A population-based study of survival and childbearing among female subjects with birth defects and the risk of recurrence in their children.
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BACKGROUND AND METHODS: Persons with birth defects are at high risk for death during the perinatal period and infancy. Less is known about the later survival or reproduction of such persons. We studied a cohort that comprised 8192 women and adolescent girls with registered birth defects and 451,241 women and adolescent girls with no birth defects, all of whom were born in Norway from 1967 through 1982. The rate of survival was determined through 1992, and the rate of childbearing was determined through October 1997. We also estimated the risk of birth defects in the children of these subjects. RESULTS: Among the subjects with birth defects, 80 percent survived to 15 years of age, as compared with 98 percent of those with no birth defects. Among the surviving subjects, 53 percent of those with birth defects gave birth to at least one infant by the age of 30 years, as compared with 67 percent of those with no birth defects. The subjects with birth defects were one third less likely to give birth by the age of 30 than those with no birth defects. The children of the subjects with birth defects had a significantly higher risk of birth defects than the children of those with no birth defects (relative risk, 1.6; 95 percent confidence interval, 1.3 to 2.1). This increased risk was confined entirely to the specific defect carried by the mother, with the relative risk of recurrence varying from 5.5 to 82 according to the defect. In contrast, there was no increase in the risk of having an infant with a different type of defect. CONCLUSIONS: Women and girls with birth defects have decreased survival as compared with those with no birth defects, especially in the first years of life, and are less likely to have children. In addition, they have an increased risk of having children with the same defect. (+info)
A randomised controlled trial of specialist health visitor intervention for failure to thrive.
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AIMS: To determine whether home intervention by a specialist health visitor affects the outcome of children with failure to thrive. METHODS: Children referred for failure to thrive were randomised to receive conventional care, or conventional care and additional specialist home visiting for 12 months. Outcomes measured were growth, diet, use of health care resources, and Bayley, HAD (hospital anxiety and depression), and behavioural scales. RESULTS: Eighty three children, aged 4-30 months, were enrolled, 42 received specialist health visitor intervention. Children in both groups showed good weight gain (mean (SD) increase in weight SD score for the specialist health visitor intervention group 0.59 (0.63) v 0.42 (0.62) for the control group). Children < 12 months in the intervention group showed a higher mean (SD) increase in weight SD score than the control group (0.82 (0.86) v 0.42 (0.79)). Both groups improved in developmental score and energy intake. No significant differences were found for the primary outcome measures, but controls had significantly more dietary referrals, social service involvement, and hospital admissions, and were less compliant with appointments. CONCLUSIONS: The study failed to show that specialist health visitor intervention conferred additional benefits for the child. However, the specialist health visitor did provide a more coordinated approach, with significant savings in terms of health service use. Problems inherent to health service research are discussed. (+info)
ESBRA-Nordmann 1998 Award Lecture: Visual P3 as a potential vulnerability marker of alcoholism: evidence from the Amsterdam study of children of alcoholics. European Society for Biomedical Research on Alcoholism.
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Recent data from the Amsterdam Study of Children of Alcoholics add to the evidence for considering the P300 or P3 component of the event-related potential (ERP) as a potential vulnerability marker of alcoholism. In this study, multi-channel ERPs were recorded from 7- to 18-year-old children of alcoholics (COAs) and age- and sex-matched low-risk controls using several experimental paradigms, including a visual novelty oddball task and a visual selective attention task. The results indicated that differences between COAs and controls in the visual P3 amplitude: (1) can be elicited both actively by task-relevant target stimuli and passively by irrelevant novel stimuli; (2) are a function of both the attentional relevance and the target properties of the eliciting stimulus; (3) are mediated by multiple brain generators, rather than by a single generator; (4) originate from a difference in the strength, rather than in the spatial configuration, of the underlying brain generators; (5) cannot be accounted for by differences in visual attention-related earlier occurring ERP components; and (6) can be moderated by current behavioural and emotional problems, general intellectual ability, and socio-economic background. These findings support the notion that a relatively small visual P3 amplitude in COAs reflects heritable biases in attention and information processing that are related to their increased vulnerability to alcoholism. (+info)
Estimates of US children exposed to alcohol abuse and dependence in the family.
