Maternal behavioral health symptom profiles in early family life: complexity and context.

Behavioral health problems affect at least 15% of mothers, but few studies have examined how different problems cluster together. Characterizing symptom profiles and their correlates early in the family life cycle can extend existing understanding beyond that provided by studies based on single problems. Mothers in the Fragile Families and Child Wellbeing study, a national birth cohort of racially diverse and mostly unmarried mothers (N = 4205), reported depression, anxiety, and substance dependence symptoms. Latent class analysis (LCA) identified mothers' symptom profiles in their children's third year. We explored associations between symptom profiles and demographics, reproductive health outcomes, functional limitations, and postpartum behavioral health. LCA identified five profiles: (1) Depression only (14.5% of sample), (2) Severe depression and anxiety (5.3%), (3) Anxiety only (2.2%), (4) Depression and substance use (1.4%), and (5) Currently symptom free (76.6%). Depressive symptoms were more moderate when co-occurring with substance dependence and more severe when co-occurring with anxiety. Postpartum depression, postpartum anxiety, and smoking during pregnancy were the most robust correlates of being symptomatic in year 3. Mothers in the "Severe depression and anxiety" group were more likely to be in that profile if they reported functional impairment and/or relationship dissolution. Mothers in the "Depression only" profile were more likely to have higher parity and/or functional impairment. A quarter of mothers of young children had significant behavioral health symptoms, with most reporting depression symptoms. Psychosocial and physical health factors in the pregnancy and postpartum periods were associated with future symptoms, warranting obstetrician and pediatrician attention.

Early identification of impending cardiac arrest in neonates and infants in the cardiovascular ICU: a statistical modelling approach using physiologic monitoring data.

OBJECTIVE: To develop a physiological data-driven model for early identification of impending cardiac arrest in neonates and infants with cardiac disease hospitalised in the cardiovascular ICU. METHODS: We performed a single-institution retrospective cohort study (11 January 2013-16 September 2015) of patients ≤1 year old with cardiac disease who were hospitalised in the cardiovascular ICU at a tertiary care children's hospital. Demographics and diagnostic codes of cardiac arrest were obtained via the electronic health record. Diagnosis of cardiac arrest was validated by expert clinician review. Minute-to-minute physiological monitoring data were recorded via bedside monitors. A generalized linear model was used to compute a minute by minute risk score. Training and test data sets both included data from patients who did and did not develop cardiac arrest. An optimal risk-score threshold was derived based on the model's discriminatory capacity for impending arrest versus non-arrest. Model performance measures included sensitivity, specificity, accuracy, likelihood ratios, and post-test probability of arrest. RESULTS: The final model consisting of multiple clinical parameters was able to identify impending cardiac arrest at least 2 hours prior to the event with an overall accuracy of 75% (sensitivity = 61%, specificity = 80%) and observed an increase in probability of detection of cardiac arrest from a pre-test probability of 9.6% to a post-test probability of 21.2%. CONCLUSIONS: Our findings demonstrate that a predictive model using physiologic monitoring data in neonates and infants with cardiac disease hospitalised in the paediatric cardiovascular ICU can identify impending cardiac arrest on average 17 hours prior to arrest.

Association Between Health Literacy and Parental Self-Efficacy among Parents of Newborn Children.

OBJECTIVE: To determine whether health literacy was associated with parental self-efficacy in a diverse sample of parents of newborns. We hypothesized that parents with lower health literacy would have lower parental self-efficacy. STUDY DESIGN: We conducted a cross-sectional analysis of baseline surveys from 253 English and Spanish speaking parents >18 years old with newborns <28 days old enrolled in a trial testing a multisite primary care-based parenting intervention. Surveys assessed parental, child, and environmental characteristics, and used validated instruments to measure health literacy and parental self-efficacy (total and 4 subtypes). Bivariate analyses identified parental, child, and environmental characteristics associated with parental self-efficacy. Multivariable linear regression models examined the associations between health literacy and parental self-efficacy, adjusting for covariates. RESULTS: Parents (median age, 29 years) were 92.1% female, 54.5% black/African American, and 29.6% Hispanic/Latino. More than one-half (58.9%) had completed some college education or more, 49.0% spoke mostly English, and 16.2% had low health literacy. In bivariate analyses, parental self-efficacy was significantly lower in parents with fewer household residents. In multivariable analyses, parents with low compared with high health literacy had significantly lower parental self-efficacy scores (total and 4 subtypes including caretaking procedures, evoking behaviors, reading behaviors and signaling, and situational beliefs). CONCLUSIONS: Lower health literacy was associated with lower parental self-efficacy in parents of newborns. To maximize impact on positive parenting behaviors and child outcomes, interventions assisting parents with low parental self-efficacy should consider strategies to address low health literacy.

