AN INVESTIGATION OF THE IMPACT OF CHILDREN WITH BIRTH DEFECTS ON STRESS IN THEIR FAMILIES

A child with a birth defect places physical, financial and emotional stress upon the family. The purpose of this study was to assess the impact of a mildly handicapped child on the family's coping abilities.^ Two groups, 101 mothers of children with birth defects and 107 mothers of intact children, completed the Holroyd Questionnaire on Resources and Stress and the Luborsky Social Assets Scale. From these groups, 86 pairs were matched on four factors: the age (two to eight years) and sex of the study child and the mother's education and marital status.^ The children with birth defects had completed the diagnostic evaluation at the Meyer Center for Developmental Pediatrics, Texas Children's Hospital. Children with severe defects were excluded. The mean I.Q of the group was 88, s.d. 17; 17 children were mildly retarded and 35 had an I.Q. of 100 or above; areas of dysfunction included motor abnormalities, behavior disturbance, speech problems, and sensory impairments.^ The expected direction and statistically significant differences were obtained from the data for the matched pairs on the Q.R.S. scales. The mothers of children with a birth defect reported poor health, a negative attitude toward the child, being over-protective, financial problems and feeling a lack of social support and family integration. They perceived the child as socially obtrusive, limited as to occupational opportunities, and as having a difficult personality.^ The functioning levels of the handicapped children contributed to the respondent's problems. The child with behavior and speech problems but adequate intelligence was a situation which resulted in a poor health/mood of the mother. The mother's pessimism was related to the child's low intelligence.^ The social assets of the respondents with intact children were significantly higher than those of respondents of handicapped children. There was no relationship between the total social assets score and the scores on the Q.R.S. for mothers of handicapped children. These mothers did report poorer physical conditions, more smoking, and quarreling of their parents as they grew up. ^

Prevention of birth defects in a national study

The following analyses covered two main objectives focused on the prevention of and identification of risk factors for birth defects, the leading cause of infant mortality. All analyses utilized data from the National Birth Defects Prevention Study (NBDPS), an ongoing, population-based, case-control study of major structural birth defects. ^ The first objective was to identify predictors of folic acid supplementation among women of reproductive age. To meet this objective, a previous analysis of potential predictors of periconcecptional folic acid use in the NBDPS was repeated using data from more recent years (1997-2000 versus 2001-2005). The results of these analyses were consistent with the initial analyses, indicating that folic acid use is associated with maternal race/ethnicity, age, education, pregnancy awareness, smoking status, first prenatal care visit, previous live births, and fertility treatments). In addition, data from NBDPS controls were used to identify predictors of preconceptional folic acid use, since supplementation is optimally initiated prior to pregnancy (rather than after conception). These analyses indicated that maternal race/ethnicity, education, age, nativity, employment status, income, number of dependents, smoking, and birth control are significantly associated with preconceptional folic acid supplementation. Ultimately the results of these analyses can be used to guide the development of targeted interventions for preconceptional folic acid use. ^ The second objective was to investigate the association between parental Hispanic acculturation and the risk of gastroschisis, a congenital malformation of the abdominal wall, in offspring. Significant association were not observed for mothers < 20 years of age at conception. Among mothers ≥ 20 years of age, white parents were at a decreased risk of having a child with gastroschisis as compared to Hispanic parents who were born in the United States (US) [odd ratios (ORs) ranging from 0.60 to 0.55] and Hispanics parents who predominantly spoke English (ORs ranging from 0.65 to 0.58). Compared to Hispanic mothers born in the US, the risk of gastroschisis was lower among Hispanic mothers who had lived in the US < 5 years (OR=0.36, 95% CI: 0.42, 0.81) at the time of delivery and Hispanic mothers who migrated to the US at ≥ 20 years of age (OR=0.48, 95% CI: 0.26, 0.89). The results of these analyses provide further evidence that the risk of gastroschisis in offspring is associated with parent Hispanic ethnicity and, among Hispanics, with the degree of parental acculturation. Future studies should focus on characteristic differences between less and more acculturated parents to better understand the relationship between acculturation and gastroschisis.^

A comparative state policy analysis of the adoption of birth defects surveillance legislation

