Monozygotic twins concordant and discordant for DCD: two sides to the story.

Being an identical twin does not necessarily mean having identical perceptions of family functioning, nor of the twin relationship. Using the co-twin control design, the aim of this study was to explore perceptions of family dynamics and the twin relationship in monozygotic (MZ) twins discordant and concordant for Developmental Coordination Disorder (DCD). It was hypothesized that, as has been found in twins discordant for cerebral palsy, twins without DCD would perceive family functioning as less healthy than would their co-twins with DCD. It was also hypothesized that the twin relationship would be regarded generally as mutually supportive. Questionnaire data on 866 sets of MZ twins aged 6 to 17 years were used to identify seven sets discordant, and two sets concordant for DCD. Quantitative (General Functioning Scale of the Family Assessment Device - FAD), and qualitative (semi-structured interview) measures were used to assess family dynamics and the twin relationship. In discordant sets, six of seven twins without DCD rated family functioning at a less healthy level than did their co-twins with DCD. All twins in the DCD concordant sets rated their family functioning at a healthy level. From the semi-structured interviews, emergent themes included friendship, support, minimal sibling rivalry, and minor difficulties. It was concluded that, overall, the twin relationship was regarded as close and mutually supportive, with an ambivalent polarity between the best and most difficult aspects of being an identical twin. Implications for research, policy and clinical practice are discussed.

The experience of adoptive parents in adoption reunion relationships: a qualitative study.

The issues experienced by adoptive parents when faced with an adult child's searching or reunion relationship with his or her birth family, how adoptive parents place themselves within this process, and the factors that influence their experience at this time were explored in a qualitative study of 21 adoptive parents. Themes derived from semistructured interviews are discussed, and implications for clinical practice and future research are suggested.

Treatment of tinnitus with a customized acoustic neural stimulus: a controlled clinical study.

In patients with tinnitus, achieving consistently positive treatment results is a challenge. We conducted a controlled clinical study of a new treatment approach (Neuromonics Tinnitus Treatment) that involves the use of a customized neural stimulus. This stimulus is delivered to the patient in the form of a pleasant acoustic sensation that is spectrally modified according to each patient's individual audiometric profile. This treatment approach is provided as part of a structured rehabilitation program. In our study, patients who received the customized stimulus (Neuromonics group) reported significantly greater and more consistent alleviation of tinnitus symptoms than did patients who participated in a counseling and support program with and without delivery of a broadband noise stimulus (Noise+Counseling group and Counseling-Only group, respectively). After 6 months of treatment, 86% of the Neuromonics patients met the minimum criterion for clinical success, defined as an alleviation of tinnitus disturbance of at least 40% (as determined by the Tinnitus Reaction Questionnaire score). By contrast, only 47 and 23% of the Noise+Counseling and Counseling-Only groups, respectively, reported a successful result according to this criterion. Mean improvements in tinnitus disturbance scores in the Neuromonics, Noise+Counseling, and Counseling-Only groups were 66, 22, and 15%, respectively. The differences between the Neuromonics group and the control groups were statistically significant. Significant differences were observed in other clinical outcomes. Patient reports of user acceptability were more consistently positive in the Neuromonics group.

Prenatal screening and diagnosis: a survey of health care providers' knowledge and attitudes.

AIM: To survey the knowledge and attitudes of health care providers in Western Australia, Australia towards prenatal screening and diagnostic procedures for fetal anomalies. DESIGN: A self-administered mail survey. SAMPLE: 30 obstetricians and 313 general practitioners (GPs). RESULTS: Overall, relative to GPs, obstetricians expressed more positive attitudes towards prenatal tests. Moreover, GPs felt they had a greater need for additional information. Further group differences were found in attitudes towards the value of the tests and confidence in the availability and ease of coordination of follow-up services according to geographical area. Female health care providers were significantly more confident about the availability of follow-up services and had higher knowledge scores. They were also more likely to practice in the metropolitan area. Further group differences were found in attitudes according to participation in professional development. CONCLUSION: Overall, health care providers felt antenatal screening and diagnostic tests were valuable and they felt they could benefit from further information. Knowledge was high, however, it is unclear whether this knowledge is being communicated to women. Given that antenatal practices are rapidly evolving, continuing education and ongoing professional development is critical.

Survey of the knowledge, attitudes and experiences of Western Australian women in relation to prenatal screening and diagnostic procedures.

OBJECTIVE: To determine the knowledge, attitudes and experiences of women in Western Australia (WA) regarding prenatal procedures. DESIGN: A self-administered mail survey. SAMPLE: The survey was sent to all women who gave birth during July 2001 (n = 1801). The participants were 633 women aged 15-45. RESULTS: The mean total knowledge score was 16 out of a possible 26 (62%). The average score for all three attitude factors was four, 'agree', on a Likert scale of five. Women who reported they had private health insurance and women in the metropolitan area had significantly higher knowledge levels and had significantly more positive attitudes towards the adequacy of information. Those who did not have a screening test had less positive attitudes towards the value of the tests and had less confidence in results. Those with higher educational attainments had higher knowledge and less positive attitudes towards the value of the tests. CONCLUSIONS: Women felt positive towards the value of the tests, were confident in their results and felt positive towards the adequacy of information; however, their understanding of this information seems to be poor. It seems that the choice to undergo testing is not well informed. It was clear women need more support, information, explanations, and more time to absorb the information.