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As parents rely on an increasingly complex patchwork of care giving arrangements, one aspect of children's early care experiences that may be associated with both children's and parent's well being is the complexity of the child care arrangements. Participants in a low-income sample and in a migrant farm working family sample participated in home-based interviews. Participants in the sample of low-income mothers included 85 mothers of infants who ranged in age from 3 to 20 months (mean = 11.4 months, sd = 5). Participants in the migrant farm working sample included 83 mothers of infants age one to eighteen months (mean = 9.8 months, sd = 4.2). For the low-income sample, maternal depression was significantly predicted from a greater number of child-care arrangements, greater transportation difficulties to the child-care arrangements, and lower ratings of the quality of the child-care, even when household income and child characteristics were controlled. For the mothers from migrant farm working families, however, there were no significant associations between maternal depression and these variables. (Contains 14 tables.)

As the Russian Space Agency (RSA) and the U.S. National Aviation and Space Administration (NASA) began in the mid 1990s to plan a preliminary cooperative flight program in anticipation of the International Space Station, programmatic and philosophical differences became apparent in the technical and medical approaches of the two agencies. This paper briefly describes some of these differences and the process by which the two sides resolved differences in their approaches to the medical selection and certification of Shuttle-Mir crew members. These negotiations formed the basis for developing policies on other aspects of the medical support function for international missions, including crew training, preflight and postflight data collection, and rehabilitation protocols. The experience gained through this cooperative effort has been invaluable for developing medical care capabilities for the International Space Station.

Because of the time and distance involved in returning a patient from space to a definitive medical care facility, the capability for Advanced Cardiac Life Support (ACLS) exists onboard Space Station Freedom. Methods: In order to evaluate the effectiveness of terrestrial ACLS protocols in microgravity, a medical team conducted simulations during parabolic flights onboard the KC-135 aircraft. The hardware planned for use during the MTC phase of the space station was utilized to increase the fidelity of the scenario and to evaluate the prototype equipment. Based on initial KC-135 testing of CPR and ACLS, changes were made to the ventricular fibrillation algorithm in order to accommodate the space environment. Other constraints to delivery of ACLS onboard the space station include crew size, minimum training, crew deconditioning, and limited supplies and equipment. Results: The delivery of ACLS in microgravity is hindered by the environment, but should be adequate. Factors specific to microgravity were identified for inclusion in the protocol including immediate restraint of the patient and early intubation to insure airway. External cardiac compressions of adequate force and frequency were administered using various methods. The more significant limiting factors appear to be crew training, crew size, and limited supplies. Conclusions: Although ACLS is possible in the microgravity environment, future evaluations are necessary to further refine the protocols. Proper patient and medical officer restraint is crucial prior to advanced procedures. Also emphasis should be placed on early intubation for airway management and drug administration. Preliminary results and further testing will be utilized in the design of medical hardware, determination of crew training, and medical operations for space station and beyond.

The microgravity environment presents several challenges for delivering effective cardiopulmonary resuscitation (CPR). Chest compressions must be driven by muscular force rather than by the weight of the rescuer's upper torso. Airway stabilization is influenced by the neutral body posture. Rescuers will consist of crew members of varying sizes and degrees of physical deconditioning from space flight. Several methods of CPR designed to accommodate these factors were tested in the one G environment, in parabolic flight, and on a recent shuttle flight. Methods: Utilizing study participants of varying sizes, different techniques of CPR delivery were evaluated using a recording CPR manikin to assess adequacy of compressive force and frequency. Under conditions of parabolic flight, methods tested included conventional positioning of rescuer and victim, free floating 'Heimlich type' compressions, straddling the patient with active and passive restraints, and utilizing a mechanical cardiac compression assist device (CCAD). Multiple restrain systems and ventilation methods were also assessed. Results: Delivery of effective CPR was possible in all configurations tested. Reliance on muscular force alone was quickly fatiguing to the rescuer. Effectiveness of CPR was dependent on technique, adequate restraint of the rescuer and patient, and rescuer size and preference. Free floating CPR was adequate but rapidly fatiguing. The CCAD was able to provide adequate compressive force but positioning was problematic. Conclusions: Delivery of effective CPR in microgravity will be dependent on adequate resuer and patient restraint, technique, and rescuer size and preference. Free floating CPR may be employed as a stop gap method until patient restraint is available. Development of an adequate CCAD would be desirable to compensate for the effects of deconditioning.