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OBJECTIVE: The authors sought to evaluate the acceptability, feasibility, and initial outcomes of the delivery of a group cognitive-behavioral therapy (CBT) mental health intervention for mothers in the Temporary Assistance for Needy Families (TANF) program. METHODS: An 8-week group CBT program was made available to parenting women (N=40) in a large, urban TANF system from April to August 2019. Participants completed baseline and endpoint measures to assess depressive symptoms, perceived stress, social support, employment, and program acceptability. TANF administrative data were examined to assess TANF engagement. RESULTS: TANF staff were successfully trained to deliver CBT. The participants reported significantly reduced depressive symptoms and perceived stress; perceived social support significantly increased from the beginning to the end of the intervention. CONCLUSIONS: A model that fully embedded CBT delivery in a TANF system was acceptable to low-income parenting women and TANF staff and reduced depressive symptoms among the women. The scalability of interventions to address maternal depression among low-income women has presented a challenge. Delivering mental health interventions in the U.S. TANF system may offer a scalable method to reduce depression and increase employment in a population bearing a high mental health burden.
Assuntos
Saúde Mental , Assistência Pública , Emprego , Feminino , Humanos , Mães , PobrezaRESUMO
The current study aimed to examine the impact of maternal depression, maternal fetal attachment (MFA) and parenting stress on maternal sensitivity, intrusiveness and positive regard for the child with a sample of 36 low-income, mothers-infant dyads that were followed from pregnancy through the first year postpartum. Maternal depression and parenting stress were expected to have a negative impact on maternal sensitivity, intrusiveness and positive regard, while high MFA was hypothesized to have a positive impact on these three outcomes. Our data provide partial support for our hypotheses. Findings from this study add to the literature by examining the stability of the maternal prenatal and postpartum bond with her infant as well as by looking at the impact of parenting stress on maternal behaviors and processes that may lead to later attachment security differences, such as maternal sensitivity and responsiveness.
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Depressão Pós-Parto/psicologia , Relações Materno-Fetais/psicologia , Relações Mãe-Filho/psicologia , Poder Familiar/psicologia , Estresse Psicológico/psicologia , Adolescente , Adulto , Depressão Pós-Parto/diagnóstico , Feminino , Humanos , Lactente , Masculino , Gravidez , Autoimagem , Estresse Psicológico/diagnóstico , Adulto JovemRESUMO
The objective of this study was to understand the relationship between the early adverse childhood experiences (ACEs) of parents and their later parenting stress and practices. At the baseline visit of an 8-week course of cognitive behavioral therapy, parenting women completed the Parenting Stress Index-Short Form (PSI-SF) and the Positive Parenting Practices (PPP) scale. Linear regression procedures were used to assess the relationship between a parent's own early experience of ACEs and current parenting stress and practices, including if there was a dose-response relationship. For the PSI-SF, significant dose-response relationships were observed between ACEs and the PSI Total Stress score (p < 0.05) and the difficult child subscale (p < 0.05). Additionally, a relationship was suggested with the parental distress subscale (p < 0.10). No significant relationships were found between ACEs and the parent-child dysfunctional interaction subscale of the PSI-SF or the PPP scale. Given the association observed between ACEs and parenting stress, it is important that future psychosocial interventions and policy initiatives preventing ACEs are developed.
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Experiências Adversas da Infância , Poder Familiar/psicologia , Pais/psicologia , Estresse Psicológico/etiologia , Adolescente , Adulto , Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Mães/psicologia , Avaliação das Necessidades , Inquéritos e Questionários , Adulto JovemRESUMO
This study examined the relationship between self-reported depressive symptoms, directly observed maternal sensitivity, and the content and themes of pictures posted on a mobile application. Data on 20 participants were analyzed. Results suggested that mothers' scoring as more intrusive on the maternal sensitivity scale tended to post a higher proportion of photos of themselves interacting with their babies. An association between higher levels of maternal depressive symptoms and a lower proportion of posts of baby smiling photos was also suggested.