Eighteen years of paediatric extracorporeal membrane oxygenation and ventricular assist devices: insight regarding late outcomes.

BACKGROUND: We reviewed all patients who were supported with extracorporeal membrane oxygenation and/or ventricular assist device at our institution in order to describe diagnostic characteristics and assess mortality. METHODS: A retrospective cohort study was performed including all patients supported with extracorporeal membrane oxygenation and/or ventricular assist device from our first case (8 October, 1998) through 25 July, 2016. The primary outcome of interest was mortality, which was modelled by the Kaplan-Meier method. RESULTS: A total of 223 patients underwent 241 extracorporeal membrane oxygenation runs. Median support time was 4.0 days, ranging from 0.04 to 55.8 days, with a mean of 6.4±7.0 days. Mean (±SD) age at initiation was 727.4 days (±146.9 days). Indications for extracorporeal membrane oxygenation were stratified by primary indication: cardiac extracorporeal membrane oxygenation (n=175; 72.6%) or respiratory extracorporeal membrane oxygenation (n=66; 27.4%). The most frequent diagnosis for cardiac extracorporeal membrane oxygenation patients was hypoplastic left heart syndrome or hypoplastic left heart syndrome-related malformation (n=55 patients with HLHS who underwent 64 extracorporeal membrane oxygenation runs). For respiratory extracorporeal membrane oxygenation, the most frequent diagnosis was congenital diaphragmatic hernia (n=22). A total of 24 patients underwent 26 ventricular assist device runs. Median support time was 7 days, ranging from 0 to 75 days, with a mean of 15.3±18.8 days. Mean age at initiation of ventricular assist device was 2530.8±660.2 days (6.93±1.81 years). Cardiomyopathy/myocarditis was the most frequent indication for ventricular assist device placement (n=14; 53.8%). Survival to discharge was 42.2% for extracorporeal membrane oxygenation patients and 54.2% for ventricular assist device patients. Kaplan-Meier 1-year survival was as follows: all patients, 41.0%; extracorporeal membrane oxygenation patients, 41.0%; and ventricular assist device patients, 43.2%. Kaplan-Meier 5-year survival was as follows: all patients, 39.7%; extracorporeal membrane oxygenation patients, 39.7%; and ventricular assist device patients, 43.2%. CONCLUSIONS: This single-institutional 18-year review documents the differential probability of survival for various sub-groups of patients who require support with extracorporeal membrane oxygenation or ventricular assist device. The indication for mechanical circulatory support, underlying diagnosis, age, and setting in which cannulation occurs may affect survival after extracorporeal membrane oxygenation and ventricular assist device. The Kaplan-Meier analyses in this study demonstrate that patients who survive to hospital discharge have an excellent chance of longer-term survival.

Maternal Emotion Regulation and Adolescent Behaviors: The Mediating Role of Family Functioning and Parenting.

