regression, the odds ratio for an explanatory variable is adjusted for the other variables in the model. Mahalanobis distance This is the distance between a case and the centroid of the remaining cases, where the centroid is the point where the means of the explanatory variables intersect. Mahalanobis distance is used to identify multivariate outliers in regression analyses. Mann–Whitney U test A non-parametric test which is based on ranking the measure- ments from two samples to estimate whether the samples are from the same popula- tion. McNemar’s chi-square test (paired data) Paired categorical measurements taken from the same participants on two occasions or categorical data collected in matched case–control studies can be analysed using this test. Mean square Mean squares are estimates of variance used in analysis of variance and regression. The mean square is calculated as the sum of the squares divided by their degrees of freedom. Measurement error The difference between the true value of the measurement and the actual value of the measurement. Measurement errors may be due to bias (systematic errors) and/or random variation. The measurement error can be calculated using the standard deviation of the differences of observations in the same participant and is used to describe the level of agreement between observations. Median The point at which half the measurements lie above and below this value, that is, the point that marks the centre of the data. Multicollinearity Multicollinearity refers to when two or more explanatory variables are significantly related to one other. Multicollinearity between explanatory variables inflates the standard errors and causes imprecision because the variation is shared. Multiple linear regression A linear model used to measure the extent to which two or more explanatory variables predict a continuous outcome variable. Multivariate statistics Tests in which the relationship between more than two variables are examined simultaneously. Negative predictive value The proportion of individuals who have a negative diagnos- tic test result and who do not have the disease. Nominal variable A variable with values that do not have any ordering or meaningful ranking and are generally categories, for example, values to indicate that participants are retired, employed or unemployed. Non-parametric tests Statistical tests that have no assumptions about the distribution of the data. Normal distribution A probability distribution that describes the likelihood of a value occurring in the population. Null hypothesis A null hypothesis states that there is no difference between the sum- mary statistics of the populations from which the samples were drawn, that is group statistics are equal or that there is no relationship between two or more variables. If the null hypothesis is accepted, this does not necessarily mean that the null hypoth- esis is true but can suggest that there is not sufficient or strong enough evidence to reject it. Odds ratio The odds ratio is the odds of a person having a disease if exposed to a risk factor divided by the odds of a person having a disease if not exposed to the risk factor. An odds ratio of 2 can be interpreted as the odds that an exposed person has the disease 376 Glossary present are twice that of the odds that a non-exposed person has the disease present. One sample t-test A parametric test that can be used to test if the sample mean is equal to a specified value. One sided (or one tailed) tests When the direction of the effect is specified by the alter- nate hypothesis, for example, >50, a one-tailed test is used. The critical region for a one signed test is located in only one tail of the probability distribution. One-sided tests are more powerful than two-sided tests for showing a significant difference because the critical value for significance is lower and are rarely used in health care research. Ordinal variable A variable with values that indicate a logical order such as codes to indicate socioeconomic or educational status. Outcome (dependent) variable The outcome of interest in a study, that is the variable that is dependent on or is influenced by other variables (explanatory variables) such as exposures and risk factors. Univariate outliers are defined as data points that have an absolute z score greater than 3. This term is used to describe values that are at the extremities of the range of data points or are separated from the normal range of the data. Multivariate outliers are data values that have an extreme value on a combination of explanatory variables and exert too much leverage and/or discrepancy. P value A P value is the probability of a test statistic occurring if the null hypothesis is true. This test is used when two measurements are related because they are collected from the same participant at different times, from different sites on the same person at the same time or from cases and their matched controls. Parametric tests Statistical tests which assume that the continuous variables being anal- ysed has a normal distribution. Parametric tests are preferable to non-parametric tests because they have more statistical power. Partial correlation The correlation between two variables after the effects of a third or confounding variable has been removed. Planned (apriori)contrasts Specific group differences can be assessed using planned contrasts, which are decided before data collection commences. The number of planned contrasts should be limited and have a theoretical and/or empirical basis. Population A collection of individuals to whom the researcher is interested in making an inference, for example, all people residing in a specific region or in an entire country, or all people with a specific disease. Positive predictive value The proportion of individuals with a positive diagnostic test result who have the disease. Glossary 377 Post-hoc tests After a statistically significant difference is found overall between groups, post-hoc tests are conducted to identify where particular group differences exist. Post-hoc testing occurs during the data analyses and typically involves all possible comparisons between groups. Statistical power can be influenced by many factors including the frequency of the outcome, the size of the effect, the sample size and the statistical tests used. Prevalence Rate of total cases with a condition in a random population sample in a specified time, for example 1 year.