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Depressão Pós-Parto/psicologia , Comportamento Materno/psicologia , Relações Mãe-Filho , Gestantes/psicologia , Smartphone , Mídias Sociais , Adulto , Estudos de Coortes , Feminino , Humanos , Lactente , Saúde Mental , Avaliação de Resultados em Cuidados de Saúde , Período Pós-Parto , PobrezaRESUMO
BACKGROUND: Descriptive epidemiologic studies of recurrent and non-recurrent Kawasaki disease (KD) may identify other potentially important differences between these illnesses. METHODS: Data from the USA and Japan, the Centers for Disease Control and Prevention (CDC) national KD surveillance(1984-2008) and the 17th Japanese nationwide survey (2001-2002), respectively, were analyzed to examine recurrent KD patients <18 years of age meeting the CDC KD case or atypical KD case definition. These patients were compared with non-recurrent KD patients. RESULTS: Of the 5557 US KD patients <18 years of age during 1984-2008, 97 (1.7%) were identified as having had recurrent KD. Among the US Asian/Pacific Islander KD patients, 3.5% had recurrent KD, which was similar to the percentage identified among KD patients (3.5%) in the Japanese survey. Compared with non-recurrent KD patients, KD patients [with recurrent KD] were more likely to be older, fulfill the atypical KD case definition, and have coronary artery abnormalities (CAA) despite i.v. immunoglobulin (IVIG) treatment. CONCLUSIONS: Differences in the age, race, and frequency of CAA exist between recurrent and non-recurrent KD patients. The increased association of CAA with recurrent KD suggests that more aggressive treatment strategies in conjunction with IVIG may be indicated for the second episode of KD.
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Vigilância da População , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Japão/epidemiologia , Masculino , Morbidade/tendências , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Recidiva , Estudos Retrospectivos , Estados Unidos/epidemiologiaRESUMO
A small percentage of persons with leptospirosis, a reemerging zoonosis, experience severe complications that require hospitalization. The number of leptospirosis cases in the United States is unknown. Thus, to estimate the hospitalization rate for this disease, we analyzed US hospital discharge records for 1998-2009 for the total US population by using the Nationwide Inpatient Sample. During that time, the average annual rate of leptospirosis-associated hospitalizations was 0.6 hospitalizations/1,000,000 population. Leptospirosis-associated hospitalization rates were higher for persons >20 years of age and for male patients. For leptospirosis-associated hospitalizations, the average age of patients at admission was lower, the average length of stay for patients was longer, and hospital charges were higher than those for nonleptospirosis infectious disease-associated hospitalizations. Educating clinicians on the signs and symptoms of leptospirosis may result in earlier diagnosis and treatment and, thereby, reduced disease severity and hospitalization costs.
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Hospitalização , Leptospirose/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Custos de Cuidados de Saúde , História do Século XX , História do Século XXI , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Lactente , Recém-Nascido , Leptospirose/história , Masculino , Pessoa de Meia-Idade , Vigilância da População , Estados Unidos/epidemiologia , Adulto JovemRESUMO
In California, the 2010 annual Kawasaki disease hospitalization rate for children <5 years of age was higher than the rate in 2003. An increasing trend during 2003-2010 appears to be driven by an increase from 2003 to 2006, whereas the Kawasaki disease hospitalization rate remained stable through 2010.
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Hospitalização/tendências , Síndrome de Linfonodos Mucocutâneos/epidemiologia , California/epidemiologia , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
BACKGROUND: Historically, American Indian/Alaska Native (AI/AN) people have experienced a disproportionate burden of infectious disease morbidity compared with the general US population. We evaluated whether a disparity in influenza hospitalizations exists between AI/AN people and the general US population. METHODS: We used Indian Health Service hospital discharge data (2001-2011) for AI/AN people and 13 State Inpatient Databases (2001-2008) to provide a comparison to the US population. Hospitalization rates were calculated by respiratory year (July-June). Influenza-specific hospitalizations were defined as discharges with any influenza diagnoses. Influenza-associated hospitalizations were calculated using negative binomial regression models that incorporated hospitalization and influenza laboratory surveillance data. RESULTS: The mean influenza-specific hospitalization rate/100 000 persons/year during the 2001-2002 to 2007-2008 respiratory years was 18.6 for AI/AN people and 15.6 for the comparison US population. The age-adjusted influenza-associated hospitalization rate for AI/AN people (98.2; 95% confidence interval [CI], 51.6-317.8) was similar to the comparison US population (58.2; CI, 34.7-172.2). By age, influenza-associated hospitalization rates were significantly higher among AI/AN infants (<1 year) (1070.7; CI, 640.7-2969.5) than the comparison US infant population (210.2; CI, 153.5-478.5). CONCLUSIONS: American Indian/Alaska Native people had higher influenza-specific hospitalization rates than the comparison US population; a significant influenza-associated hospitalization rate disparity was detected only among AI/AN infants because of the wide CIs inherent to the model. Taken together, the influenza-specific and influenza-associated hospitalization rates suggest that AI/AN people might suffer disproportionately from influenza illness compared with the general US population.
