New Therapy for a New Normal: Comparing Telehealth and in-Person Time-Limited Parent-Child Interaction Therapy.

Telehealth treatment for child disruptive behavior has the potential to overcome multiple barriers to access (e.g., transportation, therapist availability). Traditional Parent-Child Interaction Therapy (PCIT) has demonstrated efficacy via telehealth in randomized controlled trials. The current study extends this research by examining community-based effectiveness of time-limited (i.e., 18 week) telehealth PCIT, comparing intake and posttreatment child behavior and caregiver skills for both telehealth and in-person PCIT. Participants included predominantly racially, ethnically, linguistically, and socioeconomically diverse children aged 2 to 8 years, and their caregivers. Dyads (N = 380) received either telehealth (IPCIT) or in-person PCIT.Propensity score analyses were conducted to address potential selection bias due to the nonrandomized sample. Regression analyses revealed no difference between IPCIT and in-person treatment for child disruptive behaviors or compliance outcomes. However, caregivers who received IPCIT demonstrated fewer positive statements and greater corrective/directive statements at posttreatment than caregivers who received in-person treatment.This research demonstrated that time-limited IPCIT can effectively improve child disruptive behavior among a socioeconomically, linguistically, and culturally diverse population, and represents the largest sample to date demonstrating the effectiveness of PCIT via telehealth. Future research is warranted to document intervention sustainability on a more system-wide level, and balance prioritizing caregiver skill acquisition over family-derived treatment goals.

Pacientes con indicación de traqueostomía en una cohorte de cuidados intensivos / Patients with tracheostomy indication in an intensive care cohort

Introduction: Tracheostomy is a procedure indicated for patients with extended mechanical ventilation. Objective: The objective of the study was to learn about the technical characteristics, the appropriate timing for the procedure and its evolution. Material and method: Observational, retrospective study of ICU admitted patients during 2012, with elective tracheostomy. The demographic variables, the Apache II, the pathologies, the number of days in MV, length of stay and mortality were analyzed, both globally and by groups, depending on the early or late use of the technique. The study was approved by the Ethics Committee for Clinical Research of the institution, in accordance with the institutional bioethical principles. Results: The mean age in the sample with 42 patients was 61.36, and the mean Apache II was 18. The most frequent pathology was neurological. The approach was percutaneous in 71.5%, with minor complications in 20% of the cases. In the early tracheostomy group, the number of days in MV and the length of stay were both considerably shorter. Conclusions:Elective tracheostomy is a commonly used technique in the ICU and the procedure is performed according to the protocol. The percutaneous approach is the most frequently used, with few complications. In neurological critical patients with extended weaning, an early approach reduces the number of days with ventilation and the length of stay, with no positive impact on mortality.

Introducción: La traqueostomía es un procedimiento indicado en los pacientes con ventilación mecánica prolongada. Objetivo: El objetivo del estudio fue conocer sus características, técnica, momento adecuado de realización y evolución. Material y método: Estudio observacional retrospectivo, de pacientes ingresados en UCI durante 2012, con traqueostomía electiva. Se analizaron variables demográficas, escala Apache II, patologías, días de VM, estancia y mortalidad; de forma global, y por grupos según técnica precoz o tardía. El estudio fue aprobado por el Comité Ético de Investigación Clínica del centro, cumpliendo con los principios bioéticos del mismo. Resultados: En la muestra de 42 pacientes la edad media fue 61.36, con mediana de Apache II de 18. La patología más frecuente fueron los pacientes neurológicos, se realizó la forma percutánea en el 71.5%, con complicaciones menores del 20%. En el grupo de traqueostomía precoz se observó menor número de días de VM y estancia de forma significativa. Conclusiones: La traqueostomía electiva es una técnica frecuente en UCI, realizado el procedimiento según protocolo; la modalidad percutánea es la más empleada, con escasas complicaciones. En los pacientes neurocríticos y con destete prolongado la técnica precoz reduce los días de ventilación y estancia, sin beneficio en la mortalidad.

Energy Balance in Huntington's Disease.

INTRODUCTION: Little is known about the energy needs in Huntington's disease (HD). The aims of this study are to analyze and compare the total energy expenditure (TEE) and energy balance (EB) in a representative sample of HD patients with healthy controls. METHODS: This is an observational, case-control single-center study. Food caloric energy intake (EI) and TEE were considered for estimating EB. A dietary recall questionnaire was used to assess the EI. TEE was computed as the sum of resting energy expenditure (REE), measured by indirect calorimetry and physical activity (PA) monitored by an actigraph. RESULTS: A total of 22 patients were included (36% men, mean age 50.3 ± 15.6 years, motor Unified Huntington's Disease Scale 27.9 ± 23.7, total functional capacity 11.0 (7.0-13.0), EI 38.6 ± 10.0 kcal/kg, PA 5.3 (3.0-7.4) kcal/kg, REE 30.9 ± 6.4 kcal/kg, TEE 2,023.4 (1,592.0-2,226.5) kcal/day) and 18 controls (50% men, mean age 47.4 ± 13.8 years, EI 38.6 ± 10.3 kcal/kg, PA 8.4 (5.0-13.8) kcal/kg, REE 30.8 ± 6.6 kcal/kg, TEE 2,281.0 (2,057.3-2,855.3) kcal/day). TEE was significantly lower in patients compared to controls (p = 0.03). PA was lower in patients compared to controls (p = 0.02). CONCLUSIONS: Although patients with HD appeared to have lower energy expenditure, mainly due to decreased voluntary PA, they were still able to maintain their energy needs with an adequate food intake. © 2015 S. Karger AG, Basel.

Gentrification and urban children's well-being: tipping the scales from problems to promise.

Gentrification changes the neighborhood and family contexts in which children are socialized-for better and worse-yet little is known about its consequences for youth. This review, drawn from research in urban planning, sociology, and psychology, maps out mechanisms by which gentrification may impact children. We discuss indicators of gentrification and link neighborhood factors, including institutional resources and collective socialization, to family processes more proximally related to child development. Finally, we discuss implications for intervention and public policy recommendations that are intended to tip the scales toward better outcomes for low-income youth in gentrifying areas.