Favorable Outcome In Children Research Articles

Coparenting during the Child's 2nd Year: A Descriptive Account

New parenthood calls for husbands and wives to work together, coordinate attitudes and beliefs, and to respect, and perhaps negotiate between, one another's unique ideas about raising children. The contribution of such marital processes to parent-child relationships is highlighted by more than 2 decades of research examining the interrelation of marriage, parenting, and child development (Gable, Belsky, & Crnic, 1992). Presently, it is recognized that happy marriages are frequently associated with supportive parenting and with favorable child outcomes (e.g., Belsky, Youngblade, Rovine, & Volling, 1991; Howes & Markman, 1989, 1991) and that troubled marriages are often related to less effective parenting and problematic child behavior (e.g., Jouriles, Murphy, Farris, Smith, Richters, & Waters, 1991; Kerig, Cowan, & Cowan, 1993). Because associations between marriage, parenting, and child development are not uniform and are often modest (Reid & Crisafulli, 1990), the need to move beyond global assessments of marital quality and to investigate marital processes from a more differentiated perspective is now widely acknowledged (Jouriles, Farris, McDonald, 1991; Jouriles, Murphy, et al., 1991; Vuchinich, Vuchinich, & Wood, 1993). Recent efforts to specify which aspects of the marital relationship impede parenting and place children at risk repeatedly highlight overt inter spousal arguments (Gottman & Katz, 1989; Holden & Ritchie, 1991; Jenkins & Smith, 1991; Jouriles, Murphy, & O'Leary, 1989; Katz & Gottman, 1993). Cummings and his colleagues have reported that characteristics of interparental anger (e.g., frequency, mode, topic of conflict) and its resolution (e.g., the silent treatment, compromise) are linked with child well-being (e.g., Cummings, Ballard, El-Sheikh, & Lake, 1991; Cummings & Davies, 1992; Cummings, Vogel, Cummings, & El-Sheikh, 1989; Cummings, Zahn-Waxler, Radke-Yarrow, 1981). Furthermore, in a study that considered disputes about parenting as a dimension of marital quality, Jouriles, Murphy, et: al. (1991) found that marriages characterized by high levels of conflict about childrearing were more strongly and positively associated with boys' behavior problems than were self-reports of general, non-child-related conflicts. In light of such findings, the main goal of this study is to widen the window on the marital relationship and describe how spouses function as coparents. Family systems and psychoanalytic theorists have characterized the coparenting relationship as the extent to which husbands and wives function as partners or adversaries in their parenting roles (P. Minuchin, 1985; S. Minuchin, 1974; Weissman & Cohen, 1985). Despite the apparent significance of these ideas, few studies of coparenting processes have been conducted (for exceptions, see Buchanan, Maccoby, & Dornbusch, 1991; Floyd & Zmich, 1991; Frank, Jacobson, Hole, Justkowski, & Huych, 1986; Maccoby, Depner, & Mnookin, 1990). Some researchers have indirectly estimated coparenting by comparing mothers' and fathers' childrearing attitudes and beliefs (e.g., Block, 1965; Block, Block, & Morrison, 1981; Vaughn, Block, & Block, 1988); still others have interviewed parents about their perceptions of their partner as a supportive coparent (Frank et al., 1986). Although this research adds to the understanding of parental alliances, it is striking that a naturalistic, behavioral data base about coparenting has not emerged. Thus, the purpose of this investigation is to characterize the nature of coparenting processes using home-based observations of family interaction. Toward this end, a behavior-based classification system designed expressly for measuring naturally occurring coparenting events will be detailed, and evidence pertaining to stability and change in the frequency and style of coparenting over a 6-month period during the 2nd year of life will be presented. …

Favorable outcome in children with Beckwith-Wiedeman syndrome and intraabdominal malignant tumors

Children with Beckwith-Wiedemann syndrome (BWS) have an increased risk of developing Wilms' tumors, hepatoblastomas, and adrenal tumors. This study evaluates disease-free survival in children with BWS and intraabdominal tumors. Sixteen tumors occurred in 13 children with BWS (8 boys, 5 girls). Diagnoses included Wilms' tumor (10) (2 bilateral, 20%), hepatoblastoma (2), bladder rhabdomyosarcoma (1), and adrenal cortical tumor (1). In the 10 children with Wilms' tumor, the average age at diagnosis was 3.5 years (range, 7 months to 5 years). Nine of 10 had initial tumor resection, chemotherapy, and radiation therapy (when indicated). One child with bilateral disease had tumor biopsy, chemotherapy, and partial nephrectomy. Tumors were classified as stage I (5), stage II (2), stage IV (1) and stage V (2), all with favorable histology. Disease-free survival rate was 100% with median follow-up of 9 years (range, 4 to 22 years). One patient had a left adrenal tumor detected during screening sonography 11 years after Wilms' tumor resection. Two infants with advanced-stage hepatoblastoma responded to chemotherapy, allowing subsequent complete hepatic resection. Both tumors had unfavorable histology. Both completed postoperative chemotherapy and have no evidence of disease (NED) with normal alpha-fetoprotein levels at 21 and 12 months, respectively, after tumor detection. One patient with stage III (group 3) bladder rhabdomyosarcoma underwent partial cystectomy following chemoradiation and is alive (NED) after 20 months. Children with BWS should be screened at regular intervals (every 3 to 6 months) for renal, adrenal, and hepatic tumors. The exact duration of screening is not yet determined. Despite an increased risk of tumor occurrence, this study suggests that children with BWS have an improved survival rate (100%). All 13 children are currently alive with NED. BWS may be a favorable biological characteristic for survival.

