Children of the new reproductive technologies: social and genetic parenthood.

OBJECTIVE: To review empirical studies on families created by new reproductive technologies (NRT) in which only one parent has a genetic link to the child. METHODOLOGY: Literature search was conducted among computerized databases. Inclusion criteria were that studies should focus on childrearing or parenting, as well as on the psychological adjustment of children in: heterosexual families formed through artificial insemination with donated semen (AID), single-mother AID families, oocyte-donation families, planned lesbian-mother families, planned gay-father families, and partial surrogacy families. RESULTS: Compared to natural-conception parents, parents in these NRT families have better relationships with their children, and their children are functioning well. CONCLUSION: Although several studies show that parents in NRT families are more emotionally involved in their parenting than are parents in naturally conceived families, no empirical evidence was found that the psychological adjustment of children in NRT families differs from that of their counterparts in natural-conception families. PRACTICAL IMPLICATION: The results inform counselors and infertile couples that concerns regarding the use of NRT in relation to negative consequences for the parent-child relationship or the psychological adjustment of the child are till now unfounded.

The Impact of Having a Baby on the Level and Content of Women's Well-Being.

The primary objective of this study was to more fully understand the impact of having a baby on women's well-being by attending to both the level and the content of well-being. To cover the judgemental and affective aspects of well-being we included global measures of life satisfaction and well-being and affective experience measures derived from the day reconstruction method. In a sample of 19 first-time mothers no differences between pre and postnatal reports of general life satisfaction, depression, anxiety, and experienced positive and negative affect were found, suggesting that the arrival of the newborn baby does not universally impact on women's level of well-being. Changes in the content of well-being were studied by examining changes in the way women experience specific activities and interactions with various social partners. There appeared to be an upward shift in experienced positive affect during active leisure and a slight decrease in negative affect during time spent with relatives. The results are discussed in light of previously documented changes across the transition to motherhood in negative mood states, time use, women's evaluation of various aspects of daily life, and relational satisfaction.

Family relationships and the psychosocial adjustment of school-aged children in intact families.

The authors investigated whether the quality of three family relationships (i.e., marital, parent-child, sibling) in intact families are associated with each other and with children's psychosocial adjustment. Data were collected by means of maternal and child reports (N = 88) using standardized instruments (i.e., Marital Satisfaction Scale, Strengths and Difficulties Questionnaire). The findings confirm associations between the marital and the parent-child relationship, and between the parent-child and the sibling relationship, Further, both father-child relationships and sibling relationships predict children's adjustment. Father-child conflicts contribute to children's problem behavior, while father-child acceptance and sibling affection contribute significantly to children's general self-esteem. However, contrary to previous studies no support was found for the association between marital relationship and sibling relationship, or for that between marital relationship quality and children's adjustment.

Experience as a doctor in the developing world: does it benefit the clinical and organisational performance in general practice?

BACKGROUND: Many physicians have medical experience in developing countries early in their career, but its association with their medical performance later is not known. To explore possible associations we compared primary care physicians (GPs) with and without professional experience in a developing country in performance both clinical and organisational. METHODS: A retrospective survey using two databases to analyse clinical and organisational performance respectively. Analysis was done at the GP level and practice level.517 GPs received a questionnaire regarding relevant working experience in a developing country. Indicators for clinical performance were: prescription, referral, external diagnostic procedures and minor procedures. We used the district health insurance data base covering 570.000 patients. Explorative secondary analysis of practice visits of 1004 GPs in 566 practices in the Netherlands from 1999 till 2001. We used a validated practice visit method (VIP; 385 indicators in 51 dimensions of practice management) to compare having experience in a developing country or not. RESULTS: Almost 8% of the GPs had experience in a developing country of at least two years.These GPs referred 9,5% less than their colleagues and did more surgical procedures. However, in the multivariate analysis 'experience in a developing country' was not significantly associated with clinical performance or with other GP- and practice characteristics. 16% of the practices a GP or GPs with at least two years experience in a developing country. They worked more often in group and rural practices with less patients per fte GP and more often part-time. These practices are more hygienic, collaborate more with the hospital and score better on organisation of the practice. These practices score less on service and availability, spend less time on patients in the consultation and the quality of recording in the EMD is lower. CONCLUSIONS: We found interesting differences in clinical and organisational performance between GPs with and without medical experience in developing countries and between their practices. It is not possible to attribute these differences to this experience, because the choice for medical experience in a tropical country probably reflects individual differences in professional motivation and personality. Experience in a developing country may be just as valuable for later performance in general practice as experience at home.

The experiences of involuntarily childless Turkish immigrants in the Netherlands.

