Welfare reform, family support, and child development: perspectives from policy analysis and developmental psychopathology

This article explores the implications of recent welfare-related policy change for the well-being of children in low-income families, and for research investigating child development processes and outcomes. It provides an overview of current welfare-related policies and explores the implications for developmental researchers. The article also synthesizes early findings from research, highlighting both overall impacts and the more nuanced evidence that while families are transitioning off welfare, only a small number are transitioning out of poverty, and a subgroup of families at risk are not faring well. It then examines, from a theoretical and methodological framework, what developmental psychopathology might bring to the study of welfare-related impacts on children in the context of this complex and changing policy landscape, and what welfare researchers might bring to the field of developmental psychopathology. The article concludes with broad recommendations for both research and policy.     

Early transvaginal ultrasound following an accurately dated pregnancy: the importance of finding a yolk sac or fetal heart motion

Our goals were to determine the prognostic value of a yolk sac or fetal heart motion seen during an early accurately dated transvaginal ultrasound (TVU). We reviewed 225 consecutive pregnancies for fetal heart motion data. Furthermore, 63 pregnancies following in-vitro fertilization were reviewed for yolk sac information. The TVU was performed between 5 and 6 weeks following presumed conception (heart motion data) and between 22 and 32 days following in-vitro fertilization (yolk sac data). Pregnancies were followed until an ongoing pregnancy or spontaneous abortion was documented. The presence of a yolk sac between 22 and 32 days from fertilization was associated with the development of fetal heart motion in 94% of cases. The absence of the yolk sac by 32 days after fertilization was always associated with a poor outcome. In women < 36 years of age, the presence of fetal heart motion was associated with a spontaneous abortion in only 4.5% of the cases. However, the incidence of spontaneous abortion following fetal heart motion increased to 10% in women 36-39 years and 29% in women > or = 40 years of age. The presence of heart motion should not be considered a reassuring sign in the older woman. These data have implications regarding early embryology and the counselling of infertility patients.      

Clinical and genetic analysis of Korean patients with Marfan syndrome: possible ethnic differences in clinical manifestation

Yoo E‐H, Woo H, Ki C‐S, Lee HJ, Kim D‐K, Kang I‐S, Park P, Sung K, Lee CS, Chung T‐Y, Moon JR, Han H, Lee S‐T, Kim J‐W. Clinical and genetic analysis of Korean patients with Marfan syndrome: possible ethnic differences in clinical manifestation. Marfan syndrome (MFS) is an autosomal dominant disorder of the fibrous connective tissue caused by mutations in the fibrillin‐1 (FBN1) gene. Although clinical and genetic analyses have been performed in various populations, there have been few studies in Korea. The aim of this study was to investigate the clinical characteristics and genetic background of Korean patients with MFS. In 39 Korean patients with MFS who met the Ghent criteria, the most common clinical finding was aortic dilatation and/or dissection (94.9%), whereas only 35.9% of patients had ectopia lentis. The majority of MFS patients had fewer than four of the skeletal findings required to fulfill the major skeletal Ghent criterion for MFS. Only 21% of Korean patients had major skeletal abnormalities and most cases showed only minor skeletal involvement. FBN1 gene mutations were detected in 35 out of 39 patients (89.7%), which is similar to rates presented in the previous reports. These results suggest that some clinical features in Korean patients with MFS differed from those reported in Western MFS patients.     

Q waves in hypertrophic cardiomyopathy in relation to the distribution and severity of right and left ventricular hypertrophy

The cause of abnormal Q waves in hypertrophic cardiomyopathy remains unclear. Myocardial wall thickness was assessed by two-dimensional echocardiography at 8 left ventricular and 10 right ventricular sites in 67 patients (mean age 40 years) with hypertrophic cardiomyopathy and the findings were analyzed in relation to the presence of abnormal Q waves on the 12 lead rest electrocardiogram (ECG). Nineteen (28%) of the 67 patients had abnormal Q waves. Right ventricular hypertrophy was significantly more common in patients without abnormal Q waves (25 [52%] of 48 versus 2 [11%] of 19, p less than 0.001). With univariate analysis, there were six measurements that were significantly associated with abnormal Q waves: an increase in upper anterior septal thickness (p less than 0.005) and maximal left ventricular wall thickness (p less than 0.02), a decrease in mean and maximal right ventricular wall thickness (both p less than 0.005) and an increase in the ratio of both upper anterior septal to mean right ventricular wall thickness (p less than 0.005) and upper anterior septal to upper posterior wall thickness (p less than 0.005). With multivariate analysis, only the ratios of upper anterior septal to mean right ventricular wall thickness (p less than 0.005) and to upper posterior wall thickness (p less than 0.05) were significantly related to the presence of abnormal Q waves and predicted Q wave location with a sensitivity, specificity and predictive accuracy of 90%, 88% and 89%, respectively. In hypertrophic cardiomyopathy, the presence of abnormal Q waves on the 12 lead ECG is primarily a function of the relation of right ventricular wall thickness and upper anterior septal thickness.     

