Fetal Cerebral Ventricular Pointing as a Marker of Spina Bifida

Objective. Occipital cerebral ventricular pointing is a promising intracranial marker for spina bifida. We sought to determine (1) the incidence of pointing in fetuses with and without spina bifida and (2) inter‐observer and intraobserver agreement for visualizing pointing. Methods. Second‐trimester transverse axial images of the lateral cerebral ventricles from an equal number of affected and unaffected fetuses were independently reviewed in a blinded fashion by 2 examiners. Results. Sixty‐two fetuses (31 with isolated spina bifida and 31 without) had sonographic examinations at 19.2 ± 1.3 weeks (mean ± SD). Pointing was present in 77.3% of fetuses with spina bifida and 15% of those without by the first examiner and in 78.3% of fetuses with spina bifida and 10% of those without by the second examiner. Interobserver and intraobserver agreement were substantial (κ = 0.69 and 0.78, respectively). Conclusions. Ventricular pointing is a highly agreed‐on finding that is substantially associated with but not pathognomonic for fetal spina bifida.     

A diagnostic approach for the evaluation of spina bifida by three-dimensional ultrasonography.

OBJECTIVE: To describe a prenatal diagnostic method for evaluating spina bifida by three-dimensional ultrasonography. METHODS: Two- and three-dimensional ultrasonography were used to determine the extent of vertebral defects among fetuses with spina bifida. Spinal levels were independently counted from the most caudal thoracic vertebra with a rib (e.g., 12th thoracic rib). A virtual cutting plane was manipulated through a volume-rendered spine to generate optimal multiplanar views for this blinded analysis. Prenatal diagnosis was compared with a postnatal analysis of bony spine defects derived from radiographic films or magnetic resonance imaging. RESULTS: Nine fetuses were examined by two-dimensional ultrasonography (21.8 +/- 3.4 menstrual weeks) and three-dimensional ultrasonography (22.8 +/- 4.4 menstrual weeks). For two-dimensional ultrasonography, the spinal level agreed to within 1 vertebral segment in 6 of 9 infants. In contrast, three-dimensional ultrasonography agreed to within 1 vertebral segment in 8 of 9 infants. Three fetuses had vertebral defect levels on two-dimensional ultrasonography that were 1.5 to 2 segments away from postnatal findings. The same fetuses had results that were within 1 vertebral segment on three-dimensional ultrasonography. Volume rendering showed splayed vertebral pedicles and disrupted vertebrae. An intact meningeal sac was easily rendered in 5 of 9 subjects. CONCLUSIONS: Multiplanar views are generally more informative than rendered views for localizing bony defects of the fetal spine. The level of the defect on three-dimensional ultrasonography correlates well with those on two-dimensional ultrasonography and postnatal imaging studies. This approach may improve characterization of spina bifida by adding diagnostic information that is complementary to the initial assessment by two-dimensional ultrasonography.     

Homeless Parents'Perceptions of Parenting Stress

PURPOSE. To describe homeless parents' perceptions of parenting stress as potential indicators of needs for support in parenting roles.
SAMPLE. Forty-seven homeless parents (30 mothers, 17 fathers).
METHODS. Subjects completed the Parenting Stress Index to measure perceived parenting stress in the areas of child domain, parent domain, and life stress.
FINDINGS. Homeless mothers and homeless fathers both identified the child domain as the most frequent source of stress. T tests showed a significant dierence between groups only in the parent domain sub- scale of competence.
CONCLUSIONS. Findings from this study indicate the need to include parenting stress questions in an initial nursing or health assessment.     

尿毒症儿童父母教养压力调查与分析

目的 调查尿毒症儿童父母教养压力水平,为开展心理干预和社会支持提供科学依据.方法 采取教养压力指标简表对49例尿毒症儿童父母和50例正常儿童父母的教养压力进行调查.结果 尿毒症儿童父亲与母亲教养压力总分和各维度得分均高于正常儿童父母(P<0.01);尿毒症儿童母亲在教养压力总分和亲职愁苦、困难儿童维度得分高于父亲(...     