Prior research links poor maternal emotion regulation to maladaptive parenting and child behaviors, but little research is available on these relationships during the adolescent period. We use structural equation modeling to assess the influence of poor maternal emotion regulation, measured as emotional reactivity and distancing, on adolescent behaviors (measured as aggression and prosocial behaviors) among 478 adolescents (53 % female; baseline age 10-13 years) and their mothers over a 5 year period. We also tested the possible mediating roles of family functioning and parenting behaviors between maternal emotion regulation and adolescent behaviors. Results indicated that higher baseline maternal emotional distancing and reactivity were not directly predictive of adolescents' behaviors, but they were indirectly related through family functioning and parenting. Specifically, indulgent parenting mediated the relationship between maternal emotional reactivity and adolescent aggression. Maternal-reported family functioning significantly mediated the relationship between maternal emotional distancing and adolescent aggression. Family functioning also mediated the relationship between emotional distancing and regulation parenting. The results imply that poor maternal emotion regulation during their child's early adolescence leads to more maladaptive parenting and problematic behaviors during the later adolescent period. However, healthy family processes may ameliorate the negative impact of low maternal emotion regulation on parenting and adolescent behavioral outcomes. The implications for future research and interventions to improve parenting and adolescent outcomes are discussed.

Adolescent language brokering in diverse contexts: associations with parenting and parent-youth relationships in a new immigrant destination area.

In the US, children in immigrant families have a longstanding history of language brokering for their parents. Scholars have surmised that youth's role in language brokering may influence the nature of parenting practices and parent-child relationships that are important to the positive adjustment of adolescent youth. Research findings in this regard, however, have been mixed. Drawing from the family stress model and the concept of adolescent helpfulness, the present study examined how language brokering across different contexts-school, community, and home-was associated with indicators of parental support and parental behavioral control. The sample included 118 (53% female) primarily Mexican- and Central American-origin 7th, 9th, and 11th grade children in Latino immigrant families living in suburban Atlanta, an important new immigrant destination. The results from structural equation models indicated that language brokering at home-translations for items such as bills, credit card statements, and insurance forms-was associated with less parental decision-making authority, lower levels of parental knowledge, and less parent-child closeness. Language brokering pertinent to school and community contexts, on the other hand, was not associated with variations in parenting. The adverse consequences for parenting conferred by youth translating insurance forms and family financial bills may stem from the excessive cognitive demands placed on youth in these situations, as well as the elevated power that youth gain in relationship to their immigrant parents. For the country's rapidly growing population of youth being raised by immigrant Latino parents, it is important to consider that youth's role as language broker at home may affect closeness in the parent-child relationship as well as the degree to which parents are able to maintain authority over youth's behaviors.

Antibody levels correlate with creatine kinase levels and strength in anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase-associated autoimmune myopathy.

OBJECTIVE: Autoantibodies recognizing 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) are found in patients with statin-associated immune-mediated necrotizing myopathy and, less commonly, in statin-unexposed patients with autoimmune myopathy. The main objective of this study was to define the association of anti-HMGCR antibody levels with disease activity. METHODS: Anti-HMGCR levels, creatine kinase (CK) levels, and strength were assessed in anti-HMGCR-positive patients. Associations of antibody level with CK level and strength at visit 1 were analyzed in 55 patients, 40 of whom were exposed to statins. In 12 statin-exposed and 5 statin-unexposed patients with serum from 5 serial visits, the evolution of antibody levels, CK levels, and strength was investigated. RESULTS: Antibody levels were associated with CK levels (P < 0.001), arm strength (P < 0.05), and leg strength (P < 0.05) at visit 1, but these associations were only significant among statin-exposed patients in stratified analyses. With immunosuppressive treatment over 26.2 ± 12.6 months (mean ± SD), antibody levels declined (P < 0.05) and arm abduction strength improved (P < 0.05) in the 17 patients followed up longitudinally. The separate analysis showed that statin-exposed patients developed decreased antibody levels (P < 0.01), decreased CK levels (P < 0.001), improved arm strength (P < 0.05), and improved hip flexion strength (P < 0.05) with treatment. Anti-HMGCR antibody levels did not normalize in any patient. CONCLUSION: In the entire cohort, initial anti-HMGCR levels correlated with indicators of disease activity; with immunosuppressive treatment, antibody levels declined and arm strength improved. Statin-exposed patients had significant improvements in CK levels and strength whereas statin-unexposed patients did not, suggesting a phenotypic difference between statin-exposed and statin-unexposed anti-HMGCR-positive patients.

Characteristics of children eligible for public health insurance but uninsured: data from the 2007 National Survey of Children's Health.

