Personal experiences of bereaved twins, parents of twins, and their carers.

We invited bereaved twins, parents of twins and carers to describe some of their personal experiences. We are grateful to all of them for their brave candour. We gave extra space to Kathy's story about the impacts of the loss of her own twin because it vividly illustrates the profound connections twinship can generate. Similarly we thought the cruelly long and complex saga of the life and death of Maxine's twins could help understanding of the distressing repercussions that often attend the low birth weight and prematurity that are so common amongst multiple births.     

Genetic analysis of indicators of cholesterol synthesis and absorption: lathosterol and phytosterols in Dutch twins and their parents.

Significant familial aggregation was observed for plasma levels of lathosterol (an indicator of whole-body cholesterol synthesis) and plant sterols campesterol and beta-sitosterol (indicators of cholesterol absorption) in 160 Dutch families consisting of adolescent mono- and dizygotic twin pairs and their parents. For lathosterol a moderate genetic heritability in parents and offspring (29%) was found. In addition, shared environment also contributed significantly (37%) to variation in plasma lathosterol concentrations in twin siblings. However, a model with different genetic heritabilities in the two generations (10% in parents and 68% in offspring) fitted the data almost as well. For plasma plant sterol concentrations high heritabilities were found. For campesterol heritability was 80% and for beta-sitosterol it was 73%, without evidence for differences in heritability between sexes or generations. No influence of common environmental influences shared by family members was seen for either campesterol or beta-sitosterol. Taken together, these results confirm and expand the hypothesis that individual differences in plasma levels of noncholesterol sterols are moderately (lathosterol) to highly (plant sterols) heritable.     

Genetic and environmental influences on the relationship between aggression and hyperactivity-impulsivity as rated by teachers and parents.

This study examined genetic and environmental contributions to the covariance between aggression and hyperactivity-impulsivity as rated by twins' teachers and parents. Sex-differences in these genetic and environmental contributions and rater bias/sibling interaction effects were of interest as well. Part of an ongoing nation-wide twin-family study of behavioral development and health habits, the sample consisted of 1636 Finnish twin pairs ascertained from five consecutive and complete twin birth cohorts. Data were collected at ages 11-12, using teacher and parental rating forms of the Multidimensional Peer Nomination Inventory. Bivariate analyses were performed using structural equation modeling allowing sex-limitation effects. Results show that, in addition to significant genetic and environmental influences specific to each behavior, aggression and hyperactivity-impulsivity share common genetic and environmental etiology. Results provide evidence that both genetic and environmental factors are important in creating the observed correlation between aggression and hyperactivity-impulsivity.     

Feelings and the need for information and counselling of expectant parents of twins.

In this study, expectant parents of twins were questioned about their feelings and need for information and counselling on the parenting of twins. Data were obtained from self-rating questionnaires and an interview with the expectant mother. From the results it is argued that expectant parents of twins need specific information and counselling about the medical, emotional and parenting issues of having twins. Guidelines for organising this counselling are proposed.     

Small for gestational age as a predictor of behavioral and learning problems in twins.

The study examines the effects of being born small for gestational age (SGA) on rates of behavioral problems in twins and siblings, utilising data from the Australian Twin Study of disruptive behavior disorders in twins and their siblings. Participants were 3944 twins and their siblings who were assessed at two intervals three years apart. At the first assessment (1991), they ranged between 4 and 12 years of age. Items assessing Attention Deficit/Hyperactivity Disorder were based on DSM-III-R criteria (Time 1) and DSM-IV criteria (Time 2). Other measures included history of speech and reading therapy, demographic information and obstetric and neonatal history. Results indicated that both male and female twins, who were extremely growth restricted (small for gestational age up to the third percentile-WGA3) showed more inattention, and poorer speech and reading scores. The effects were greater for males. Male twins who were small for gestation age, up to the 10th percentile, were more likely to have a DSM-IV diagnosis of Inattention. Implications of these results included WGA3 male twins being at a "triple disadvantage" for subsequent behavioral and learning problems, in that being male, being a twin and being small for gestational age are all significant factors. Recommendations are made for early intervention for low birthweight male twins. The study is consistent with recent follow-up studies of very-low-birthweight singletons, indicating male disadvantage in cognitive outcome. While there is some genetic component to SGA, it does constitute a potentially major contribution to common environmental effects that must be considered in twin-based genetic analyses.     

