RESUMEN
The resource depletion model proposes that self-control is a limited resource that may become depleted after repeated use. This study aimed to improve our understanding of the correlates of resource depletion in parents, examine the association between resource depletion and use of coercive food parenting practices, and explore the relationship between resource depletion and stress. Children aged 5-9 and their parents (n = 631 dyads) were recruited from primary care clinics in a large metropolitan area in the United States in 2016-2019. Ecological momentary assessment was carried out over seven days with parents. Frequency tabulations and descriptive statistics were calculated to examine the overall, between-participant, and within-participant frequency of resource depletion, stress, and coercive food parenting practices. Resource depletion was higher among mothers (as compared to fathers) and native born participants (as compared to immigrants). Resource depletion was found to decrease significantly with each increase in household income level and perceived co-parenting support was negatively associated with resource depletion. Greater resource depletion earlier in the day was positively associated with coercive food parenting practices (e.g., food restriction, pressure-to-eat) at dinner the same night. Further, prior day resource depletion was associated with greater pressure-to-eat the next day. Parents with lower chronic stress were found to engage in pressuring when experiencing higher depletion. Clinicians and public health professionals should be aware of the role the resource depletion can play in parent's use of specific food parenting practices and seek to provide parents with the support they need to manage the cognitive load they are experiencing.
Asunto(s)
Evaluación Ecológica Momentánea , Responsabilidad Parental , Padres , Humanos , Responsabilidad Parental/psicología , Femenino , Masculino , Niño , Adulto , Preescolar , Padres/psicología , Relaciones Padres-Hijo , Estrés Psicológico/psicología , Estados Unidos , Conducta Alimentaria/psicología , Autocontrol/psicologíaAsunto(s)
Adquisición en Grupo/legislación & jurisprudencia , Planes de Asistencia Médica para Empleados/legislación & jurisprudencia , Reforma de la Atención de Salud/legislación & jurisprudencia , Planes Estatales de Salud/legislación & jurisprudencia , Educación Continua , Florida , Federación para Atención de Salud , Reforma de la Atención de Salud/economía , Fondos de Seguro , Planes Estatales de Salud/economía , Planes Estatales de Salud/organización & administración , Estados UnidosRESUMEN
Problems of substance abuse damage the well-being of many workers and drain substantial resources from the organization. While companies have adopted drug testing to screen out drug users and employee assistance programs to provide services to troubled workers, serious substance abuse prevention strategies have been virtually ignored. The authors describe some of the obstacles to implementing substance abuse programs. Attempts to integrate these programs into worksite health promotion are described and a model for a health-oriented substance abuse program is presented.
Asunto(s)
Alcoholismo/prevención & control , Promoción de la Salud/organización & administración , Salud Laboral , Trastornos Relacionados con Sustancias/prevención & control , Humanos , Estados UnidosRESUMEN
In unilateral lung injury, application of global positive end-expiratory pressure (PEEP) may cause overdistension of normal alveoli and redistribution of blood flow to diseased lung areas, thereby worsening oxygenation. We hypothesized that selective application of tracheal gas insufflation (TGI) will recruit the injured lung without causing overdistension of the normal lung. In eight anesthetized dogs, left lung saline lavage was performed until Pa(O(2))/FI(O(2)) fell below 100 mm Hg. Then, the dogs were reintubated with a Univent single lumen endotracheal tube that incorporates an internal catheter to provide TGI. After injury, increasing PEEP from 3 to 10 cm H(2)O did not change gas exchange, hemodynamics, or lung compliance. Selective TGI, while keeping end-expiratory lung volume (EELV) constant, improved Pa(O(2))/FI(O(2)) from 212 +/- 43 to 301 +/- 38 mm Hg (p < 0.01) while Pa(CO(2)) and airway pressures decreased (p < 0.01). During selective TGI, reducing tidal volume to 5.2 ml/kg while keeping EELV constant, normalized Pa(CO(2)), did not affect Pa(O(2))/FI(O(2)), and decreased end-inspiratory plateau pressure from 16.6 +/- 1.0 to 11.9 +/- 0.5 cm H(2)O (p < 0.01). In unilateral lung injury, we conclude that selective TGI (1) improves oxygenation at a lower pressure cost as compared with conventional mechanical ventilation, (2) allows reduction in tidal volume without a change in alveolar ventilation, and (3) may be a useful adjunct to limit ventilator-associated lung injury.