To describe the state variation, demographic and family characteristics of children eligible for public health insurance but uninsured. Using data from the National Survey of Children's Health we selected a subset of children living in households with incomes <200 % of the federal poverty level, who are generally eligible for Medicaid or CHIP. We used multiple logistic regression to examine associations between insurance status among this group of eligible children and certain demographic factors, family characteristics, and state of residence. In adjusted models children aged 6-11 and 12-17 years were more likely to be eligible but uninsured compared to those aged 0-5 years (AOR 1.57; 95 % CI 1.15-2.16 and AOR 1.93; 95 % CI 1.41-2.64). Children who received school lunch (AOR 0.67; 95 % CI 0.52-0.86) and SNAP (AOR 0.33; 95 % CI 0.24-0.46) were less likely to be eligible but uninsured compared to those children not receiving those needs based services; however, a majority (58.7 %) of eligible uninsured children were enrolled in the school lunch program. Five states (Texas, California, Florida, Georgia, New York) accounted for 46 % of the eligible uninsured children. Vermont had the lowest adjusted estimate of eligible uninsured children (3.6 %) and Nevada had the highest adjusted estimate (35.5 %). Using nationally representative data we have identified specific state differences, demographic and household characteristics that could help guide federal and local initiatives to improve public health insurance enrollment for children who are eligible but uninsured.

Unpacking acculturation: cultural orientations and educational attainment among Mexican-origin youth.

Given educational risks facing Mexican-origin children of immigrant parents, it is important to understand how aspects of the acculturation process influence Mexican-origin youth's educational success. Drawing from selective assimilation theory, this study examined how cultural orientations across myriad facets of acculturation were associated with the educational attainment of second-generation Mexican immigrant youth. The sample included 755 Mexican-origin youth (50% female) in the "Children of Immigrants Longitudinal Study." Results from structural equation models indicated that youth reporting greater facility in the English language and a stronger value on familism attained higher levels of education in young adulthood than did other youth. Parents' U.S. social ties and youth's value on early paid work were associated with less educational attainment. Innovative findings from this study indicate the importance of considering both Mexican and American cultural orientations across myriad facets of acculturation for understanding second-generation immigrant Mexican youth's educational attainment.

Heart Transplantation for Pediatric and Congenital Cardiac Disease: A Comparison of Two Eras over 23 Years and 188 Transplants at a Single Institution.

BACKGROUND: To assess changes in patterns of practice and outcomes over time, we reviewed all patients who underwent heart transplantation (HTx) at our institution and compared two consecutive eras with significantly different immunosuppressive protocols (cohort 1 [80 HTx, June 1995-June 2006]; cohort 2 [108 HTx, July 2006-September 2018]). METHODS: Retrospective study of 180 patients undergoing 188 HTx (June 1995-September 2018; 176 first time HTx, 10 second HTx, and 2 third HTx). In 2006, we commenced pre-HTx desensitization for highly sensitized patients and started using tacrolimus as our primary postoperative immunosuppressive agent. The primary outcome was mortality. Survival was modeled by the Kaplan-Meier method. Univariable and multivariable Cox proportional hazard models were created to identify prognostic factors for survival. RESULTS: Our 188 HTx included 18 neonates, 85 infants, 83 children, and 2 adults (>18 years). Median age was 260.0 days (range: 5 days-23.8 years). Median weight was 7.5 kg (range: 2.2-113 kg). Patients in cohort 1 were less likely to have been immunosensitized preoperatively (12.5% vs 28.7%, P = .017). Nevertheless, Kaplan-Meier analysis suggested superior survival in cohort 2 (P = .0045). Patients in cohort 2 were more likely to be alive one year, five years, and ten years after HTx. Multivariable analysis identified the earlier era (hazard ratio [HR] [95% confidence interval] for recent era = 0.32 [0.14-0.73]), transplantation after prior Norwood operation (HR = 4.44 [1.46-13.46]), and number of prior cardiac operations (HR = 1.33 [1.03-1.71]) as risk factors for mortality. CONCLUSIONS: Our analysis of 23 years of pediatric and congenital HTx reveals superior survival in the most recent 12-year era, despite the higher proportion of patients with elevated panel reactive antibody in the most recent era. This improvement was temporally associated with changes in our immunosuppressive strategy.

