Tuberculosis Patients Who Are A Potential Source for Unprotected Exposure in Health Care Systems: A Multicenter Case Control Study.

SETTING: Five health care systems in Texas. OBJECTIVE: To describe the epidemiology of inadequate isolation for pulmonary tuberculosis leading to tuberculosis (TB) exposures from confirmed TB patients and the patient factors that led to the exposures. DESIGN: A retrospective cohort and case-control study of adult patients with TB resulting in exposures (cases) vs those TB patients who did not result in exposures (controls) during January 2005 to December 2012. RESULTS: There were 335 patients with pulmonary TB disease, 199 cases and 136 controls. There was no difference between groups in age (46 ± 14.6 vs 45 ± 17 years; P > .05), race, or substance abuse. Cases were more likely to be transplant recipients (adjusted odds ratio [AOR], 18.90; 95% CI, 1.9-187.76), have typical TB chest radiograph (AOR, 2.23; 95% CI, 1.1-4.51), and have positive acid-fast bacilli stains (AOR, 2.36; 95% CI, 1.31-4.27). Cases were less likely to have extrapulmonary disease (AOR, 0.47; 95% CI, 0.24-0.95). CONCLUSIONS: TB exposure resulting from inadequate isolation is frequent in health care settings. Extrapulmonary involvement resulted in earlier airborne isolation. Being a transplant recipient, having chest radiograph findings typical for TB, and sputum positivity acid-fast bacilli upon staining were associated with increased risk of inadequate isolation.

Reconsidering the "acculturation gap" narrative through an analysis of parent-adolescent acculturation differences in Mexican American families.

Using a sample of 193 Mexican American adolescents (M age at Wave 1 = 14) and three waves of data over two years, this study longitudinally examined the effects of parent-youth acculturation differences, relative to no differences, on parent-adolescent relationship quality and youth problem behavior. We examined parent-youth differences in overall acculturation, Mexican acculturation, and American acculturation. We differentiated between cases in which the adolescent was more acculturated than the parent and cases in which the parent was more acculturated than the adolescent. Adolescents were more commonly similar to their parents than different. Where differences existed, adolescents were not uniformly more American than their parents, no type of difference was associated with parent-adolescent relationship quality, and no type of difference in overall acculturation was associated with youth problem behavior. One type of difference by dimension (adolescent had less Mexican acculturation than mother) was associated with less risk of problem behavior.

Guided cognitive reframing of adolescent-father conflict: who Mexican American and European American adolescents seek and why.

Adolescents may seek to understand family conflict by seeking out confidants. However, little is known about whom adolescents seek, whether and how such support helps youth, and the factors that predict which sources are sought. This chapter offers a conceptual model of guided cognitive reframing that emphasizes the behavioral, cognitive, and affective implications of confidant support as well as individual, family, and cultural factors linked to support seeking. The authors present empirical data from 392 families of seventh graders of Mexican and European ancestry to predict whether adolescents seek mothers, coresident fathers, and other sources and provide directions for subsequent research.

Fathering and Adolescent Adjustment: Variations by Family Structure and Ethnic Background.

The current study investigated how fathering behaviors (acceptance, rejection, monitoring, consistent discipline, and involvement) are related to preadolescent adjustment in Mexican American and European American stepfamilies and intact families. Cross-sectional data from 393 7th graders, their schoolteachers, and parents were used to examine links between different dimensions of fathering and adolescent outcomes. Following an ecological multivariate model, family SES, marital satisfaction, and mothers' parenting were included as controls. In all contexts, fathering had significant effects on adolescent adjustment. Both mothers' parenting and adolescent gender moderated the associations, and we uncovered some provocative nonlinear relations between fathering and adolescent outcomes. The importance of ethnicity and family structure in studies of fathering are highlighted.

Framing divorce reform: media, morality, and the politics of family.

No-fault statutes changed divorce from an adversarial system pitting victims against victimizers, with the state acting as enforcer of marital norms, to a private decision between unhappily married but legally blameless partners. Divorce reform following no-fault primarily focused on making divorce more fair for the parties involved. Over the last several decades, divorce reform has transitioned from making divorce better to making marriage healthier. The good divorce has slipped from policy attention, elevating the potential for restigmatization of divorced couples and their children. We trace the trajectory of media framing of divorce reform discourse in three general circulation newspapers from the start of the no-fault revolution, noting how media framing parallels and naturalizes the transition in divorce reform policy. We conclude by observing the prevalence of divorce and the related need for therapists to be cognizant of this naturalization process, thereby keeping the good divorce as a goal for those who desire to end their marriages.