Asunto(s)
Modelos Animales de Enfermedad , Insuflación/métodos , Terapia por Inhalación de Oxígeno/métodos , Respiración con Presión Positiva/métodos , Síndrome de Dificultad Respiratoria/terapia , Tráquea , Animales , Análisis de los Gases de la Sangre , Perros , Hemodinámica , Insuflación/instrumentación , Terapia por Inhalación de Oxígeno/instrumentación , Respiración con Presión Positiva/efectos adversos , Respiración con Presión Positiva/instrumentación , Intercambio Gaseoso Pulmonar , Radiografía , Síndrome de Dificultad Respiratoria/inducido químicamente , Síndrome de Dificultad Respiratoria/diagnóstico por imagen , Síndrome de Dificultad Respiratoria/metabolismo , Síndrome de Dificultad Respiratoria/fisiopatología , Mecánica Respiratoria , Cloruro de Sodio , Irrigación Terapéutica , Volumen de Ventilación PulmonarRESUMEN
OBJECTIVE: During unilateral lung injury, we hypothesized that we can improve global lung function by applying selective tracheal gas insufflation (TGI) and partial liquid ventilation (PLV) to the injured lung. DESIGN: Prospective, interventional animal study. SETTING: Animal laboratory in a university hospital. SUBJECTS: Adult mixed-breed dogs. INTERVENTIONS: In six anesthetized dogs, left saline lung lavage was performed until PaO(2)/FiO(2) fell below 100 torr (13.3 kPa). The dogs were then reintubated with a Univent single-lumen endotracheal tube, which incorporates an internal catheter to provide TGI. In a consecutive manner, we studied 1) the application of 10 cm H(2)O of positive end-expiratory pressure (PEEP); 2) instillation of 10 mL/kg of perflubron (Liquivent) to the left lung at a PEEP level of 10 cm H(2)O (PLV+PEEP 10 initial); 3) application of selective TGI (PLV+TGI) while maintaining end-expiratory lung volume (EELV) constant; 4) PLV+TGI at reduced tidal volume (VT); and 5) PLV+PEEP 10 final. MEASUREMENTS AND MAIN RESULTS: Application of PLV+PEEP 10 initial did not change gas exchange, lung mechanics, or hemodynamics. PLV+TGI improved PaO(2)/FiO(2) from 189 +/- 13 torr (25.2 +/- 1.7 kPa) to 383 +/- 44 torr (51.1 +/- 5.9 kPa) (p <.01) and decreased PaCO(2) from 55 +/- 5 torr (7.3 +/- 0.7 kPa) to 30 +/- 2 torr (4.0 +/- 0.3 kPa) (p <.01). During ventilation with PLV+TGI, reducing VT from 15 mL/kg to 3.5 mL/kg while keeping EELV constant decreased PaO(2)/FiO(2) to 288 +/- 49 torr (38.4 +/- 6.5 kPa) (not significant) and normalized PaCO(2). At this stage, end-inspiratory plateau pressure decreased from 19.2 +/- 0.7 cm H(2)O to 13.6 +/- 0.7 cm H(2)O (p <.01). At PLV+PEEP 10 final, measurements returned to those observed at previous baseline stage (PLV+PEEP 10 initial). CONCLUSIONS: During unilateral lung injury, PLV with a moderate PEEP did not improve oxygenation, TGI superimposed on PLV improved gas exchange, and combination of TGI and PLV allowed a 77% reduction in VT without any adverse effect on PaCO(2).
Asunto(s)
Insuflación/métodos , Ventilación Liquida/métodos , Síndrome de Dificultad Respiratoria/terapia , Animales , Perros , Hemodinámica , Respiración con Presión Positiva/métodos , Mecánica Respiratoria , Irrigación Terapéutica , TráqueaRESUMEN
Recruitment maneuvers (RM), consisting of sustained inflations at high airway pressures, have been advocated as an adjunct to mechanical ventilation in acute respiratory distress syndrome (ARDS). We studied the effect of baseline ventilatory strategy and RM on end-expiratory lung volume (EELV) and oxygenation in 18 dogs, using three models of acute lung injury (ALI; n = 6 in each group): saline lavage (LAV), oleic acid injury (OAI), and intratracheal instillation of Escherichia coli (pneumonia; PNM). All three models exhibited similar degrees of lung injury. The PNM model was less responsive to positive end-expiratory pressure (PEEP) than was the LAV or OAI model. Only the LAV model showed an oxygenation response to increasing tidal volume (VT). After RM, there were transient increases in Pa(O(2)) and EELV when ventilating with PEEP = 10 cm H(2)O. At PEEP = 20 cm H(2)O the lungs were probably fully recruited, since the plateau airway pressures were relatively high ( approximately 45 cm H(2)O) and the oxygenation was similar to preinjury values, thus making the system unresponsive to RM. Sustained improvement in oxygenation after RM was seen in the LAV model when ventilating with PEEP = 10 cm H(2)O and VT = 15 ml/kg. Changes in EELV correlated with changes in Pa(O(2)) only in the OAI model with PEEP = 10 cm H(2)O. We conclude that responses to PEEP, VT, and RM differ among these models of ALI. RM may have a role in some patients with ARDS who are ventilated with low PEEP and low VT.