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The early introduction of non-milk foods among African-American infants has been well documented. Several studies report the addition of semi-solids as early as 1-2 weeks of age. This study investigated, through ethnographic, repeat indepth interviews with teen mothers and grandmothers of infants, the determinants of such feeding practices and the inter-generational factors involved in infant feeding decision-making. Nineteen adolescent mothers were recruited from Baltimore City WIC programs. The teen mothers were interviewed in their homes during four separate visits and the grandmothers at least twice. Ethnographic field guides focused on questions about what, why and how infants were fed and on the 'ethnotheories' of parenting and infant care in this population. All interviews were taped and transcripts were analyzed using text retrieval software. Results confirmed that it is the cultural norm to feed cereal in the bottle and to feed other semi-solid foods within the first month of life. Most grandmothers played the dominant role in deciding what the infant should eat and the timing of the introduction of solids. This pattern occurred both because grandmothers had extensive physical access to their grandchildren and because teen mothers were dependent upon grandmothers. The use of qualitative research methods, with an ecological, multi -generational focus, provides a rich description of the context within which infant feeding decisions are made. [ABSTRACT FROM AUTHOR]

Introduction: Venous thromboembolism (VTE) is a serious, frequent, and preventable medical complication in hospitalized patients. Although the efficacy of prophylaxis (pharmacological and/or mechanical) has been demonstrated, compliance with prophylaxis is poor at international and national levels., Aim: To determine the indication and use of pharmacological thromboprophylaxis in hospitalized patients in Uruguay., Methods: An observational, descriptive, cross-sectional, multicentre study involving 31 nationwide healthcare facilities was conducted. Baseline characteristics associated with hospital admission, the percentage of the population with an indication for thromboprophylaxis, and the percentage of patients receiving pharmacological thromboprophylaxis were assessed. The VTE risk was determined using the Padua score for medical patients; the Caprini score for surgical patients; the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines for pregnant-postpartum patients., Results: 1925 patients were included, representing 26% of hospitalized patients in Uruguay. 71.9% of all patients were at risk of VTE. Of all patients at risk of VTE, 58.6% received pharmacological thromboprophylaxis. The reasons for not receiving thromboprophylaxis were prescribing omissions in 16.1% of cases, contraindication in 15.9% and 9.4% of patients were already anticoagulated for other reasons. Overall, just 68% of patients were "protected" against VTE. Recommendations of major thromboprophylaxis guidelines were followed in 70.1% of patients at risk., Conclusions: Despite the progress made in adherence to thromboprophylaxis indications, nonadherence remains a problem, affecting one in six patients at risk of VTE in Uruguay., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The European Noise Directive 2002/49/EC requires to draw up noise action plans. Most of the implemented solutions consist in using barriers, even if some studies evidenced that annoyance could increase after their installation. This action dumps the high frequencies, decreasing the masking effect on low ones. Therefore, people annoyance and complaints may increase despite the mitigation. This can happen even in pedestrian zones near main roads due to the screening effect of first buildings row. In this paper, the authors analyze the post-operam screening effects in terms of low frequency noise. The difference between C- and A-weighted levels is calculated as annoyance indicator (LC-A). Different methods able to map noise with octave bands detail are tested in order to establish differences in the estimates of annoyance exposure. In particular, a comparison is carried out between data from interim method NMPB 96, its updated version 2008, NORD 2000 and those provided by a customized procedure through ISO 9613 propagation and Statistical Pass By measurements. Test sites are simulated in order to validate each model results through measurements. Results are discussed for real locations in Pisa city center and virtual scenarios in a rising scale of complexity., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objective: To estimate the effects of a managed behavioral healthcare organization's (MBHO's) products/plans and financial risk on levels and amount of care authorized for patients with alcohol-related problems., Study Design: Secondary analysis of 1995-1998 MBHO authorization files., Patients: Individuals diagnosed as having an alcohol-related problem without comorbidities., Methods: Episodes (n = 10,872) were constructed with 60-day clear zones. Multinomial regression equations were used to analyze the proportional distribution of care authorized within episodes at 5 levels: inpatient, residential, partial hospitalization, intensive outpatient, and traditional outpatient. Care equivalency hours were calculated to combine data across outpatient sessions and inpatient days. A linear regression equation analyzed quantity of care within episodes. Product/plan types, financial risk, state of residence, and participation in the MBHO's network were explanatory variables. Age, sex, diagnosis, and episode number were control variables., Results: Most utilization management care hours authorized are inpatient and residential. Relative to other products/plans for managing care, utilization management leads to 50% more authorized hours. More financial risk does not predict fewer care units authorized but shifts hospitalizations toward residential treatment. Increasing age and higher-severity diagnoses predict more overnight care authorizations. Pennsylvania, which mandates minimum levels of care and follows American Society of Addiction Medicine criteria, has significantly more care authorized compared with 8 other states with data., Conclusions: Other than in utilization management, MBHO financial risk does not predict less care authorization. The MBHO authorizes higher-level care for older adults, for those with more severe diagnoses, and for those with episodes of care beyond the second. Authorization data do not necessarily reflect utilization but can provide a useful, partial view of management strategies.