The consequences of involuntary childlessness are influenced by culture in several ways. In this study we explored the experiences and responses of infertile Turkish immigrants in the Netherlands. Twenty in-depth interviews were conducted with involuntarily childless Turkish immigrants in the Netherlands (11 couples and 9 women). Interviews were transcribed verbatim and were analyzed using interpretative phenomenological analysis (IPA). The respondents' experiences were clustered around six superordinate themes: effects on self; effects on the relationship with the partner; effects on the relationship with others; disclosure; coping; and the future. Most transcripts revealed that involuntary childlessness has a profound negative influence on multiple aspects of the lives of the respondents. Strong pronatalist ideology, misconceptions about infertility and treatment, and migration-related aspects such as language difficulties, appear to play a role in the negative experiences of Turkish immigrants. Respondents reported several ways of coping (to some extent) with these negative experiences.

The USA National Longitudinal Lesbian Family Study (NLLFS): homophobia, psychological adjustment, and protective factors.

The study assessed the influence of protective factors on the psychological adjustment of children who had experienced homophobia and whose mothers were participants in a longitudinal study of planned lesbian families. Data were collected as part of the National Longitudinal Lesbian Family Study by interviewing the children and having the mothers complete questionnaires. No significant differences were found in the psychological adjustment of children in the present study and their age-matched peers in a U.S.-population sample. Homophobia had a negative impact on the well-being of children who experienced it. Attending schools with LGBT curricula and their mothers' participation in the lesbian community were found to protect children against the negative influences of homophobia.

Children in planned lesbian families: a cross-cultural comparison between the United States and the Netherlands.

A total of 78 planned lesbian families in the United States were compared with 74 planned lesbian families in the Netherlands. Children were interviewed about disclosure to peers about living in a lesbian family and about their experiences of homophobia; mothers filled out the Child Behavior Checklist (CBCL). Results showed that Dutch children were more open about growing up in a lesbian family, experienced less homophobia, and demonstrated fewer emotional and behavioral problems than American children. Homophobia was found to account for part of the difference in psychosocial adjustment between the Dutch and the American children.

Children in planned lesbian families: stigmatisation, psychological adjustment and protective factors.

The study assessed the extent to which children between eight and 12 years old in planned lesbian families in the Netherlands experience stigmatization, as well as the influence of protective factors (relationship with parents, social acceptance by peers, contact with children from other families headed by lesbian mothers or gay fathers) on their psychological adjustment (conduct problems, emotional symptoms, hyperactivity, self-esteem). Data were collected by questionnaires filled out by the mothers and by the children themselves. The children in the sample generally reported low levels of stigmatization. However, boys more often reported that, in their view, they were excluded by peers because of their non-traditional family situation. Girls more often reported that other children gossiped about the fact that they had two lesbian mothers. Higher levels of stigmatization were associated with more hyperactivity for boys and lower self-esteem for girls. Having frequent contact with other children who have a lesbian mother or gay father protects against the negative influence of stigmatization on self-esteem. Findings support the idea that children in planned lesbian families benefit from the experience of meeting other children from similar families.

Emotional distress and infertility: Turkish migrant couples compared to Dutch couples and couples in Western Turkey.

The present study investigates cultural differences in the effects of infertility on emotional distress. The study compares emotional distress among infertile people in three samples: Turkish migrants (n = 58), Turkish people living in Western Turkey (n = 46), and Dutch people (n = 199). Participants answered structured questionnaires on self-image, blame-guilt, sexual problems, depression, anxiety, and anger-hostility. Separate analyses were conducted for men and women. In general, the levels of emotional distress were higher for infertile Turkish migrant women and infertile Turkish women than they were for infertile Dutch women. Turkish migrant women reported more self-image problems and fewer feelings of blame-guilt than did Turkish women. Among men, Turkish migrant men showed the highest overall levels of emotional distress, and Dutch men showed the lowest. Our results indicate that the experience of infertility among Turkish migrants is more similar to those of Turkish people than it is to that of Dutch people, especially among women. The importance of having children in the different cultures may offer a possible explanation for these findings.

Child adjustment and parenting in planned lesbian-parent families.

One hundred planned lesbian-parent families (i.e., two-mother families in which the child was born to the lesbian relationship) were compared with 100 heterosexual-parent families on child adjustment, parental characteristics, and child rearing. Questionnaires, observations, and a diary of activities were used to collect the data. The results show that especially lesbian social mothers (i.e., nonbiological mothers) differ from heterosexual fathers on parental characteristics (e.g., more parental justification and more satisfaction with the partner as coparent) and child rearing (e.g., more parental concern and less power assertion). Child adjustment is not associated with family type (lesbian-parent families vs. heterosexual-parent families), but is predicted by power assertion, parental concern, and satisfaction with the partner as coparent.

Attitudes towards sex selection in the Western world.