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OBJECTIVES: This study sought to provide direct estimates of the number of US children younger than 18 years who are exposed to alcohol abuse or alcohol dependence in the family. METHODS: Data were derived from the National Longitudinal Alcohol Epidemiologic Survey. RESULTS: Approximately 1 in 4 children younger than 18 years in the United States is exposed to alcohol abuse or alcohol dependence in the family. CONCLUSIONS: There is a need for approaches that integrate systems of services to enhance the lives of these children. (+info)
Relational Psychotherapy Mothers' Group: a developmentally informed intervention for at-risk mothers.
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The Relational Psychotherapy Mothers' Group (RPMG), a developmentally informed, supportive psychotherapy designed to serve heroin-addicted mothers with children up to 16 years of age, aims at addressing psychosocial vulnerabilities, and facilitating optimal parenting, among at-risk mothers. We present preliminary evidence on the efficacy of RPMG as an "add on" treatment in comparison with standard methadone counseling alone. At the end of the 24-week treatment period, mothers receiving RPMG plus standard methadone counseling demonstrated lower levels of risk for child maltreatment, greater involvement with their children, and more positive psychosocial adjustment than women who received methadone counseling alone. Children of RPMG participants also reflected fewer problems in multiple areas. At 6 months posttreatment, RPMG recipients continued to be at a relative advantage, although the magnitude of group differences was often attenuated. Notably, urinalyses indicated that RPMG mothers showed greater improvements in levels of opioid use over time than comparison mothers. (+info)
HIV-infected parents and their children in the United States.
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OBJECTIVES: This study sought to determine the number, characteristics, and living situations of children of HIV-infected adults. METHODS: Interviews were conducted in 1996 and early 1997 with a nationally representative probability sample of 2864 adults receiving health care for HIV within the contiguous United States. RESULTS: Twenty-eight percent of infected adults in care had children. Women were more likely than men to have children (60% vs 18%) and to live with them (76% vs 34%). Twenty-one percent of parents had been hospitalized during the previous 6 months, and 10% had probably been drug dependent in the previous year. Parents continued to have children after being diagnosed with HIV: 12% of all women conceived and bore their youngest child after diagnosis, and another 10% conceived before but gave birth after diagnosis. CONCLUSIONS: Clinical and support services for people affected by the HIV epidemic should have a family focus. (+info)
The specificity of disrupted processes in families of adult children of alcoholics.
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Children of alcoholics (COAs) have been characterized as an at-risk population in part, because of the dysfunctional family environments that disrupt psychosocial development among offspring exposed to parental alcoholism. This study examined the specificity of problematic family environments to children of alcoholics vs children exposed to other significant family stressors that included parental death, unemployment, separation, divorce, or major illness. University students completed self-report measures of family stressors, family relationship problems, family communication quality, family conflict, and relationship with parents. Based on a family stressor checklist, 20 students exposed only to parental alcoholism and no other family stressors were compared to several other groups exposed to specific family stressors, and to 50 control subjects who had reported no family stressors. Results showed that students from families where a parent is or was an alcoholic, and where there were no other family stressors, recall disturbed family relations no more commonly than students specifically exposed to other family stressors such as parental divorce, death, or major illness, and no more commonly than those who reported no family stressors. Further analyses suggest that the disruption of COAs' family environments may be explained by their increased likelihood of experiencing additional family stressors that can have a disruptive effect, such as parental separation, divorce and unemployment. (+info)
Maternal addiction, child maladjustment and socio-demographic risks: implications for parenting behaviors.
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AIMS: In this study we examined three parenting dimensions (involvement, autonomy, and limit-setting) and three potential determinants (maternal addiction, low SES and its correlates, and mothers' perceptions of their children's maladjustment) in order to disentangle features of parenting that are uniquely related to maternal addiction from those related to contextual determinants. We also examined conditional effects of low SES and its correlates on parenting. DESIGN: Based on a literature review and predictions arising from an ecological model of parenting, we expected that maternal addiction would be related with problems in parental involvement, but that the other parenting dimensions would be related with mothers' perceptions of children's maladjustment and low SES. Accordingly, we examined variance in each parenting dimensions accounted for by each of the three determinants, respectively. PARTICIPANTS: Subjects included 120 (69 opiate-addicted and 51 SES-matched comparison) mothers with children under 16 years of age. MEASUREMENTS: Children's maladaptive behavior was assessed with the Behavioral Assessment System for Children, and parental adjustment with the Parent Child Relationship Inventory. FINDINGS: Direct effect predictions were confirmed and two conditional effects involving single status and family size were also found. CONCLUSIONS: Although many parenting problems have previously been attributed to maternal addiction, only parental involvement is directly related to being an addict; other parenting dimensions may be better explained by contextual factors. (+info)