Prenatal detection of congenital heart disease: Recent experience across the state of Arizona.

OBJECTIVE: To determine the prenatal detection rate (PDR) of congenital heart disease (CHD) in Arizona as well as describe various factors that may influence detection rates. METHODS: This was a retrospective chart review using the Society of Thoracic Surgeons and Phoenix Children's Fetal Cardiology databases. We included all cases of CHD requiring surgery <1 year of age between 2013 and 2018. A total of 1137 patients met the criteria, and various demographic, socioeconomic, and patient outcome data were collected. RESULTS: The overall PDR was 58% with an improving detection rate over the course of our study, with the final year having a PDR of 67%. Over time, PDR improved in urban communities, but this was not seen in rural communities. Rural address, public insurance, and Native American ethnicity were associated with lower PDR. Postnatal outcomes, including Apgars, initial pH, and lactate, did not differ with the presence of a prenatal diagnosis. Diagnoses typically identified with the outflow tract and 3-vessel views on the fetal echocardiogram were less likely to be detected prenatally. CONCLUSIONS: The PDR of CHD continues to improve with evolving technologies and guidelines. We highlight a discrepancy between urban, rural, and Native American populations. Additionally, by supplying descriptors of missed diagnosis and associated echocardiography views, we hope to provide data for future interventions.

A state-by-state comparison of policies that protect private well users.

BACKGROUND: While the Safe Drinking Water Act allows states and localities to adopt stronger protections for drinking water, state and local requirements concerning private drinking water wells vary dramatically and often do not provide necessary protections for residents who rely on well water. OBJECTIVE: This paper inventories ten types of policies including laws, regulations, programs, and activities that states have adopted or partaken in to encourage safe drinking water for residential well owners. METHODS: To identify categories of private well protections, we conducted a preliminary internet search with key search terms to create an initial list of 10 categories of laws, regulations, programs, and activities (collectively referred to as "policies") that states have taken to protect residential well water quality. To have a private well safety category present, the law, regulation, program, or activity must fit within the scope of the ten classifications. To limit the breadth of our search, we excluded local and county protections, as well as activities by non-governmental organizations. We also excluded basic construction standards for new wells and licensing standards for well drillers, both of which are covered under a previous study. We conducted an additional internet search to complete a comprehensive review of each state and category and to validate our previous findings. In addition to this internet search, we completed phone and email outreach to the state agencies implementing the well safety categories identified in our internet search to confirm our results. RESULTS: The results indicate a wide range of state-based well water protections. The number of residential well water protections present in each state ranged from 8 policies in Iowa, Kentucky, and Maine to 1 policy in Oklahoma, with a median of 5 policies across the 50 states. IMPACT: This paper examines protections that states have implemented to safeguard residential well water quality and to protect the health of people who rely on well water. This research reviews state-level regulations, laws, and programs, as opposed to local, municipal, county-level, or quasi-governmental protections for residential well owners. Residential well policies were examined across ten categories. Without any protections at the federal level, this research reveals gaps in state regulation and demonstrates the need for broader adoption of comprehensive state-level policies to better protect residential well owners from drinking water contaminants and their associated public health impacts.

The Still-Face Paradigm and bidirectionality: associations with maternal sensitivity, self-esteem and infant emotional reactivity.

The Still-Face Paradigm (SFP) is a structured stressful event within which researchers have investigated the influence of maternal psychological and behavioral characteristics on infant behavior. The present investigation contributes to this body of work by examining the joint contributions of maternal and child behavioral and affective characteristics on subsequent behaviors and affectations following the SFP. A sample of non-clinically depressed mothers and their infants (n=31) engaged in a modified Still-Face Paradigm (SFP), followed by a period of toy play. These interactions were videotaped and behaviorally coded along the following dimensions: maternal sensitivity prior to the SFP and during toy play, infant negative emotional reactivity during the still-face, and infant resistance during the reunion phase. Additionally, mothers reported global self-esteem and this was examined as a predictor of infant behavior. Results revealed significant bidirectional influences such that maternal self-esteem predicted infant emotional reactivity, maternal sensitivity pre-SFP predicted infant resistance during the reunion phase, and infant resistance predicted subsequent levels of maternal sensitivity. Indirect effects were also examined, and provided additional support for bidirectionality in mother-infant interactions. Implications for clinical practice are discussed in light of these findings.