Birth defects are the leading cause of infant mortality in the United States and are a major cause of lifetime disability. However, efforts to understand their causes have been hampered by a lack of population-specific data. During 1990–2004, 22 state legislatures responded to this need by proposing birth defects surveillance legislation (BDSL). The contrast between these states and those that did not pass BDSL provides an opportunity to better understand conditions associated with US public health policy diffusion. ^ This study identifies key state-specific determinants that predict: (1) the introduction of birth defects surveillance legislation (BDSL) onto states' formal legislative agenda, and (2) the successful adoption of these laws. Secondary aims were to interpret these findings in a theoretically sound framework and to incorporate evidence from three analytical approaches. ^ The study begins with a comparative case study of Texas and Oregon (states with divergent BDSL outcomes), including a review of historical documentation and content analysis of key informant interviews. After selecting and operationalizing explanatory variables suggested by the case study, Qualitative Comparative Analysis (QCA) was applied to publically available data to describe important patterns of variation among 37 states. Results from logistic regression were compared to determine whether the two methods produced consistent findings. ^ Themes emerging from the comparative case study included differing budgetary conditions and the significance of relationships within policy issue networks. However, the QCA and statistical analysis pointed to the importance of political parties and contrasting societal contexts. Notably, state policies that allow greater access to citizen-driven ballot initiatives were consistently associated with lower likelihood of introducing BDSL. ^ Methodologically, these results indicate that a case study approach, while important for eliciting valuable context-specific detail, may fail to detect the influence of overarching, systemic variables, such as party competition. However, QCA and statistical analyses were limited by a lack of existing data to operationalize policy issue networks, and thus may have downplayed the impact of personal interactions. ^ This study contributes to the field of health policy studies in three ways. First, it emphasizes the importance of collegial and consistent relationships among policy issue network members. Second, it calls attention to political party systems in predicting policy outcomes. Finally, a novel approach to interpreting state data in a theoretically significant manner (QCA) has been demonstrated.^

The association between parity and selected structural birth defects

BACKGROUND: Parity is a risk factor in neonatal morbidity and mortality. This dissertation examined the association between first births and selected birth defects. The first aim was to assess the risk of 66 birth defects among first births and third or greater births. The second aim was to determine if maternal race, maternal age, infant sex or infant birth weight modify the association between first births and selected birth defects. METHODS: The Texas Birth Defects Registry provided data for 1999-2009. For the first aim, odds ratios were calculated for each birth defect. For the second aim, analysis was restricted to the ten birth defects significantly associated with first births. Stratified analyses were conducted and interaction terms were added to logistic regression models to assess whether differences in the odds ratios for the effect of first birth were statistically significant across strata. RESULTS: Findings for the first aim showed that first births had significantly increased odds of having an infant with 24 of the 66 birth defects. Third or greater births had significantly increased odds of having four of the 66 birth defects. For the second aim, a number of significant effect modifiers were observed. For patent ductus arteriosis, obstructive urinary defects and gastroschisis, the effect of first births was significantly modified by black or U.S.-born Hispanic mothers. The effect of first birth was also significantly modified among mothers ≥30 years for mitral valve insufficiency, atrial septal defect and congenital hip dislocation. The effect of first births was significantly modified among infants with low birth weight for hypospadias, congenital hip dislocation and gastroschisis. CONCLUSIONS: First births were associated with an elevated risk of 24 categories of birth defects. For some of the birth defects studied, the effect of first birth is modified by maternal age, maternal race and low birth weight. Knowledge of the increased risk for birth defects among women having their first birth allows physicians and midwives to provide better patient care and spur further research into the etiology of associated birth defects. This knowledge may bring about interventions prior to conception in populations most likely to conceive.^

Chlorophyll and true-color maps of sediments from the intertidal zones in Winyah Bay, South Carolina, USA and List, Sylt, Germany

We used hyperspectral imaging to study short-term effects of bioturbation by lugworms (Arenicola marina) on the surficial biomass of microphytobenthos (MPB) in permeable marine sediments. Within days to weeks after the addition of a lugworm to a homogenized and recomposed sediment, the average surficial MPB biomass and its spatial heterogeneity were, respectively, 150 - 250% and 280% higher than in sediments without lugworms. The surficial sediment area impacted by a single medium-sized lugworm (~4 g wet weight) over this time-scale was at least 340 cm**2. While sediment reworking was the primary cause of the increased spatial heterogeneity, experiments with lugworm-mimics together with modeling showed that bioadvective porewater transport from depth to the sediment surface, as induced by the lugworm ventilating its burrow, was the main cause of the increased surficial MPB biomass. Although direct measurements of nutrient fluxes are lacking, our present data show that enhanced advective supply of nutrients from deeper sediment layers induced by faunal ventilation is an important mechanism that fuels high primary productivity at the surface of permeable sediments even though these systems are generally characterized by low standing stocks of nutrients and organic material.

The new dysmorphology: application of insights from basic developmental biology to the understanding of human birth defects.

Information obtained from studies of developmental and cellular processes in lower organisms is beginning to make significant contributions to the understanding of the pathogenesis of human birth defects, and it is now becoming possible to treat birth defects as inborn errors of development. Mutations in genes for transcription factors, receptors, cell adhesion molecules, intercellular junctions, molecules involved in signal transduction, growth factors, structural proteins, enzymes, and transporters have been identified in genetically caused human malformations and dysplasias. The identification of these mutations and the analysis of their developmental effects have been greatly facilitated by the existence of natural or engineered models in the mouse and even of related mutations in Drosophila, and in some instances a remarkable conservation of function in development has been observed, even between widely separated species.