Objective: This study explored the main and interactive effects of sexual abuse history and relationship satisfaction on self-reported parenting, controlling for histories of physical abuse and parental alcoholism., Method: The community sample consisted of 90 mothers of 5- to 8-year-old children. The sample was limited to those mothers currently in an intimate relationship, 19 of whom reported a history of childhood sexual abuse. Participants completed the Child Behavior Checklist, the Parenting Stress Inventory, the Family Cohesion Index, and questions assessing parent-child role reversal, history of abuse and parental alcoholism, and current relationship satisfaction., Results: Results of analyses and multivariate analyses of covariance suggested that sexual abuse survivors with an unsatisfactory intimate relationship were more likely than either sexual abuse survivors with a satisfactory relationship or nonabused women to endorse items on a questionnaire of role reversal (defined as emotional overdependence upon one's child). Role reversal was not significantly predicted by histories of physical abuse or parental alcoholism or child's gender. While parenting stress was inversely predicted by the significant main effect of relationship satisfaction, neither parenting stress nor child behavior problems were predicted by the main effect of sexual abuse history or by the interaction between sexual abuse history and relationship satisfaction., Conclusions: These results suggest the unique relevance of sexual abuse history and relationship satisfaction in the prediction of a specific type of parent-child role reversal--namely, a mother's emotional overdependence upon her child.

Objective: To use social learning theory to develop and examine the effectiveness of a 15-minute, culturally sensitive videotape in altering mealtime communication and attitudes among African-American adolescent mothers., Design: Randomized clinical trial with baseline and follow-up evaluations., Setting: High schools, WIC (Women, Infants, and Children) Clinics, and Family Support Centers serving low-income families., Participants: Fifty-nine first-time, African-American adolescent mothers of infants., Intervention: Intervention group viewed and received a copy of a videotape titled "Feeding Your Baby With Love." The messages, title, music, and setting were designed by an advisory group of six African-American adolescent mothers who were filmed feeding their infants in their homes., Measurements and Results: During baseline and follow-up evaluations, mothers were videotaped feeding their baby and completed a questionnaire on attitudes toward mealtime behavior. Analysis of covariance with repeated measures indicated changes in both behavior and attitudes. At follow-up, intervention mothers were more involved with their infant and reported more favorable attitudes toward feeding and communication than control mothers., Conclusions: Brief culturally sensitive videotapes may be effective strategies to promote parenting skills and to prevent social and health problems among adolescents.

Clinical conceptualizations of emotion that stress its disruptive influences and functional models of emotion that emphasize its adaptive aspects can be integrated into a developmental psychopathology framework. Under certain conditions, emotion regulation may develop dysregulatory aspects that can become a characteristic of an individual's coping style. This style may then jeopardize or impair functioning and become associated with symptomatic, disordered functioning. Emotional development provides a critical vantage point from which to study the development of symptomatology and psychopathology, particularly given the prevalence of emotional symptoms in various forms of psychopathology. Dimensions of emotionality that can be used to characterize dysregulation include access to the range of emotions, flexible modulation of intensity, duration, and transitions between emotions, acquisition and use of cultural display rules, and the ability to reflect on the complexity and value of one's own emotions in a self-supporting manner. Developmental psychopathology provides a framework within which to examine how emotions are regulatory, how their regulation changes over time, and under what conditions an adaptive emotion process can develop into a pattern of dysregulation that then becomes, or sustains, some symptoms of mental disorders. Such research requires samples that include children with and without risk or presence of particular mental health problems, paradigms that allow the examination of dimensions of emotionality in context and provide multiple assessments that include observations of children's reactions beyond what they themselves can report, and analyses that extend beyond simple global aggregates such as positive and negative emotion. We believe that it is particularly important to study children and their families in situations that challenge their emotional adaptation. The developmental tasks of emotional life evolve in exchanges between the child and the world of events and relationships. The emotional conditions of early childhood appear to be very important in optimizing or interfering with how the child's emotionality regulates his or her interpersonal and intrapsychic functioning and how the child learns to regulate emotion. The experiences that accrue around emotional events influence the stable aspects of the developing personality and become trait-like aspects of the person (Malatesta & Wilson, 1988). Dysregulation occurs when an emotional reaction loses breadth and flexibility. If a dysregulatory pattern becomes stabilized and part of the emotional repertoire, it is likely that this pattern is a symptom and supports other symptoms. When development and adaptation are compromised, the dysregulation has evolved into a form of psychopathology. The line between normative variations and clinical conditions is not clearly drawn.(ABSTRACT TRUNCATED AT 400 WORDS)