Interparental conflict and academic achievement: an examination of mediating and moderating factors.

Using a risk and resiliency theoretical framework, the association between interparental conflict and academic achievement was examined. The sample consisted of 2,297 6th grade youth with a mean age of 11.92. Participants were mostly European American (81.8%) and 52% were girls. Results demonstrated that interparental conflict is a risk factor for lower academic achievement, suggesting that family interactions play a significant role in how youth perform in the academic setting. Youth self-blame acted as a significant mediator, providing some explanation for how interparental conflict affects academic achievement. Maternal acceptance and monitoring knowledge partially buffered the association between interparental conflict and youth self-blame. Additionally, the positive association between interparental conflict and perceived threat was stronger for youth who perceived relationships with mothers as more supportive, connected, and involved. Results from this study underscore the need for continued focus on the link between family and school environments with respect to youth developmental outcomes.

Social support and low-income, urban mothers: longitudinal associations with adolescent delinquency.

The current study examined the role of engaged parenting in explaining longitudinal associations between maternal perceptions of social network support and whether youth engage in delinquent behaviors during the transition into adolescence. The sample included 432 low-income, African American and Latino youth (49% female) and their mothers participating in "Welfare, Children, and Families: A Three City Study". Results from longitudinal SEM analyses demonstrated that social network support was associated positively with mothers' engaged parenting as youth transitioned into early adolescence. Engaged parenting, which functioned as a mediating variable, was associated with less youth delinquency during transitions into middle adolescence. Taken together, social network supports appeared to facilitate mothers' abilities to remain engaged with their children and to deter youth from becoming involved in delinquent behaviors.

Deep Learning for Improved Risk Prediction in Surgical Outcomes.

The Norwood surgical procedure restores functional systemic circulation in neonatal patients with single ventricle congenital heart defects, but this complex procedure carries a high mortality rate. In this study we address the need to provide an accurate patient specific risk prediction for one-year postoperative mortality or cardiac transplantation and prolonged length of hospital stay with the purpose of assisting clinicians and patients' families in the preoperative decision making process. Currently available risk prediction models either do not provide patient specific risk factors or only predict in-hospital mortality rates. We apply machine learning models to predict and calculate individual patient risk for mortality and prolonged length of stay using the Pediatric Heart Network Single Ventricle Reconstruction trial dataset. We applied a Markov Chain Monte-Carlo simulation method to impute missing data and then fed the selected variables to multiple machine learning models. The individual risk of mortality or cardiac transplantation calculation produced by our deep neural network model demonstrated 89 ± 4% accuracy and 0.95 ± 0.02 area under the receiver operating characteristic curve (AUROC). The C-statistics results for prediction of prolonged length of stay were 85 ± 3% accuracy and AUROC 0.94 ± 0.04. These predictive models and calculator may help to inform clinical and organizational decision making.

The Longitudinal Relations of Teacher Expectations to Achievement in the Early School Years.

There is relatively little research on the role of teacher expectations in the early school years or on the importance of teacher expectations as a predictor of future academic achievement. The current study investigated these issues in the reading and mathematic domains for young children. Data from nearly 1,000 children and families at first, third, and fifth grades were included. Child sex and social skills emerged as consistent predictors of teacher expectations of reading and, to a lesser extent, math ability. In predicting actual future academic achievement, results showed that teacher expectations were differentially related to achievement in reading and math. There was no evidence that teacher expectations accumulate but some evidence that they remain durable over time for math achievement. Additionally, teacher expectations were more strongly related to later achievement for groups of children who may be considered to be at risk.

Targeted Education and Trends in Pediatric Nurses Perceptions of Barriers, Facilitators, Confidence, and Attitudes Toward Research and Evidence-Based Practice Over Time.

The purpose of this repeated cross-sectional study was to periodically assess perceptions of pediatric nurses' confidence, attitudes, barriers, and facilitators to research utilization and evidence-based practice as changes to the nursing research environment and a targeted curriculum were implemented. The study results were used by the nursing professional development specialist to further customize the nursing research curriculum to better meet the self-reported education and mentorship needs of the nurses.