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Dolnick (19) comments on this in between 20% and 60% are thought to be deaf due to genetic “Deafness as Culture”: “So strong is the feeling of cultural solidarity causes rabeprazole 20mg discount viral gastritis symptoms, 20% to 40% due to environmental causes rabeprazole 10mg lowest price erythematous gastritis definition, and the that many deaf parents cheer on discovering that their baby is deaf purchase rabeprazole 20mg on-line granulomatous gastritis symptoms. Between 59% and 85% of Attitudes of deaf people and their families towards issues surrounding genetics 165 cases of genetic deafness are thought to be caused by autosomal Genetic counselling for deafness recessive genes 20 mg rabeprazole otc gastritis diet meals, 15% to 33% by autosomal dominant genes, and up to 5% by X-linked or mitochondrial genes (26–28). There is often interest from Deaf individuals to know if and Several hundred genes are known to play a part in inher- how they have inherited their deafness and what the chances ited deafness (29). Alterations in the connexin 26 gene are are of passing this on to their children (35). These are issues thought to account for up to 50% of childhood genetic deaf- that can be covered within the clinical service of genetic coun- ness, with 1 in 31 people carrying alterations in this gene in cer- selling. Such services are available from genetic counsellors and tain populations (30,31). Advances in which patients or relatives at risk of a disorder that may be the molecular genetic research into deafness mean that, for cer- hereditary are (informed) of the consequences of the disorder, tain families, it is possible to offer a genetic test to define whether (and) the probability of developing or transmitting it” (36). Such testing and information genetic conditions and their heritability within a supportive relating to this is can be obtained via genetic counselling services. Some deaf parents worry that they would be told that they should not have children if they came for genetic counselling (37). This would not happen within the present-day genetic Genetic testing counselling services in the United Kingdom as the service is “nondirective,” i. Therefore, there is an assump- ■ Prenatal genetic testing tells a pregnant mother, via an inva- tion that the process of genetic counselling will inevitably sive test such as amniocentesis or chorionic villus sampling, reduce the numbers of deaf children born, which may or may whether the foetus has a gene alteration(s) that could cause not be the case in reality. This means that Deaf parents who prefer to have deaf a prenatal genetic test could then be used by the parents to children would be able to access information about genetics and decide whether the pregnancy should be continued or not. There are limited numbers of people who feel that deafness is a As more genes linked to deafness are identified and the serious enough condition to need to find out about during preg- clinical basis understood, it will become easier to incorporate nancy or to opt for a termination if the foetus was likely to be genetic testing for deafness within routine clinical services. When asked for their opinion on this subject, the major- Many clinicians are excited by this prospect (34), but, others ity of deaf and hearing individuals interested in having a test in may prefer to treat this with some caution. However, in thinking about having a whether deafness is a “serious” enough condition to warrant “nondisabled” child, created outside a natural conception, such a course of action. Just because a test is technically possi- preimplantation genetic diagnosis could be a viable alternative. Before Such testing for connexin 26 deafness has been requested, where such testing becomes routine, it is helpful to consider the two hearing parents wanted to avoid having deaf children, longer-term consequences of this procedure. Some of the issues that arise Different individuals have different opinions about passing may be similar to those that have come up as genetic technology has on deafness to the next generation. One deaf couple, known to been applied to the diagnosis and treatment of other hereditary the author through her work as a genetic counsellor, were so conditions. The sociocultural aspects of deafness will lend additional fearful of passing on deafness to their children that they had considerations to these discussions” (35). The negative personal experience they had in relation to being deaf meant that they felt a heavy responsibility to not “inflict” this on their children. However, the process of diagnostic genetic testing and knowledge of Genetics, eugenics, and inheritance patterns revealed that their chances of having deaf deaf people children were minimal. Another Deaf couple had assumed that because their families There have been many attempts throughout history to prevent were hearing and that their deafness could not be inherited, deaf people from having children so that the numbers of deaf they were then pleasantly surprised when their two children people would be reduced within society. Genetic testing revealed that they were both Bell, inventor of the telephone and also a leader in the eugen- deaf due to an alteration in the connexin 26 gene and conse- ics movement, delivered a paper in 1883, called “Memoir Upon quently all their children would be deaf. They had a strong Deaf the Formation of a Deaf Variety of the Human Race” to the identity and were really pleased to pass on their deafness, lan- National Academy of Sciences. At that time were more fully informed about their genetic heritage and con- the inheritance of genetic conditions was poorly understood sequently better able to engage in their future. Genetic coun- and he mistakenly made the assumption that this would be