RESUMO
OBJECTIVES: To examine the epidemiology of infectious disease (ID) hospitalisations among Alaska Native (AN) people. METHODS: Hospitalisations with a first-listed ID diagnosis for American Indians and ANs residing in Alaska during 2001-2009 were selected from the Indian Health Service direct and contract health service inpatient data. ID hospitalisations to describe the general US population were selected from the Nationwide Inpatient Sample. Annual and average annual (2007-2009) hospitalization rates were calculated. RESULTS: During 2007-2009, IDs accounted for 20% of hospitalisations among AN people. The 2007-2009 average annual age-adjusted ID hospitalisation rate (2126/100,000 persons) was higher than that for the general US population (1679/100,000; 95% CI 1639-1720). The ID hospitalisation rate for AN people increased from 2001 to 2009 (17%, p < 0.001). Although the rate during 2001-2009 declined for AN infants (< 1 year of age; p = 0.03), they had the highest 2007-2009 average annual rate (15106/100,000), which was 3 times the rate for general US infants (5215/100,000; 95% CI 4783-5647). The annual rates for the age groups 1-4, 5-19, 40-49, 50-59 and 70-79 years increased (p < 0.05). The highest 2007-2009 age-adjusted average annual ID hospitalisation rates were in the Yukon-Kuskokwim (YK) (3492/100,000) and Kotzebue (3433/100,000) regions; infant rates were 30422/100,000 and 26698/100,000 in these regions, respectively. During 2007-2009, lower respiratory tract infections accounted for 39% of all ID hospitalisations and approximately 50% of ID hospitalisations in YK, Kotzebue and Norton Sound, and 74% of infant ID hospitalisations. CONCLUSIONS: The ID hospitalisation rate increased for AN people overall. The rate for AN people remained higher than that for the general US population, particularly in infants and in the YK and Kotzebue regions. Prevention measures to reduce ID morbidity among AN people should be increased in high-risk regions and for diseases with high hospitalisation rates.
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Hospitalização/estatística & dados numéricos , Indígenas Norte-Americanos/estatística & dados numéricos , Infecções/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Alaska/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To examine dog bites among American Indian (AI) and Alaska Native (AN) children visiting Indian Health Service and tribal health facilities. STUDY DESIGN: We retrospectively analyzed hospitalizations and outpatient visits with a diagnosis of dog bite between 2001 and 2008 in AI/AN children aged <20 years. Rates of dog bite hospitalizations and outpatient visits were estimated by age group, sex, region, and number and location of open wounds using Indian Health Service data. Analyses of hospitalizations for the general US population aged<20 years used the Nationwide Inpatient Sample. RESULTS: The average annual dog bite hospitalization rate was higher among AI/AN children in Alaska (6.1/100,000 population) and the Southwest region (5.3/100,000) compared with the general US child population (3.1/100,000; 95% CI, 2.9-3.3/100,000). The average annual outpatient visit rate in AI/AN children was highest in the Alaska (596.4/100,000), Southwest (540.0/100,000), and Northern Plains West (537.6/100,000) regions. The hospitalization rate was highest in both AI/AN and US males aged<5 years, and outpatient visit rates were highest in AI/AN males aged 5-9 years. Open wounds diagnoses were most commonly seen on the head, neck, and face in hospitalized children (45.5% of open wounds in AI/AN children, 59.3% in US children; SE, 1.0%) and on the leg in AI/AN outpatients (35.6%). CONCLUSION: Dog bites represent a significant public health threat in AI/AN children in the Alaska, the Southwest, and Northern Plains West regions of the US. Enhanced animal control and education efforts should reduce dog bite injuries and associated problems with pets and stray dogs, such as emerging infectious diseases.