Good steroid response in vivo predicts a favorable outcome in children with T-cell acute lymphoblastic leukemia. The Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP).

Improved outcome of children with acute lymphoblastic leukemia (ALL) who received intensive chemotherapy was observed by the Italian Association for Pediatric Hematology Oncology (AIEOP). To verify if this improved outcome was also extended to T-cell acute lymphoblastic leukemia (T-ALL) patients after introduction of intensive chemotherapy, treatment responses of 2011 patients, including 184 with T-ALL treated over the decade 1982-1991, were analyzed. Further, the potential use of the association of presenting clinical and biologic features with treatment outcome to determine risk factors that might be useful for planning risk-directed therapeutic studies was analyzed. Of the 2011 children consecutively entered on the three sequential AIEOP trials ('82, '87, and '88), 1528 (76%) had successful immunologic studies of the bone marrow blasts. One hundred eighty-four (12%) had T-ALL. During these studies, four consecutive high-risk ALL treatment protocols (i.e., 8303, 8503, 8703, and 8803) were used. Because the treatment schedule in protocols 8503 and 8703 were almost identical, those patients were grouped together for the purpose of survival analysis. The 137 boys and 47 girls ranged in age from 16 months to 15.5 years (median, 7.8 years) at diagnosis, and 38% had a mediastinal mass. The rates of treatment response [i.e. complete remission (CR) and event free survival (EFS) rates] were compared for patients with T-ALL or B-cell progenitor ALL, overall and by individual study. Presenting features and early response to steroid monotherapy were also tested as possible prognostic factors. Overall, the CR rate was 94%, and the 7-year survival (SE) was 51.9% (4.2). T-ALL patients had a significantly worse outcome than B-lineage ALL patients [7-year EFS 40.4% (5.2) vs. 61.7% (1.7), P < 0.001]. Progressive improvement in EFS for T-ALL patients treated during 1 decade was observed, with 7-year EFS (SE) of 23.2% (8.3) for protocol 8303, 5-year EFS of 39.5% (7.1) for combined protocols 8503-8703, and 54.6% (7.1) for study '88, respectively. The analysis of prognostic factors for T-ALL patients showed that poor in vivo steroid response was the most unfavorable prognostic factor, followed by leukocyte level count > 50 x 10(9)/l (P = 0.04). The EFS for patients with T-ALL and good steroid response [63% (3.0)] was comparable with that of the unselected B-lineage ALL patients. EFS for patient with T-ALL has steadily increased in consecutive AIEOP ALL trials. However T-ALL patients still have a significantly worse EFS compared with patients with B-lineage ALL. Patients with T-ALL and a poor in vivo response to steroid monotherapy represent a particularly high risk treatment group.

