Behavioral and socioemotional outcomes through age 5 years of the legacy for children public health approach to improving developmental outcomes among children born into poverty.

OBJECTIVES: We evaluated Legacy for Children, a public health strategy to improve child health and development among low-income families. METHODS: Mothers were recruited prenatally or at the birth of a child to participate in Legacy parenting groups for 3 to 5 years. A set of 2 randomized trials in Miami, Florida, and Los Angeles, California, between 2001 and 2009 assessed 574 mother-child pairs when the children were 6, 12, 24, 36, 48, and 60 months old. Intent-to-treat analyses from 12 to 60 months compared groups on child behavioral and socioemotional outcomes. RESULTS: Children of mothers in the intervention group were at lower risk for behavioral concerns at 24 months and socioemotional problems at 48 months in Miami, and lower risk for hyperactive behavior at 60 months in Los Angeles. Longitudinal analyses indicated that children of intervention mothers in Miami were at lower risk for behavior problems from 24 to 60 months of age. CONCLUSIONS: Randomized controlled trials documented effectiveness of the Legacy model over time while allowing for implementation adaptations by 2 different sites. Broadly disseminable, parent-focused prevention models such as Legacy have potential for public health impact. These investments in prevention might reduce the need for later intervention strategies.

Legacy for ChildrenTM: a pair of randomized controlled trials of a public health model to improve developmental outcomes among children in poverty.

BACKGROUND: One in five Americans under age 18 lives in a family below the Federal poverty threshold. These more than 15 million children are at increased risk of a wide variety of adverse long-term health and developmental outcomes. The early years of life are critical to short- and long-term health and well-being. The Legacy for ChildrenTM model was developed in response to this need and marries the perspectives of epidemiology and public health to developmental psychology theory in order to better address the needs of children at environmental risk for poor developmental outcomes. METHODS/DESIGN: The Legacy for ChildrenTM group-based parenting intervention model was evaluated as a pair of randomized controlled trials among low-income families in Miami and Los Angeles. The study was designed to allow for site-stratified analysis in order to evaluate each model implementation separately. Evaluation domains include comprehensive assessments of family, maternal, and child characteristics, process outcomes, and prospective programmatic cost. Data collection began prenatally or at birth and continues into school-age. DISCUSSION: The societal costs of poor developmental outcomes are substantial. A concerted effort from multiple sectors and disciplines, including public health, is necessary to address these societal concerns. Legacy uses a public health model to engage parents and promote overall child well-being in families in poverty through rigorous evaluation methodologies and evidence-based intervention strategies. This study collects rich and modular information on maternal and child outcomes, process, and cost that will enable a detailed understanding of how Legacy works, how it can be refined and improved, and how it can be translated and disseminated. Taken together, these results will inform public policy and help to address issues of health disparities among at-risk populations. TRIAL REGISTRATION: NCT00164697.

Do Bach flower remedies have a role to play in pain control? A critical analysis investigating therapeutic value beyond the placebo effect, and the potential of Bach flower remedies as a psychological method of pain relief.

UNLABELLED: This paper explores the potentiality of Bach flower remedies as a means of pain relief through a retrospective case-study analysis to establish how clients suffering with painful conditions responded to the therapy. RESULTS: Of 384 subjects, 41 suffered pain. Of these, 46% felt treatment had relieved their pain; in 49% the physical outcome was unknown. About 88% of all subjects reported an improvement in their emotional outlook. DISCUSSION: The role of placebo and its influence on the study's key features: focus shift from physical pain to emotional outlook, and the importance of the client-practitioner relationship and belief in the therapy. CONCLUSION: The use of Bach flower remedies has brought about positive emotional changes in the majority of clients in this study. Whilst it is difficult to draw a definitive conclusion as to significance of the therapeutic value of these remedies in relation to pain above that of a placebo, the results are encouraging. In particular, relief of negative emotions and promotion of positive thought including how clients opened up about, and dealt with, emotional issues. The indication is that potential for Bach flower remedies as a therapeutic agent in the relief of pain does exist and is worthy of further qualitative and quantitative investigation through robust, purpose-designed studies to replicate and progress the results shown here.

Neurobehaviors of Japanese newborns in relation to the characteristics of early mother-infant interaction.