Establishment of erythropoiesis following bone marrow transplantation in a patient with congenital hypoplastic anemia (Diamond-Blackfan syndrome)

Marrow transplantation was attempted in a 13-yr-old boy with congenital hypoplastic anemia who had never responded to corticosteroid therapy. Prior to the transplant, he had received 238 transfusions, at least 12 of which were from his father. He was prepared for grafting with antilymphocyte globulin, procarbazine, and total body irradiation (1000 rads). The patient, whose red cells were Group B, then received marrow cells from his Group O, histocompatible, sister. Thereafter, reticulocytes, Group O erythrocytes, and female leukocytes appeared in the peripheral blood. Erythroid precursors were seen in the patient's marrow for the first time in his life, and all lacked fluorescent Y chromosomes. Dividing cells were all female. After initially progressing well, the patient developed interstitial pneumonia and died 55 days after the transplant. The successful erythroid graft suggested that this patient's failure to produce red blood cells was due to a defective stem cell rather than to a humoral defect, plasma inhibitor, or abnormal marrow microenvironment. It suggested further that sibling marrow may be engrafted in patients who have received multiple transfusions, even from a parent.     

High prevalence of hypertriglyceridaemia and apolipoprotein abnormalities in coronary artery disease.

Serum lipids and apolipoproteins A-I and B were measured in 174 men aged less than 60 with angiographically confirmed coronary artery disease and in 572 healthy control men. Two thirds of the patients had raised age-corrected values of fasting serum cholesterol and/or triglyceride and/or a low high density lipoprotein (HDL) cholesterol compared with the controls. Eighteen (30%) of the 61 normolipidaemic patients had a concentration of serum apolipoprotein A-I below the 5th percentile of 233 controls. In normolipidaemic patients on beta blockers the relative prevalence of serum low density lipoprotein (LDL)-apolipoprotein B values above the 95th percentile of 339 controls was significantly increased. Discriminant function analysis showed that a raised concentration of serum triglyceride was the best discriminant between patients and controls, with raised LDL-apolipoprotein B and reduced apolipoprotein A-I coming second only to triglyceride in analyses where each was separately compared with all the lipid variables. These associations were highly significant and were independent of other influences, including beta blockade. These findings re-emphasise the importance of hypertriglyceridaemia as a risk factor and confirm that apolipoprotein abnormalities occur frequently in coronary disease, even in normolipidaemic patients.     

Assessment of bone mineral density in the jaws and its relationship to radiomorphometric indices

Objectives

The aim of this study was to evaluate maxillary, mandibular and femoral neck bone mineral density using dual energy X-ray absorptiometry (DXA) and to determine any correlation between the bone mineral density of the jaws and panoramic radiomorphometric indices.

Methods

49 edentulous patients (18 males and 31 females) aged between 41 and 78 years (mean age 60.2 ± 11.04) were examined by panoramic radiography. Bone mineral density (BMD) of the jaws and femoral neck was measured with a DXA; bone mineral density was calculated at the anterior, premolar and molar regions of the maxilla and mandible.

Results

The mean maxillary molar BMD (0.45 g cm⁻²) was significantly greater than the maxillary anterior and premolar BMD (0.31 g cm⁻², P < 0.05). Furthermore, the mean mandibular anterior and premolar BMD (1.39 g cm⁻² and 1.28 g cm⁻², respectively) was significantly greater than the mean mandibular molar BMD (1.09 g cm⁻², P < 0.01). Although BMD in the maxillary anterior and premolar regions were correlated, BMD in all the mandibular regions were highly correlated. Maxillary and mandibular BMD were not correlated with femoral BMD. In addition, mandibular cortical index (MCI) classification, mental index (MI) or panoramic mandibular index (PMI) values were not significantly correlated with the maxillary and mandibular BMDs (P > 0.05).

Conclusions

The BMD in this study was highest in the mandibular anterior region and lowest in the maxillary anterior and premolar regions. The BMD of the jaws was not correlated with either femoral BMD or panoramic radiomorphometric indices.     

Osteopetrosis: MR characteristics at 1.5 T

Four patients with proved osteopetrosis (three with the infantile malignant form and one with the benign form) were examined with magnetic resonance imaging at 1.5 T. All patients were studied in the coronal and sagittal planes using both short and long repetition time/echo time sequences. The infantile malignant form was characterized by a complete lack of signal from the marrow alternating with a signal intensity equivalent to that of the intervertebral disks, resulting in a "stepladder" appearance. In the benign form or after successful marrow transplantation in the infantile malignant form, intermediate or high signal intensity in the vertebrae was noted, suggesting the presence of some marrow elements.