A Watershed Approach to Managing the Natural Resources in South Carolina

Environmental degradation from point and non-point source pollution in the past ten years has made it increasingly clear that threats to aquatic resources cannot adequately be addressed without a more integrated watershed approach to the management. Through comprehensive, qualitative interviews of experts in the watershed approach in South Carolina, recommendations will be made to improve this holistic process. Conducting interviews to compile institutional knowledge on the incentives and barriers from professionals working within the watershed approach will show how managing the natural resources in South Carolina could be more effective and efficient. By gathering experiences of lessons learned, best approach techniques, and suggestions for future watershed planning, several recommendations were made to further the use of the watershed approach in South Carolina.

Charles Town, South Carolina: with a chart of the bars & harbour

by R. Cowley.

Map of General Sherman's March : Georgia, South Carolina, and North Carolina, 1865 (Raster Image)

This layer is a georeferenced raster image of the historic paper map: Map showing route of marches of the army of Genl. W.T. Sherman, from Atlanta, Ga. to Goldsboro, N.C. : to accompany the report of operations from Savannah, Ga. to Goldsboro, N.C., prepared by order of the Secretary of War for the officers of the U.S. Army under the command of Maj. Gen. W.T. Sherman. It was published by the Engineer Bureau, War Dept. in 1865. Scale [ca. 1:1,950,000]. Shows Sherman's March through the Carolinas covering South Carolina and portions of North Carolina, Georgia, and Tennessee. The image inside the map neatline is georeferenced to the surface of the earth and fit to the Universal Transverse Mercator projection (WGS 1984 UTM Zone 17N). All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, or other information associated with the principal map. This map shows features such as roads, railroads, cities and towns, drainage, and more. Relief shown by hachures. The routes of the 14th, 15th, 17th, and 20th corps and the cavalry are indicated by colors and symbols. This layer is part of a selection of digitally scanned and georeferenced historic maps of the Civil War from the Harvard Map Collection. Many items from this selection are from a collection of maps deposited by the Military Order of the Loyal Legion of the United States Commandery of the State of Massachusetts (MOLLUS) in the Harvard Map Collection in 1938. These maps typically portray both natural and manmade features, in particular showing places of military importance. The selection represents a range of regions, originators, ground condition dates, scales, and purposes.

Charleston Harbor, South Carolina, 1863 (Raster Image)

This layer is a georeferenced raster image of the historic paper map: Charleston Harbor and its approaches showing the positions of the Rebel-batteries, [by] U.S. Coast Survey. It was published in 1863 by Lith. of J. Bien. Scale 1:30,000. Nautical chart covering Charleston Harbor and a portion of Charleston, South Carolina. The image inside the map neatline is georeferenced to the surface of the earth and fit to the South Carolina State Plane Coordinate System (in Meters) (Fipszone 3900). All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, or other information associated with the principal map. This map shows features such as roads, railroads, houses, vegetation, drainage, military batteries and fortifications, coastal features (shoals, rocks, channels, floating batteries, etc.) and more. Overprinted to show 1/4-mile concentric circles centered on St. Michaels, Charleston; positions occupied by the Union Army and Navy; "Rebel batteries in possession of National forces [and] batteries still held by the Rebels [on] Sept. 7th 1863." Union positions are based "on the authority of Maj. T.B. Brooks." Relief shown by hachures; depths shown by soundings and shading. This layer is part of a selection of digitally scanned and georeferenced historic maps of the Civil War from the Harvard Map Collection. Many items from this selection are from a collection of maps deposited by the Military Order of the Loyal Legion of the United States Commandery of the State of Massachusetts (MOLLUS) in the Harvard Map Collection in 1938. These maps typically portray both natural and manmade features, in particular showing places of military importance. The selection represents a range of regions, originators, ground condition dates, scales, and purposes.

Fort Wagner, Morris Island, South Carolina,1863 (Raster Image)

This layer is a georeferenced raster image of the historic paper manuscript map: Battery Wagner, Morris Isld., Francis D. Lee, Capt. Engrs. ; Langdon Cheves, Asst. Engr. in charge of work ; drawn by F.W. Bornemann, C.S. Engr. Office. It was drawn Nov 26, 1863. Scale [1:480]. The image inside the map neatline is georeferenced to the surface of the earth and fit to the South Carolina State Plane Coordinate System (in Meters) (Fipszone 3900). All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, or other information associated with the principal map. This map shows features such as Fort dimensions and structures, landscape of area surrounding Fort, drainage, and more. This layer is part of a selection of digitally scanned and georeferenced historic maps of the Civil War from the Harvard Map Collection. Many items from this selection are from a collection of maps deposited by the Military Order of the Loyal Legion of the United States Commandery of the State of Massachusetts (MOLLUS) in the Harvard Map Collection in 1938. These maps typically portray both natural and manmade features, in particular showing places of military importance. The selection represents a range of regions, originators, ground condition dates, scales, and purposes.