Parenting Processes and Adolescent Adjustment in Immigrant Latino Families: The Use of Residual Centering to Address the Multicollinearity Problem.

Family cohesion and parental monitoring promote Latino adolescents' positive adjustment. For Latino immigrant families, these parenting processes tend to be interdependent due to shared roots in cultural values emphasizing family togetherness and parental authority. This covariance poses a significant methodological problem with respect to multicollinearity. The present article uses a novel technique-residual centering-to remove shared variance among family cohesion and parental monitoring constructs and, in turn, to identify how the unique variance of each is associated with Latino adolescent adjustment. Participants include 249 9th and 10th graders in Mexican and Central American immigrant families. We compared findings from structural equation models in which parenting constructs were examined simultaneously with residual-centered models, in which shared variance among parenting constructs was removed for each parenting variable. Findings from residual-centered models revealed that parents' monitoring of youth's daily activities was associated with less alcohol use and fewer youth depressive symptoms, and that parents' monitoring of youth's peer activities outside the home was associated with less marijuana use and more depressive symptoms. Family cohesion was unrelated to Latino youth outcomes in residual-centered models. By isolating specific, "pure" parenting effects, residual centering can clarify the ways in which family cohesion and parental monitoring behaviors matter for Latino adolescents' adjustment.

La cohesión familiar y la supervisión de hijos promueven el bien estar de los adolescentes Latinos. Para las familias inmigrantes, estos procesos de crianza son interdependientes por que los valores de unidad y autoridad dentro de la familia son ambos culturales. Esta covarianza es un problema metodológico por que causa multicolinealidad. Este estudio usa una técnica innovadora ("residual centering") para resolver el problema de covarianza entre los constructos de la cohesión familiar y la supervisión de hijos; y de esta manera, identificar como la varianza única de cada constructo es asociada con el ajustamiento de los adolescentes. Participantes fueron 249 adolescentes del grado 9° y 10° de familias inmigrantes de México y Centroamérica. Comparamos los resultados de modelos de ecuaciones estructurales en que los dos constructos fueron examinados simultáneamente a los modelos de "residual centering" en que los constructos fueron examinados independientemente. Según los modelos de "residual centering," la supervisión de las actividades diarias de hijos es asociada con menos consumo de alcohol y síntomas de depresión, y la supervisión de las actividades fuera de casa es asociada con menos consumo de marihuana pero más síntomas de depresión. Sin embargo, la cohesión familiar no tuvo asociación con el ajustamiento de los adolescentes. En separar los efectos de los constructos, esta técnica de "residual centering" puede clarificar el impacto único de la cohesión familiar y la supervisión de hijos en los adolescentes.

An RCT of Dating Matters: Effects on Teen Dating Violence and Relationship Behaviors.

INTRODUCTION: Teen dating violence is a serious public health problem with few effective prevention strategies. This study examines whether the Dating Matters comprehensive prevention model, compared with a standard of care intervention, prevented negative relationship behaviors and promoted positive relationship behaviors. STUDY DESIGN: This longitudinal, cluster-RCT compared the effectiveness of Dating Matters with standard of care across middle school. Standard of care was an evidence-based teen dating violence prevention curriculum (Safe Dates) implemented in eighth grade. SETTING/PARTICIPANTS: Forty-six middle schools in high-risk urban neighborhoods in four U.S. cities were randomized. Schools lost to follow-up were replaced with new schools, which were independently randomized (71% school retention). Students were surveyed in fall and spring of sixth, seventh, and eighth grades (2012-2016). The analysis sample includes students from schools implementing Dating Matters or standard of care for >2 years who started sixth grade in the fall of 2012 or 2013 and had dated (N=2,349 students, mean age 12 years, 49% female, and 55% black, non-Hispanic, 28% Hispanic, 17% other). INTERVENTION: Dating Matters is a comprehensive, multicomponent prevention model including classroom-delivered programs for sixth to eighth graders, training for parents of sixth to eighth graders, educator training, a youth communications program, and local health department activities to assess capacity and track teen dating violence-related policy and data. MAIN OUTCOME MEASURES: Self-reported teen dating violence perpetration and victimization, use of negative conflict resolution strategies, and positive relationship skills were examined as outcomes. Imputation and analyses were conducted in 2017. RESULTS: Latent panel models demonstrated significant program effects for three of four outcomes; Dating Matters students reported 8.43% lower teen dating violence perpetration, 9.78% lower teen dating violence victimization, and 5.52% lower use of negative conflict resolution strategies, on average across time points and cohorts, than standard of care students. There were no significant effects on positive relationship behaviors. CONCLUSIONS: Dating Matters demonstrates comparative effectiveness, through middle school, for reducing unhealthy relationship behaviors, such as teen dating violence and use of negative conflict resolution strategies, relative to the standard of care intervention. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01672541.

