Disparities in the prenatal detection of critical congenital heart disease.

OBJECTIVES: Prenatal diagnosis of critical congenital heart disease, which requires surgical or catheter intervention in the first 30 days of life, allows for delivery at a specialized center and can reduce preoperative morbidity and mortality. We sought to identify the risk factors for a missed prenatal diagnosis of critical congenital heart disease. METHODS: Patients presenting to the Children's Hospital of Wisconsin with critical congenital heart disease from 2007 to 2013 were included. Those with a prenatal diagnosis were compared with those with a postnatal diagnosis. RESULTS: The cohort included 535 patients with prenatal diagnosis made in 326 (61%). The prenatal diagnostic rate improved from 44% in 2007 to 69% in 2013. Independent factors associated with a postnatal diagnosis were a lesion that required a view other than a four chamber view to make the diagnosis (p < 0.0001), absence of another organ system anomaly (p < 0.0001), and living in a higher poverty (p = 0.02) or lower population density communities (p = 0.002). CONCLUSIONS: While the prenatal diagnostic rate for critical congenital heart disease is improving, those living in impoverished or rural communities are at highest risk of not having a diagnosis made prenatally. Interventions to improve prenatal detection of congenital heart disease should target these vulnerable areas.

Self-concept and need for achievement of men with physical disabilities.

Self-concept and need for achievement of athletically active and relatively inactive American males with physical disabilities were investigated using the Tennessee Self-Concept Scale Counseling Form (Fitts, 1965) and the Thematic Apperception Test (McClelland, Clark, Roby, & Atkinson, 1949). The subjects were 45 men, ranging from 18 to 40 years old, with physical disabilities. We hypothesized that subjects in the athletically active group had a more favorable mean self-concept and a higher mean need for achievement than subjects in the inactive group. Fifty able-bodied subjects, composing two counterpart groups, were also included in the study. It was hypothesized that the differences regarding the criterion variables between disabled and able-bodied counterpart groups would be negligible. The results of an analysis of variance (ANOVA) and an analysis of covariance (ANCOVA) supported the hypothesis that predicted significant differences at the .025 alpha level between the athletic and the inactive disabled groups. Age, education, and level of disability were treated as covariates. The results of this study also supported the hypothesis that predicted negligible differences (p less than .10) between the disabled subjects and the able-bodied counterpart groups.

Illicit drug use and consumption of alcohol, tobacco, and over-the-counter medicine among adolescents.

Over 9,000 junior and senior high school students in 79 schools in 10 cities completed an anonymous questionnaire concerning use of and attitudes toward licit and illicit drugs. Single and multivariate analyses indicated strong and statistically significant relationships between the consumption of alcohol, tobacco, and over-the-counter medicines and experience with illicit drugs. Also, the user of illicit drugs is also a relatively frequent user of licit drugs--alcohol, tobacco, and over-the-counter medications. The user is more likely than the nondrug user to be a "trier," if not a consistent consumer, of a variety of different substances. The patterns of relationships held across cities, types of schools, and age levels, and distinguished between those ever using illicit drugs vs never using them, present vs former users, and single vs polydrug users. Various alternative explanations are discussed.