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Mordeduras e Picadas/epidemiologia , Hospitalização/estatística & dados numéricos , Adolescente , Alaska/epidemiologia , Animais , Criança , Criança Hospitalizada , Pré-Escolar , Cães , Feminino , Humanos , Indígenas Norte-Americanos , Lactente , Masculino , Estudos Retrospectivos , Adulto JovemRESUMO
AIM: To examine clinical characteristics, treatment and outcome of Kawasaki syndrome patients in Denmark. METHODS: A retrospective chart review of hospitalization records for children <15 years of age with a Kawasaki syndrome discharge diagnosis identified through the Danish National Patient Registry during 1994 through June 2008 was conducted. RESULTS: A total of 284 cases <15 years of age were identified as Kawasaki syndrome (n = 279) and atypical Kawasaki syndrome (n = 5); 70.4% were <5 years of age and 64.4% were male. Most patients (91.5%; 258/282) were treated with intravenous immunoglobulin and 74.6% of these patients (191/256) received intravenous immunoglobulin before the 10th day of illness. A total of 37 (13.3%) Kawasaki syndrome patients were diagnosed with coronary artery abnormalities. Not receiving intravenous immunoglobulin treatment before the 10th day of illness, young age and male sex were significantly associated with the development of coronary artery abnormalities. CONCLUSIONS: In Denmark, more than one in 10 children with Kawasaki syndrome develop coronary artery abnormalities. Physicians should increase their index of suspicion for early diagnosis and treatment of Kawasaki syndrome among patients susceptible to increased risk of coronary artery abnormalities, particularly in infants who may have a more atypical presentation of the illness.
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Doença da Artéria Coronariana/etiologia , Imunoglobulinas Intravenosas/uso terapêutico , Síndrome de Linfonodos Mucocutâneos/complicações , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Doença da Artéria Coronariana/epidemiologia , Dinamarca/epidemiologia , Diagnóstico Precoce , Feminino , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Síndrome de Linfonodos Mucocutâneos/fisiopatologia , Alta do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Distribuição por SexoRESUMO
OBJECTIVES: To quantify and examine factors related to unexplained death due to possible infectious causes (UDPIC) in infants and to analyze the associations between these factors in unexplained deaths and infants with fatal and nonfatal outcomes. STUDY DESIGN: Infant deaths meeting the International Classification of Diseases, Tenth Revision code inclusion and exclusion criteria for UDPIC were selected from the 2006 US Linked Birth and Infant Death data set. Two control groups of surviving and nonsurviving infants were selected and compared with the infants with UDPIC using a case-control study design with multivariate logistic regression models stratified by birth weight category. Comparisons with infants with identified infectious causes of death were also made. RESULTS: During 2006, 3570 infant deaths (12.5% of all US infant deaths) were categorized as a UDPIC. The highest rates for these unexplained infants deaths were found in blacks and American Indians/Alaska Natives. Infants of black mothers were more likely to experience UDPIC. Birth weight was a significant effect modifier in these models. CONCLUSIONS: Many factors may contribute to an infant's death being classified as a UDPIC, including race and marital status. Other factors, such as Hispanic ethnicity and maternal age, also may play a role. Infant characteristics, such as birth weight, may be related to factors that influence the decision not to conduct a postmortem examination in infant death cases. Additional research is needed to determine the true extent of infectious disease and its relationship to UDPIC in infants.
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Infecções/mortalidade , Causas de Morte , Feminino , Humanos , Lactente , Masculino , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Kawasaki syndrome (KS) occurs in children <18 years of age and is the leading cause of acquired heart disease among children in the United States. Understanding the epidemiology of KS and factors associated with coronary artery abnormalities (CAA) may lead to timely diagnosis and treatment of KS and could limit CAA. METHODS: Epidemiologic characteristics, including risk factors for the development of CAA, among KS and incomplete KS patients <18 years of age with onset during 2000-2009 reported by the California Department of Public Health to the Centers for Disease Control and Prevention's national KS surveillance system were analyzed. RESULTS: A total of 2056 KS and incomplete KS patients <18 years of age were reported during 2000-2009. The median age of patients was 2 years; 60% of patients were male. Of 1818 patients with race information reported, 56% were white and 28% were Asian/Pacific Islander. Ninety-eight percent of patients received intravenous immunoglobulin. Of 1843 patients with information on cardiac complications, 89 (5%) had coronary artery aneurysms and 341 (19%) had CAA. Characteristics associated with the occurrence of CAA in KS patients were male sex, Asian/Pacific Islander race, age <1 year or 9-17 years, and not receiving intravenous immunoglobulin treatment before the fifth day of illness. CONCLUSIONS: This study suggests that intravenous immunoglobulin treatment before the fifth day of illness may reduce CAA among KS patients. Timely diagnosis and treatment of KS continue to be important in reducing the occurrence of cardiac complications.