Coparenting within the Family System: Influences on Children's Development

Understanding the contributions that different family relationships make to child development presents an imposing challenge. This is due, in part, to the fact that families are complicated systems. Take for example the case of a family with two adults and two children; there are husband-wife, parent-child, and sibling relationships that all play a unique role in children's experiences. Similarly influential forces are present for children's growth within family triads (e.g., parent-child-sibling and parent-parent-child), On the basis of these constellations and the demands inherent within each relationship, the possibilities seem endless for the associations between family relations and individual development. For decades, scholars have conducted extensive theoretical and empirical work to enhance our understanding of the contributions made by these various family relationships to child development. For instance, parenting styles (Baumrind, 1978) and sibling relations (Dunn, 1988) have been found to be systematically associated with children's growth and development. Additionally, links between marital satisfaction and child well-being (e.g., Belsky, Youngblade, Rovine, & Volling, 1991) and parent-sibling relations and child behavior (Dunn & Munn, 1985) have been revealed. Furthermore, the bidirectional nature of parent-child relationships has been explored (Bell, 1968; Belsky, 1990); not only do parents' words and actions influence children's development, the behavioral tendencies of children can make parenting more or less pleasant. Although this body of work has contributed enormously to our understanding of families and child development, questions as to the processes by which these relations play a role in children's lives remain unanswered. The issue of process is especially striking regarding the connections between marriage, parenting, and child development (for a review, see Gable, Belsky, & Crnic, 1992). Researchers have found that harmonious marriages tend to be associated with more sensitive, responsive, and supportive parenting and, in turn, with more favorable child outcomes, such as attachment security and interpersonal competence (Belsky et al., 1991; Howes & Markman, 1989, 1991). Additionally, investigators have reported that troubled marriages are often related to less effective parenting and more problematic child behavior (Kerig, Cowan, & Cowan, 1993). Despite these relations, it must be acknowledged that such associations fluctuate in magnitude and are not uniformly found. In fact, a recent meta-analysis indicated that the mean effect size for the correlation between marital discord and child behavior problems across studies is modest at best (Reid & Crisafulli, 1990). These results prompt a call to redirect efforts in the study of marriage, parenting, and child development. One such move involves going beyond global assessments of marital quality and satisfaction to more domain-specific and process-oriented accounts of marital functioning (Jouriles, Farris, & McDonald, 1991; Jouriles, Murphy, et al., 1991; Vuchinich, Vuchinich, & Wood, 1993). With this notion in mind, the central thesis of this article is that learning about husbands and wives as coparents will serve to further illuminate the processes that link marriage, parenting, and child development. Before we provide a theoretical rationale for investigating the coparenting relationship, a review of background research will be offered. Specifically, we will present a developmental overview of the associations between marriage, parenting, and child development. After this presentation, recent efforts to specify which aspects of the marital relationship are central to understanding the coparenting alliance will be considered. The article will conclude with a discussion of preliminary results from an ongoing study of coparenting processes in families raising firstborn toddler sons. BACKGROUND Previous research has shown that there are positive associations between the quality of marital relations and parenting effectiveness and indicators of children's well-being. …

Malrotation of the intestine.

Malrotation of the intestinal tract is a product of a well defined aberrant embryology. Because the consequences of malrotation associated with a midgut volvulus may be catastrophic, an understanding of the anatomy, diagnostic criteria, and appropriate therapy for this putative emergency illness is imperative. This report summarizes a recent 18-month experience with this diagnosis and contrasts this experience with that in the published literature. More than half (14/22) of the patients presented during the first month of life, and all had vomiting, which in most cases was bilious. The barium upper gastrointestinal series was the preferred diagnostic study, being both sensitive (18/19, 95%) and accurate (18/21, 86%). In this series two-thirds of the patients presented with volvulus (15/22, 68%) of whom five had ischemic intestine requiring resection. One of these children died of overwhelming sepsis. A Ladd procedure was the preferred treatment, which as defined by us includes evisceration and inspection of the mesenteric root, counterclockwise derotation of a midgut volvulus, lysis of Ladd's bands with straightening of the duodenum along the right abdominal gutter, inversion-ligation appendectomy, and placement of the cecum into the left lower quadrant. A high index of suspicion in the neonate with vomiting, rapid diagnosis, and appropriate operative therapy results in a predictable favorable outcome for children with intestinal malrotation.

Favorable Outcomes in Children After Parental Divorce

The present paper is based on a review of the literature that considers the short- and long-term effects parental divorce has on children. Most studies in this literature have identified unfavorable outcomes that develop in many areas of children's lives as they struggle to cope with their changed family situations. However, as children adjust to the challenges they face before, during, and after parental divorce, neutral and favorable outcomes are also possible in one or more areas of their lives. In fact, the literature review indicated that many investigators have identified certain strengths in children who had experienced parental divorce. In particular they have observed that following the divorce of their parents some children, in comparison to peers or their own pre-divorce development, have shown enhanced levels of functioning in four areas: maturity, self-esteem, empathy, and androgyny.

Thoracic neuroblastoma: A pediatric oncology group study

Ninety-six patients with thoracic neuroblastoma were studied in a prospective fashion. Median age at presentation was 0.9 years. Forty-eight percent of the patients presented with stage A disease, 20% stage B, 13% stage C, 17% stage D, and 2% stage DS. Seventy-five patients have been followed for greater than 4 years. A posterior mediastinal mass was diagnosed on incidental chest roentgenograms performed for nontumor-related symptoms in 49% of the cases. Sixteen percent of the cases presented with neurological symptoms and 14% of the patients presented with acute respiratory distress. Urinary catecholamines were elevated in 76% of the cases. Complete surgical resection was carried out in 47% of the cases, while incomplete resection or biopsy was performed in 45%. No operation was performed in 3 patients. Minor surgical complications occurred in 20% of the patients, and 3% of the patients had significant perioperative complications. One patient died as a complication of therapy. Overall actuarial survival was 88% at 4 years. This study confirms the favorable outcome in children with mediastinal neuroblastoma. The basic biology of thoracic neuroblastomas seems to differ from that of other sites in that the majority of patients present at a younger age with localized disease or regional lymph node metastases, and have an improved survival even after correcting for age and stage. While complete excision is recommended, if possible, radical surgical procedures are not indicated since an excellent prognosis is associated with combined modality therapy.