The impact of litigation on midwives.

Litigation is rising in maternity care and there is no evidence that it will slow down. Advertisements with a 'no win no fee' message encourage people to seek out lawyers. It is true that we are becoming an increasingly litigious society and claims in maternity care often lead to very high pay-outs. This can be millions of pounds for child with cerebral palsy if liability is admitted. Legal processes are fascinating but it does not feel like this if you are personally caught up in them.

QTL and candidate gene mapping for polyphenolic composition in apple fruit.

BACKGROUND: The polyphenolic products of the phenylpropanoid pathway, including proanthocyanidins, anthocyanins and flavonols, possess antioxidant properties that may provide health benefits. To investigate the genetic architecture of control of their biosynthesis in apple fruit, various polyphenolic compounds were quantified in progeny from a 'Royal Gala' × 'Braeburn' apple population segregating for antioxidant content, using ultra high performance liquid chromatography of extracts derived from fruit cortex and skin. RESULTS: Construction of genetic maps for 'Royal Gala' and 'Braeburn' enabled detection of 79 quantitative trait loci (QTL) for content of 17 fruit polyphenolic compounds. Seven QTL clusters were stable across two years of harvest and included QTLs for content of flavanols, flavonols, anthocyanins and hydroxycinnamic acids. Alignment of the parental genetic maps with the apple whole genome sequence in silico enabled screening for co-segregation with the QTLs of a range of candidate genes coding for enzymes in the polyphenolic biosynthetic pathway. This co-location was confirmed by genetic mapping of markers derived from the gene sequences. Leucoanthocyanidin reductase (LAR1) co-located with a QTL cluster for the fruit flavanols catechin, epicatechin, procyanidin dimer and five unknown procyanidin oligomers identified near the top of linkage group (LG) 16, while hydroxy cinnamate/quinate transferase (HCT/HQT) co-located with a QTL for chlorogenic acid concentration mapping near the bottom of LG 17. CONCLUSION: We conclude that LAR1 and HCT/HQT are likely to influence the concentration of these compounds in apple fruit and provide useful allele-specific markers for marker assisted selection of trees bearing fruit with healthy attributes.

Parents' childhood fever management: community survey and instrument development.

AIM: This paper is a report of a study to explore Australian parents' knowledge, beliefs, practices and information sources about fever management and develop a scale to measure parents' fever management practices. BACKGROUND: Parental fever phobia and overuse of antipyretics to reduce fever continue. No scales to measure parents' fever management practices are available. METHOD: A community-based, postal survey was carried out in 2005 with 401 Australian parents of well children aged 6 months-5 years. Respondents were recruited through advertising (48.4%), face-to-face (26.4%) and snowball (24.4%) methods. A 33-item instrument was developed; construct and content validity were determined by an expert panel and item reliability by test-retest. RESULTS: Moderate fever (40.0 +/- 1.0 degrees C) was reported to be harmful (88%), causing febrile convulsions (77.7%). Usual practices targeted temperature reduction, antipyretic administration (87.8%), temperature monitoring (52.5%). Fewer evidence-based practices, such as encouraging fluids (49.0%) and light clothing (43.8%), were reported. Positive changes over time (36.4%) included less concern and delayed or reduced antipyretic use. Negative practice changes (22.7%) included greater concern and increased antipyretic use. Medical advice was sought for illness symptoms (48.7%) and high (37.4%) or persistent (41.5%) fevers. Fever management was learnt from doctors, family and friends and working experience, while receiving conflicting information (41.9%) increased concerns and created uncertainty about best practice. CONCLUSION: Parents need consistent evidence-based information about childhood fever management. The Parental Fever Management Scale requires further testing with different populations and in different cultures and healthcare systems to evaluate its usefulness in nursing practice and research.

Queensland nurses' attitudes towards and knowledge of the legislative duty to report child abuse and neglect: results of a state-wide survey.

In 2005, legislation commenced requiring Queensland nurses to make reports of suspected child abuse and neglect to government child protection authorities. This development further harmonised Australian mandatory reporting laws and their application to the nursing profession, although inconsistencies still exist between States and Territories. As indicated by research published in 2006, little is known about nurses and the reporting of child abuse and neglect. The legislative change in Queensland provided a new opportunity to study nurses' attitudes to reporting, knowledge of the legal reporting duty, and reporting practice, all of which provides much-needed evidence about the reporting of child abuse and neglect, and about the laws themselves. This article describes results from a State-wide survey of Queensland nurses. Findings have implications for law reform, nursing practice, and nurses' training in child abuse and neglect reporting.

Disentangling the underlying dimensions of psychopathy and conduct problems in childhood: a community study.

The psychometric and predictive validity of callous-unemotional (CU) traits as an early precursor of conduct disorder and antisocial behavior were assessed. A community sample of children (4-9 years of age) were tested 12 months apart with the Antisocial Process Screening Device (APSD; P. J. Frick & R. D. Hare, 2002), a measure of early signs of psychopathy in children. Factor analysis supported the structure of the APSD. Given controversy surrounding construct overlap between psychopathy and conduct problems, a factor analysis was conducted on pooled items from the Strengths and Difficulties Questionnaire and APSD. A 5-factor solution resulted: antisocial, hyperactivity, CU traits, anxiety, and peer problems. CU traits added small but significant improvements in the 12-month prediction of antisocial behavior for boys and older girls, after controlling for Time 1 measures. These results indicate that although the dimensions of the APSD overlap with dimensions of the disruptive behavior disorders, CU traits have unique predictive validity in childhood.

Development and evaluation of an intensive intervention program for children with a chronic health condition: a pilot study.

A range of developmental risk factors threatens the psychosocial well-being of children with a chronic health condition (CCHC). Early intervention and prevention programs are emerging as an effective response to improving individual and family coping mechanisms. In particular, efforts to address individual and family coping throughout the important pre-teen transitional ages for CCHC have gained popularity although their effectiveness has not been adequately demonstrated. We conducted a pre-post intervention study to evaluate an intensive intervention program for CCHC aged 10-14 years that aimed to enhance well-being. Twelve CCHC participated in a pilot 8-week intensive intervention program. At three month follow-up there was a significant increase in children's self esteem (t = 3.39, p < .01). There was a decrease in mean scores for anxiety and depression symptoms. Parental perceptions of the impact of the condition on the child reduced significantly (t = 2.37, p < .05). It was beyond the scope of the present study to conclusively evaluate the effectiveness of the intensive intervention program, however results show that it was a promising strategy to improve a range of outcomes for CCHC. Further research using a larger sample is needed to determine the ways in which this program influences psychosocial well-being of CCHC and their families.

Aicardi syndrome in a 47 XXY male - a variable developmental phenotype?

BACKGROUND: Aicardi syndrome (AS) is a rare neurodevelopmental disorder characterized by the triad of corpus callosum agenesis, chorioretinal lacunae, and infantile spasms. Most patients with AS also have intractable epilepsy, moderate to severe learning disability, and a reduced life expectancy. An X-linked dominant inheritance caused by de novo mutations pattern, lethal in males, is postulated, but the gene has not yet been isolated. There are three case reports of 47 XXY males with classic features of AS who all had severe developmental disability. CASE REPORT: We report a case of a 3.5-year old 47 XXY male with the classic triad of Aicardi syndrome but with good seizure control and mild learning disability.