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Aneurisma Coronário/epidemiologia , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Adolescente , California/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Aneurisma Coronário/complicações , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Fatores de RiscoRESUMO
Flagstaff, Arizona, USA, experienced notable outbreaks of rabies caused by a bat rabies virus variant in carnivore species in 2001, 2004, 2005, 2008, and 2009. The most recent epizootic involved transmission among skunk and fox populations and human exposures. Multiple, wide-ranging control efforts and health communications outreach were instituted in 2009, including a household survey given to community members. Although the Flagstaff community is knowledgeable about rabies and the ongoing outbreaks in general, gaps in knowledge about routes of exposure and potential hosts remain. Future educational efforts should include messages on the dangers of animal translocation and a focus on veterinarians and physicians as valuable sources for outreach. These results will be useful to communities experiencing rabies outbreaks as well as those at current risk.
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Surtos de Doenças , Inquéritos Epidemiológicos , Raiva/epidemiologia , Raiva/veterinária , Adolescente , Adulto , Idoso , Animais , Arizona/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Quarentena , Raiva/prevenção & controle , Inquéritos e Questionários , Adulto JovemRESUMO
Death from Rocky Mountain spotted fever (RMSF) is preventable with prompt, appropriate treatment. Data from two independent sources were analyzed to estimate the burden of fatal RMSF and identify risk factors for fatal RMSF in the United States during 1999-2007. Despite increased reporting of RMSF cases to the Centers for Disease Control and Prevention, no significant changes in the estimated number of annual fatal RMSF cases were found. American Indians were at higher risk of fatal RMSF relative to whites (relative risk [RR] = 3.9), and children less than 10 years of age (RR=5.1) [corrected] and adults ≥ 70 years of age (RR = 3.0) were also at increased risk relative to other ages. Persons with cases of RMSF with an immunosuppressive condition were at increased risk of death (RR = 4.4). Delaying treatment of RMSF was also associated with increased deaths. These results may indicate a gap between recommendations and practice.
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Febre Maculosa das Montanhas Rochosas/epidemiologia , Febre Maculosa das Montanhas Rochosas/prevenção & controle , Adolescente , Adulto , Idoso , Centers for Disease Control and Prevention, U.S. , Criança , Pré-Escolar , Feminino , Humanos , Imunossupressores , Incidência , Indígenas Norte-Americanos , Lactente , Masculino , Pessoa de Meia-Idade , Vigilância da População , Fatores de Risco , Febre Maculosa das Montanhas Rochosas/mortalidade , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Diarrhea-associated deaths among US children increased from the mid-1980s through 2006, particularly among infants. Understanding risk factors for diarrhea-associated death could improve prevention strategies. METHODS: Records of singleton infants with diarrhea listed anywhere on the death certificate were selected from the US Linked Birth/Infant Death data for the period, 2005 to 2007; characteristics of these infants were compared with those of infants who survived their first year. RESULTS: During 2005 to 2007, 1087 diarrhea-associated infant deaths were reported; 86% occurred among low birth weight (LBW, <2500 g) infants. Compared with normal birth weight (NBW, ≥2500 g) infants, LBW infants had a greater mortality rate (risk ratio: 91.9, 95% confidence interval: 77.4-109.0) and younger median age at death (7 versus 15 weeks, P<0.0001). The most common codiagnoses for diarrhea-associated death among LBW and NBW infants were sepsis (26%) and volume depletion (20%), respectively. Among LBW infants, 97% of diarrhea-associated deaths occurred in inpatient settings, whereas 27% of NBW infant deaths occurred in outpatient settings and 5.3% in the decedent's home. Male sex, black race, unmarried status and low 5-minute Apgar score (<7) increased mortality odds among LBW infants whereas, among NBW infants, low 5-minute Apgar score, black race, young maternal age (<25 years) and high birth order (third or more) increased mortality odds. CONCLUSIONS: Efforts to reduce diarrhea-associated morality should focus on understanding and improving management of diarrhea in vulnerable LBW infants. For prevention of diarrhea-associated deaths in NBW infants, educating mothers who fit the high-risk profile regarding home hydration therapy and timely access to medical treatment is important.