Why zygosity of multiple births is not always obvious: an examination of zygosity testing requests from twins or their parents.

This paper examines why parents of twins or adult twins themselves request zygosity testing. Of 405 multiples including 8 sets of triplets, the majority (93%) were monozygotic. Age of testing ranged from 0 days to 73 years. About 50% of requests came from parents or twins who were curious about, or expressed a need to be certain of, their zygosity. Other reasons included health concerns (current or future), other twins in the family, and misinformation about zygosity, frequently because of the erroneous assumption that all dichorionic twins are dizygotic. Parents of monozygotic twins may expect their twins to be 'identical' and believe their twins to be dizygotic because of minor phenotypic differences between them. Dizygotic twins like other siblings may share a phenotypic resemblance. Health professionals should be aware that zygosity of multiples may not always be obvious to parents and that accurate knowledge of zygosity may be justified.     

Special twin environments, genetic influences and their effects on the handedness of twins and their siblings.

It has been suggested that twinning may influence handedness through the effects of birth order, intra-uterine crowding and mirror imaging. The influence of these effects on handedness (for writing and throwing) was examined in 3657 Monozygotic (MZ) and 3762 Dizygotic (DZ) twin pairs (born 1893-1992). Maximum likelihood analyses revealed no effects of birth order on the incidence of left-handedness. Twins were no more likely to be left-handed than their singleton siblings (n = 1757), and there were no differences between the DZ co-twin and sibling-twin covariances, suggesting that neither intra-uterine crowding nor the experience of being a twin affects handedness. There was no evidence of mirror imaging; the co-twin correlations of monochorionic and dichorionic MZ twins did not differ. Univariate genetic analyses revealed common environmental factors to be the most parsimonious explanation of familial aggregation for the writing-hand measure, while additive genetic influences provided a better interpretation of the throwing hand data.     

The occurrence of twins and accompanying behavioural changes in the banded langur,Presbytis melalophos

The occurrence of twins in arboreal Old World monkeys and apes is extremely rare. A wild adult femalePresbytis melalophos, however, gave birth to female twins. This stimulated many patterns of behaviour which were rare or absent when single infants were born. Allomothering increased greatly and maltreatment of twins by allomothers was common, even though this was never observed with single infants. Results indicate that the amount of allomothering inP. melalophos is normally controlled by the mother rather than by potential allomothers. The behaviour of the twins also differed from that of single infants. Except when they were taken by allomothers, the twins moved away from their mother much less than did single infants by their second month of life.     

GP registrars as teachers: a survey of their level of involvement and training

The role of general practice in medical education is increasing both at the undergraduate and postgraduate level. There is a paucity of evidence as to the level of involvement of GP registrars and their training to teach. Two hundred and forty one GP trainees in the Peninsula Deanery were surveyed as to their current level of involvement in teaching and their training to provide it. Seventy eight completed surveys were returned and these revealed that 62% were regularly involved in teaching but only 41% had ever received any training in this area. There was a strong feeling that teaching was an important skill for GPs with 92% of trainees wanting further training in this area. There is clearly a need for further research in this area both to identity whether this sample is representative of the situation nationally and to determine how best to equip trainees in their roles as educators now and in the future.     

Three young children with Smith-Magenis syndrome: their distinct, recognisable behavioural phenotype as the most important clinical symptoms

We report on the development and behaviour of three young children with Smith-Magenis syndrome (SMS), del 17p11.2. The behaviour problems and the psychomotor delay in preschool children with SMS are often more striking than the dysmorphic features and can serve as a useful clue to the diagnosis. We compare the behaviour with reported data. The behaviour problems in the three four year olds include very demanding behaviour, severe temper tantrums, hyperactivity, aggressive behaviour, self injurious behaviour, sleeping problems and stereotypic behaviour. Head banging, hand, wrist or finger biting are present. Onychotyllomania is not observed. Insertion of objects in the mouth as well as excessive nose picking is very frequent, although polyembolokoilomania is not present. The so called self hug when excited is present in one child. The behaviour problems and psychomotor delay represent a major management problem for the parents.     