It appears that in most Western countries, son preference is somewhat stronger than daughter preference. However, when one considers the preference of women it looks as though the opposite pattern is emerging. There is a considerable social acceptance of 'light' methods of sex selection (such as diets), even though these methods are not proven to be effective. The inclination to use sperm separation methods appears to be greater in the United States than in some European countries. There are indications that a preference for boys or for girls is associated with attitudes towards technology, child-rearing style and the stereotyping of boys or girls.

Long-term prognosis of acute otitis media in infancy: determinants of recurrent acute otitis media and persistent middle ear effusion.

OBJECTIVES: Children under 2 years of age with acute otitis media are known to have a relatively poor prognosis. The objective of this study was to assess whether known determinants for recurrent acute otitis media and persistent middle ear effusion after an episode of acute otitis media during childhood also apply to children under 2 years. STUDY DESIGN: prospective study of 210 children under 2, with identification of potential prognostic determinants. Univariate and multivariate logistic regression analyses were applied to evaluate which parameters independently contributed to the prediction of both outcome measures (recurrent acute otitis media and persistent middle ear effusion). A prognostic function was developed, and the area under the receiving operating characteristic (ROC) was used to estimate the predictive ability of the prognostic models. POPULATION: children under 2 years of age with an episode of acute otitis media in family practice. OUTCOMES MEASURED: recurrent acute otitis media and persistent middle ear effusion. RESULTS: For the outcome recurrent acute otitis media data from 210 children were used and winter season, male sex, passive smoking and persistent symptoms for more than 10 days at presentation were independent prognostic determinants. For the outcome persistent middle ear effusion data from 190 children were used and winter season, bilateral disease at entry, a sibling history of recurrent acute otitis media, and a previous episode of acute otitis media independently predicted the outcome. No sufficiently discriminatory prognostic model could be constructed for either outcome measure. CONCLUSION: Prediction of recurrent acute otitis media or persistent middle ear effusion in individual young children remains poor.

Late parenthood among subfertile and fertile couples: motivations and educational goals.

OBJECTIVES: The percentage of first birth among women and men in their early thirties is growing rapidly. Personal development is considered as an important factor for postponement of having children. Also, subfertility may lead to late parenthood. METHODS: In this study 72 younger and 154 older first time parents in the Netherlands answered a questionnaire regarding parenthood. Subfertile parents and fertile parents were separately analysed. RESULTS: Both fertile and subfertile mothers expressed a lesser desire to have a child than younger ones. Older fertile mothers valued the personal development of their children as more important than younger fertile mothers. Also, older fertile mothers had less traditional reasons for motherhood and reported less feminine characteristics. Younger fertile fathers assessed the future material success of their child as less important than older ones. Also, they reported less feminine characteristics. CONCLUSION: There is more common ground than differences between younger and older first-time mothers. PRACTICE IMPLICATIONS: Counselors should be aware that there appears to be no ground to fear that having children in the age of 30 and 40, has negative effects regarding parenting.

Experience of parenthood, couple relationship, social support, and child-rearing goals in planned lesbian mother families.

BACKGROUND: The phenomenon of planned lesbian families (i.e., two-mother families in which the child was born to the lesbian relationship) is relatively new and very little research has been conducted among those families. The overall aim of this research was to examine whether planned lesbian mother families differ from heterosexual families on factors that are assumed to influence the parent-child relationship, such as experience of parenthood, child-rearing goals, couple relationship, and social support. METHOD: A hundred lesbian two-mother families were compared with 100 heterosexual families having naturally conceived children. A variety of measures were used to collect the data, including questionnaires and a diary of activities kept by the parents. RESULTS: Lesbian parents are no less competent or more burdened than heterosexual parents. Both lesbian and heterosexual parents consider it important to develop qualities of independence in their child. However, 'conformity' as a child-rearing goal is less important to lesbian mothers. Furthermore, lesbian social mothers feel more often than fathers in heterosexual families that they must justify the quality of their parenthood. CONCLUSION: There are few differences between lesbian couples and heterosexual couples, except that lesbian mothers appear less attuned to traditional child-rearing goals and lesbian social mothers appear more to defend their position as mother.

Clinical efficacy of three common treatments in acute otitis externa in primary care: randomised controlled trial.