The authors examined the relationship between newborn neurobehavioral profiles and the characteristics of early mother-infant interaction in Nagasaki, Japan. The authors administered the Brazelton Neonatal Behavioral Assessment Scale (NBAS; T. B. Brazelton & J. K. Nugent, 1995) in the newborn period and the Nursing Child Assessment Teaching Scale at 1 month (NCATS; G. Sumner & A. Spietz, 1994). They administered the Perceived Stress Scale (S. Cohen, T. Kamarck, & R. Mermelstein, 1983) as an index of maternal stress experienced over the past month. Lower irritability, higher stability in skin coloration, and lower tremulousness in the neonatal period were correlated with higher levels of maternal nurturing behaviors at 1 month. Birth weight and 2 NBAS range-of-state items (peak of excitement, irritability) predicted 31% of the variance in NCATS caregiver subscale score. The NBAS autonomic stability items (tremulousness, startles, lability of skin color) predicted 31% of the variance in the NCATS child subscale score. Perceived stress and maternal sociodemographic variables (education, income, age, parity) were not associated with child, caregiver, and total scores on the NCATS. The results suggested that lack of autonomic stability in Japanese neonates might serve as an early indicator of infant frailty, negative behavioral cues, and decreased maternal responsiveness.

Cross-cultural comparison of the neurobehavioral characteristics of Chinese and Japanese neonates.

BACKGROUND: Similarities and differences in the neurobehavioral repertoire of neonates from different cultures have been noted using the Brazelton Neonatal Behavioral Assessment Scale (NBAS). By identifying the behavioral attributes of newborns that are seen more universally versus those that are culture-specific, comparative studies increase understanding of the roles of cultural factors in shaping the behavioral trajectory of infants. This study compared the neurobehavioral characteristics of neonates in Chengdu, China and Nagasaki, Japan. METHODS: The Brazelton NBAS was administered within the first week of life to 40 Chinese and 62 Japanese healthy, full-term neonates in Chengdu and Nagasaki. RESULTS: The two groups differed significantly in birthweight, gender, age at time of exam, mode of delivery, and gestational age. When these variables, in addition to group status (Chinese or Japanese), were entered into multiple linear analyses with NBAS cluster scores as dependent variables, group status independently predicted Range of State and Habituation scores. The group status did not predict Orientation, Motor, Regulation of States, Autonomic Stability, and Abnormal Reflexes cluster scores. CONCLUSION: These results suggest that Japanese newborns habituated more readily to stimuli, and were less irritable than newborns in the Chinese sample. The infants in the two groups shared many similar neurobehavioral characteristics as well. The implications of these similarities and differences were discussed.

Using knowledge to cope with stress in the NICU: how parents integrate learning to read the physiologic and behavioral cues of the infant.

Parental stress in the NICU has at least a short-term impact on the establishment of the parent-child relationship and potential repercussions on long-term child development outcomes. One way to help parents mitigate stress is to help them learn what they need to know about their infant's condition and care. In this article, we examine how learning to read the infant's physiologic and behavioral cues helps parents cope with stress. We view parental learning as a process in which parents target specific domains of information for learning according to the temporal relevance of the domain to their concerns. It is important that we recognize the fluidity of the process and anticipate what parents need to learn at different times during hospitalization. The NICU staff assumes a crucial role in reducing parental stress by delivering information that is relevant to the parents' needs and by helping parents understand this information.

Trastornos gastrointestinales asociados con la ingestión de aguas contaminadas con cobre

Presenta cinco casos de ingestión de agua contaminada con altos niveles de cobre que ocasiono trastornos gastrointestinales. Los resultados de la investigación sugieren que aguas con concentraciones de cobre que exceden el límite federal,en EE.UU., de 1,3 mg./L pueden ser una causa relativa común de diarrea, malestares abdominales y náuseas. Estos síntomas son más frecuentes en infantes y niños pequeños y también en habitantes de viviendas recientemente construidas o renovadas

Trastornos gastrointestinales asociados con la ingestión de aguas contaminadas con cobre

Presenta cinco casos de ingestión de agua contaminada con altos niveles de cobre que ocasiono trastornos gastrointestinales. Los resultados de la investigación sugieren que aguas con concentraciones de cobre que exceden el límite federal,en EE.UU., de 1,3 mg./L pueden ser una causa relativa común de diarrea, malestares abdominales y náuseas. Estos síntomas son más frecuentes en infantes y niños pequeños y también en habitantes de viviendas recientemente construidas o renovadas