Philosophy behind science. Confirming affectivity, the dawn of human life: the pre-, peri- and postnatal affective-confirming. Haptonomic accompaniment of parents and their child

This article gives a short introduction to the science of Haptonomy and more specially to the application of its specific phenomenality of psychotactile affective contact and interaction during prenatal and postnatal life and during childbirth. The neurophysiological implications and the influence of this approach on the pain threshold are briefly mentioned, as well as psychological influences on the postnatal development of the child. Finally, there is a critical commentary on the use of the ultra-sound scan.     

What worries parents when their preschool children are acutely ill,and why: a qualitative study.

OBJECTIVE: To identify and explore parents'' concerns when young children become acutely ill. DESIGN: Qualitative study making use of semi-structured one to one and group interviews with parents of preschool children. SETTING: Disadvantaged inner city community. SUBJECTS: 95 parents of preschool children. RESULTS: Fever, cough, and the possibility of meningitis were parents'' primary concerns when their children became acutely ill. Parents'' concerns reflected lay beliefs, their interpretation of medical knowledge, and their fears that their child might die or be permanently harmed. Parents worried about failing to recognise a serious problem. Concerns were expressed within the context of keenly felt pressure, emphasising parents'' responsibility to protect their child from harm. They were grounded in two linked factors: parents'' sense of personal control when faced with illness in their child and the perceived threat posed by an illness. CONCLUSIONS: Better understanding of parents'' concerns may promote effective communication between health professionals and parents. Modification of parents'' personal control and perceived threat using appropriate information and education that acknowledge and address their concerns may be a means of empowering parents.     

Laron-type dwarfism: heterogeneity of the biochemical abnormality in 3 children and their parents

The authors report three cases of Laron-type dwarfism (LTD) having clinical features similar to those of congenital growth hormone (GH) deficiency, but with high levels of plasma GH and a lack of effect of exogenous GH on their growth. The main plasma growth hormone binding protein (GHBP), recently identified and considered as being identical to the extracellular part of the cell receptor to GH, was absent in two of the three patients, and lower than normal in their parents, suggesting a defect of the cell GH receptor. The third patient and his parents had a normal level of GHBP, suggesting a defect limited to the intracellular domain of the receptor or lying beyond the receptor. The conclusion is that there are two different biochemical abnormalities corresponding to LTD.     

By way of introduction: modelling living systems, their diversity and their complexity: some methodological and theoretical problems

Some principles for a current methodology for biological systems' modelling are presented. It seems possible to promote a model-centred approach of these complex systems. Among present questions, the role of mechanisms producing random or quasi-random issues is underlined, because they are implied in biological diversification and in resulting complexity of living systems. Now, biodiversity is one of our societies' and scientific research's main concerns. Basically, it can be interpreted as a manner, for Life, to resist environmental hazards. Thus, one may assume that biodiversity producing mechanisms could be selected during evolution to face to corresponding risks of disappearance: necessity of chance? Therefore, analysing and modelling these ‘biological and ecological roulettes’ would be important, and not only their outputs like nowadays by using the theory of probabilities. It is then suggested that chaotic behaviours generated by deterministic dynamical systems could mimic random processes, and that ‘biological and ecological roulettes’ would be represented by such models. Practical consequences can be envisaged in terms of biodiversity management, and more generally in terms of these ‘roulettes’ control to generate selected biological and ecological events' distribution. To cite this article: A. Pavé, C. R. Biologies 329 (2006).     

Health problems of anaesthetists and their families in the West Midlands.

A survey of all anaesthetists in the West Midlands region--that is, 10% of all the anaesthetists in England and Wales--showed that one in 10 of their children had been referred to a consultant because of a congenital or nonacquired anomaly. Abortions among anaesthetists'' families were also common but more so when the mother was an anaesthetist. The anomalies were concentrated particularly in the central nervous system and musculoskeletal system, and girls were worst affected. The mean birth weights were below normal, more so when the mothers were anaesthetists. Girls with anomalies were particularly underweight. Other effects observed were unexpected infertility, cancer both in the adults and in the children, and, possibly, impaired intellectual development in the children. Many anaesthetising areas were inadequately ventilated, and scavenging devices despite their inefficiency are recommended as a stopgap measure. The results of the study closely resemble those of other studies with similar high response rates to requests for information.