OBJECTIVE: To compare the clinical efficacy of ear drops containing acetic acid, corticosteroid and acetic acid, and steroid and antibiotic in acute otitis externa in primary care. DESIGN: Randomised controlled trial. SETTING: 79 general practices, Netherlands. PARTICIPANTS: 213 adults with acute otitis externa. PRIMARY OUTCOME: duration of symptoms (days) according to patient diaries. Secondary outcome: cure rate according to general practitioner completed questionnaires and recurrence of symptoms between days 21 and 42. RESULTS: Symptoms lasted for a median of 8.0 days (95% confidence interval 7.0 to 9.0) in the acetic acid group, 7.0 days (5.8 to 8.3) in the steroid and acetic acid group, and 6.0 days (5.1 to 6.9) in the steroid and antibiotic group. The overall cure rates at seven, 14, and 21 days were 38%, 68%, and 75%, respectively. Compared with the acetic acid group, significantly more patients were cured in the steroid and acetic acid group and steroid and antibiotic group at day 14 (odds ratio 2.4, 1.1 to 5.3, and 3.5, 1.6 to 7.7, respectively) and day 21 (5.3, 2.0 to 13.7, and 3.9, 1.7 to 9.1, respectively). Recurrence of symptoms between days 21 and 42 occurred in 29% (50/172) of patients and was seen significantly less in the steroid and acetic acid group (0.3, 0.1 to 0.7) and steroid and antibiotic group (0.4, 0.2 to 1.0) than in the acetic acid group. CONCLUSIONS: Ear drops containing corticosteroids are more effective than acetic acid ear drops in the treatment of acute otitis externa in primary care. Steroid and acetic acid or steroid and antibiotic ear drops are equally effective.

Planned lesbian families: their desire and motivation to have children.

BACKGROUND: There is no information about the desire and motivation for children among planned lesbian families. The overall aim of this research was to examine whether planned lesbian families differ from heterosexual families in desire and motivation to have a child. The reason for studying this is that desire and motivation to have children are characteristics that are supposed to effect parenting and the parent-child relationship. METHODS: A total of 100 lesbian two-mother families were compared with 100 heterosexual families. All data were collected by means of questionnaires. RESULTS: Lesbian parents and heterosexual parents rank their parenthood quite similarly; however, happiness is significantly more important for lesbian mothers than it is for heterosexual parents and identity development is less important for lesbian mothers than it is for heterosexual parents. Furthermore, compared with heterosexual parents, lesbian parents had spent more time thinking about their motives for having children, and their desire to have a child was stronger. CONCLUSIONS: Lesbian parents especially differ from heterosexual parents in that their desire to have a child is much stronger. The study's findings may be helpful for counsellors in their work to inform and assist lesbian couples in their decision to have a child.

Outpatient antibiotic prescriptions from 1992 to 2001 in the Netherlands.

OBJECTIVES: Although Dutch outpatient antibiotic prescription rates are low compared with other European countries, continuing to scrutinize trends in outpatient antibiotic use is important in order to identify possible increases in antibiotic use or inappropriate increases in the use of particular classes of antibiotics. METHODS: We assessed the volume of Dutch outpatient antibiotic prescriptions from 1992 to 2001 by calculating the mean number of outpatient antibiotic prescriptions (indicating the number of times physicians decide to prescribe an antibiotic agent) per 1000 patients insured by the Dutch Sickness Fund per year, according to subgroups (narrow-spectrum penicillins, broad-spectrum penicillins, tetracyclines, macrolides, sulphonamides and trimethoprim, and quinolones). Data were obtained from the Dutch Drug Information Project/Health Care Insurance Board. RESULTS: The total volume of outpatient antibiotic prescriptions in 2001 was 394 prescriptions per 1000 patients insured by the Dutch Sickness Fund. Overall, the rates were stable between 1992 and 2001, with small variations across years, but with marked differences in volumes within antibiotic groups across these years: a decrease in prescribing of narrow-spectrum penicillins (-29%), amoxicillin (-23%), tetracycline (-24%), doxycycline (-19%) and trimethoprim and derivatives (-45%) was accompanied by an increase in prescribing of co-amoxiclav (+85%), macrolides (+110%) and quinolones (+86%). CONCLUSIONS: The international trend of a decline in the use of narrow-spectrum and older penicillins and prescribing more broad-spectrum and new chemotherapeutics was shown to exist in a low prescribing country, The Netherlands. Therefore, inappropriate antibiotic prescribing should remain prominent on the research agenda in intervention studies in order to improve the appropriate selection of antibiotic class and to reduce the prescription of antibiotics.

Son preference, sex selection, and the "new" new reproductive technologies.

Throughout recorded history, humans have tried to influence the sex of their offspring, through pregnancy injunctions, infanticide, and infant/child neglect. Reproductive technologies developed in the late 20th century allow determination of the sex of the offspring during pregnancy, making "sex selection" through abortion possible. Especially in parts of East and South Asia, sex selection against female fetuses has had dramatic consequences for male/female sex ratios. However, "newer" new reproductive technologies, such as prenatal genetic diagnosis and DNA-weighted semen selection, can now be applied for sex selection; eventually, the latter technology may become easily accessible as a noninvasive method. The prospects of these new technologies for sex selection must be considered in the light of cultural values surrounding son preference / daughter discrimination in many parts of the world, most notably Asia, as well as preferences for a "gender-balanced" family in much of the West. The ethical issues surrounding these technologies, such as the right to life and the equal treatment of female children, are potentially profound, but legislating the appropriate use of these "newest" new reproductive technologies will be difficult.