Stress and coping in high-risk mothers: difficult life circumstances,psychiatric-mental health symptoms,education, and experiences in their families of origin

A pilot study was conducted to test methods and measures used to assess factors related to stress and coping in high-risk mothers and their effect on parenting. Twenty mothers with 12-month-old toddlers were recruited from a WIC population; they came into an observational laboratory where they were interviewed about stressors in their lives and their symptoms of stress and were videotaped interacting with their children. Maternal difficult life circumstances, psychiatric-mental health symptoms, education, maternal experiences in their families of origin, and parenting stress explained 74% of the variance in maternal sensitive-responsiveness with their toddlers in the laboratory setting. The findings support the methods of the study. Clinical implications and implications for future research to assist in the development of interventions for this population are discussed. Increased attention to screening for maternal psychiatric-mental health symptoms and for negative experiences in mothers' families of origin may provide important opportunities for intervention with these mothers.     

"Bullet"-shaped head in fetuses with spina bifida: a pointer to the spinal lesion

A "bullet"-shaped head, characterized by flattening in the parietal regions with pointing of the frontal bones, was noted in ultrasound examinations of fetuses with neural tube defects. In a series of 12 fetuses with spinal defects, this finding was present in nine. This abnormal head shape is a useful pointer to the spinal lesion.     

Sense of Coherence,Parenting Attitudes and Stress among Mothers of Children with Autism in Hong Kong

Background The moderating and mediating relationships among sense of coherence, parental attitudes and parenting stress for caregiving parents of children with autism were tested. Materials and Methods One hundred and fifty‐seven mothers of children with autism recruited from representative community service centres in Hong Kong completed the Chinese versions of Sense of Coherence Scale (SOC), Confidence and Acceptance subscales of Parent‐Attitude Survey Scales and Parenting Stress Index Short Form. Results Accounting for mothers’ demographic background, SOC showed a moderating effect with child's symptoms and parenting stress. Mothers with a strong SOC perceived lower stress than their counterparts even when their children presented with more severe autistic symptoms. Two proximal factors in parenting, parental confidence and acceptance of the child, were found to partially mediate SOC and stress. Conclusions The stress experience of mothers of children with autism is related strongly to a global sense of coherence as well as more specific parenting attitudes.     

婴儿脊髓拴系综合征高频超声表现:双中心27例报告

目的 观察婴儿脊髓拴系综合征(TCS)高频超声表现。方法 回顾性收集经手术确诊的27例TCS婴儿,回顾其TCS高频超声表现。结果 27例TCS婴儿中,术后诊断5例终丝牵张型TCS、4例Currarino综合征及18例神经管缺陷。5例终丝牵张型TCS及4例Currarino综合征脊髓高频超声均表现为单纯终丝牵张;18例神经管缺陷中,4例可见脊膜膨出、6例见脊髓脊膜膨出,8例见脂肪脊髓脊膜膨出。婴儿TCS高频超声表现为脊髓圆锥位置下移、形态狭长并向背侧移位,马尾结构紊乱;终丝牵张型可见终丝增粗(>2 mm)、搏动减弱或消失;神经管缺陷所致脊髓拴系可表现为椎管后缺损、回声中断,椎管内容物于缺损处向后下膨出形成包块。结论 婴儿TCS高频超声特征表现包括脊髓末端内容物位置、形态及搏动性异常,可伴椎管缺损及椎管内容物膨出。     

Stress and stressors of myocardial infarction patients in the early period after discharge

BACKGROUND: The period immediately following discharge after hospitalization for a first-time myocardial infarction (MI) is stressful. Recovery-related stressors include anticipation of or actual difficulties in resuming social and physical activities, and adopting recommended health actions. RATIONALE: Stress level and sources of stress in the early discharge period need to be evaluated. Identifying patient charcteristics that contribute to high stress is essential to facilitate patients' adjustment. AIMS: To evaluate stress level, identify sources of stress, and examine the significance of sociodemographics and health characteristics in predicting stress in MI patients in the early discharge period. METHODS: In this cross-sectional study, data were collected from 84 MI patients 2-16 weeks after discharge. The patients, aged 20-70 years, were attending cardiology clinics of four Jordanian public hospitals and had experienced myocarial infarction for the first time. INSTRUMENTS: A structured interview guide including a stress discharge assessment tool was used to identify stress level and sources of stress experienced after discharge. FINDINGS: Most patients experienced a moderate level of stress, with 20% reporting high stress levels. They perceived 'having many persons to provide care to, worrying about having another heart attack, and my partner worries too much about me' as their most important concerns. Age, gender, income, frequency of chest pain episodes, and physicians' recommendations to quit smoking were the most significant predictors of stress. CONCLUSION: The findings suggest that in the early discharge period MI patients worry about their social role, interpersonal relations and personal health, which can exacerbate symptoms and complicate their future care.