The Interface of Maternal Cognitions and Executive Function in Parenting and Child Conduct Problems.

OBJECTIVE: To explore the direct and indirect associations of maternal emotion control, executive functioning, and social cognitions maternal with harsh verbal parenting and child behavior and to do so guided by social information processing theory. BACKGROUND: Studies have demonstrated a relationship between maternal harsh parenting and increased child conduct problems. However, less is known about how maternal emotion and cognitive control capacities and social cognitions intersect with harsh parenting and child behavior. METHOD: Structural equation modeling was used with a convenience sample of 152 mothers from Appalachia who had a child between 3 and 7 years of age. RESULTS: Maternal emotion control and executive functioning were both inversely associated with child conduct problems. That is, stronger maternal emotion control was associated with less harsh verbal parenting and lower hostile attribution bias, and higher maternal executive functioning was related to less controlling parenting attitudes. CONCLUSION: The results suggest maternal emotion and cognitive control capacities affect how mothers interact with their children and ultimately child conduct problems. IMPLICATIONS: To more effectively reduce harsh verbal parenting and child conduct problems, interventions should help mothers to improve their emotion and cognitive control capacities.

Risk Factors for Survival After Heart Transplantation in Children and Young Adults: A 22-Year Study of 179 Transplants.

BACKGROUND: This article reviews all patients who underwent heart transplantation (HTx) within a single institution (172 patients underwent 179 HTx [167 first-time HTxs, 10 second HTxs, 2 third HTxs]) to describe diagnostic characteristics, management protocols, and risk factors for mortality. METHODS: Descriptive analysis was performed for the entire cohort using mean, standard deviation, median, interquartile range, and overall range, as appropriate. Univariable and multivariable Cox proportional hazards models were performed to identify prognostic factors for outcomes over time. The primary outcome of interest was mortality, which was modeled by Kaplan-Meier analysis. RESULTS: Median age at HTx was 263 days (range, 5 days to 24 years; mean = 4.63 ± 5.95 years; 18 neonates, 79 infants). Median weight at HTx was 7.5 kg (range, 2.2-113 kg; mean = 19.36 ± 23.54). Diagnostic categories were cardiomyopathy (n = 62), primary transplantation for hypoplastic left heart syndrome (HLHS) or HLHS-related malformation (n = 33), transplantation after cardiac surgery for HLHS or HLHS-related malformation (n = 17), non-HLHS congenital heart disease (n = 55), and retransplant (n = 12). Operative mortality was 10.1% (18 patients). Cumulative total follow-up is 1,355 years. Late mortality was 18.4% (33 patients). Overall Kaplan-Meier five-year survival was 76.2%. One hundred twenty-one patients are alive with a mean follow-up of 7.61 ± 6.46 years. No survival differences were seen among the five diagnostic subgroups ( P = .064) or between immunosensitized patients (n = 31) and nonimmunosensitized patients (n = 141; P = .422). CONCLUSIONS: Excellent results are expected for children undergoing HTx with comparable results among diagnostic groups. Pretransplant mechanical circulatory support and posttransplant mechanical circulatory support are risk factors for decreased survival. Survival after transplantation for HLHS or HLHS-related malformation is better with primary HTx in comparison to HTx after prior cardiac surgery.