Fetal cardiac axis in tetralogy of Fallot: associations with prenatal findings, genetic anomalies and postnatal outcome.

OBJECTIVE: To compare prenatal findings, associated genetic anomalies and postnatal outcome in fetuses with tetralogy of Fallot (TOF) with normal cardiac axis (CAx) and those with abnormal CAx. METHODS: In this retrospective cohort study, 85 cases diagnosed with TOF by prenatal ultrasound at our clinic between 2005 and 2015 were reviewed. Follow-up ultrasound and postnatal outcome were available for 68 cases. One case complicated with absent pulmonary valve syndrome and a further seven cases diagnosed postnatally with anomalies other than TOF were excluded from the study. The remaining 60 cases of postnatally confirmed TOF were divided according to CAx into two groups: those with normal CAx (n = 33) and those with abnormal CAx (n = 27). CAx was defined as the angle between the interventricular septum and midline of the fetal thorax at the level of the four-chamber view. CAx > 65° or < 25° was considered abnormal. Prenatal sonographic findings, associated genetic anomalies and postnatal outcome were compared between the two groups. RESULTS: Fetuses with TOF and abnormal CAx were more likely to have pulmonary atresia (40.7% vs 15.2%; P = 0.026) and right-sided aortic arch (48.1% vs 21.2%; P = 0.028) than those with normal CAx. Postnatal death occurred in 30.4% of infants with abnormal CAx vs 6.5% with normal CAx (P = 0.028). Incidence of tested genetic anomalies was similar between the two groups. CONCLUSION: In fetuses with TOF, abnormal CAx is associated with the presence of pulmonary atresia, right-sided aortic arch and a higher risk of postnatal death. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Self-efficacy and self-motivation as predictors of weight loss.

The present study was attempted to determine whether self-efficacy and self-motivation would predict outcome in an intensive weight loss program. The subjects included 52 males and 95 females who were at least fifty pounds overweight (mean age = 43 years). The data were analyzed through multiple regression on three separate dependent variables: actual weight loss, adjusted weight loss and percentage of sessions attended. Outcome was predicted based on the following variables: self-efficacy (as measured by confidence estimates and outcome expectancies) and self-motivation (as measured by the Self-Motivation Inventory). The predictors accounted for 32.2% (p less than .01) of the variance in actual weight loss, 8.5% (p less than .01) of the variance in adjusted weight loss and none of the variance in percentage of sessions attended. Self-motivation did not correlate significantly with either actual or adjusted weight loss, while self-efficacy measures did. However, the correlation of the two self-efficacy measures (r = -.07, p greater than .05) suggests that these variables do not constitute a unitary construct and should be conceptualized as independent predictors. These findings suggest that confidence estimates and outcome expectancies are useful predictors of weight loss.