an selling also offered them the opportunity to confidentially effective way of preventing deafness from being passed on. In express the burden and responsibility they felt with regards fact, even if a deaf adult married a hearing partner, if the deaf- passing (or not) deafness on to their children. This was pro- ness was due to a dominant gene alteration there would be a vided within a sensitive environment away from the perceived 50/50 chance of passing this on to any children. This view, although derived from well-meaning intentions, is seen as insulting by many culturally Potential outcomes of Deaf people. As such this work has been discussed among genetic research British, European, and American deaf studies academics and lay people for over a hundred years since (45). For families who test positive for a specific gene alteration that Another key event in history that involved deaf people could cause deafness, it is possible to identify whether hearing related to Hitler’s regime in the Second World War. In the Nazi parents or siblings are also carriers of such a gene alteration and programme, that advocated the eugenic pursuit of the perfect to offer more specific information about the chances of having Ayrian Race, Hitler ordered deaf children and adults to be ster- deaf children. It could also offer a quick and early diagnosis of ilised so that they could not pass on deafness to their children, deafness in a newborn baby in addition to the audiological test- and this happened to 16,000 to 17,000 deaf people. Therefore, as more work is to this, other deaf people were killed as part of “Operation T4” done on the molecular genetics of deafness, more accurate the Nazi programme designed to “wipe out” disabled citizens information can be offered to families. Again, the incorrect assumption was made that deafness Identifying the genetic processes that interplay within the is always inherited and also another assumption was that deaf inner ear may lend itself eventually to gene therapies for deaf- people will pass it on to their children. This could replace the need for cochlear implants in chil- deaf children are born to hearing parents. Given the historical context to the misuse of genetic It has also been suggested that, within the next 50 years, hair knowledge, it is not surprising that d/Deaf people are often sus- cell regeneration within the cochlear will be possible (43). Deaf and often a sense that genetics services in the past have “devalued” hard-of-hearing people and parents of deaf children will surely have the role of Deaf people in society. With this in mind, it is Attitudes of deaf people and their families towards issues surrounding genetics 167 therefore imperative that genetic counsellors and geneticists are “demand” that: “all genetic counsellors should receive Deaf aware- mindful of the historical context within which they practice in ness training to ensure a clear understanding of the Deaf community the present day. If asked often differing beliefs about appropriate medical intervention in for advice, the society will ensure that the family receives positive relation to this. Deaf people may be sensitive to technology that information about deafness in order to enable them to make an aims to “cure” deafness and, as such, there has been clear resis- informed choice” (53). These groups are a powerful force that aims to Wheeler, from the Deafness Research Foundation, United help prevent discrimination and promote acceptance of States, believes that there is still compatibility between the deafness, whether perceived from the medical or cultural preservation of the Deaf community and search for a cure/effec- perspective. He suggests that by removing Attitudes towards genetics may sometimes be seen as link- communication barriers, so that sign-language users have equal ing in with cultural identity. Those Deaf people who are against access to “learning and enjoyment of life,” a better quality of life the eugenic practices of the past will often have negative views will be achieved. At the same time those who wish to use treat- towards modern day genetics services (54). However, the real argument from been well documented over the last ten years, the following many Deaf people is that as most deaf children are born into gives an overview of some of this work. Such hearing people, with their igno- rance of the Deaf World, will make decisions for their deaf child according to their “hearing” perspective. Therefore, such deaf Attitudes towards genetics children are “cured” of their deafness before they are old enough to make choices for themselves, so missing the oppor- The views of a collective group of culturally Deaf people tunity to be part of a community they could have naturally attending a conference called “Deaf Nation” at the University belonged to. Delegates were something that many Deaf people aim to educate hearing peo- asked to complete a questionnaire which asked for their views ple about, so that hearing parents are able to make informed about genetic technology and how they felt about its use with decisions about their child’s future. Of the 87 delegates who completed questionnaires, ness has largely been ignored in the past (49). This situation is 55% thought that genetic testing for deafness would “do more improving but still has a long way to go to create a working harm than good”; 46% thought that its potential use “devalued partnership between parents of deaf children, the Deaf commu- d/Deaf people,” and 49% were concerned about new discover- nity, and professionals working in deafness (50). Here, the attitudes of d/Deaf, hard-of-hear- their feelings about new discoveries in genetics. The following ing, and deafened adults as well as hearing parents of deaf chil- are a selection of these.

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