Nancy Scotto Rosato

Food management practices used by people with limited resources to maintain food sufficiency as reported by nutrition educators.

The food management practices used by people with limited resources to ensure food sufficiency have not been fully characterized. Semistructured interviews were conducted with 51 nutrition educators from the New Jersey Expanded Food and Nutrition Education Program and Food Stamp Nutrition Education Program, regarding the food management practices of program participants. Practices were grouped into two categories using the constant comparative method: manage food supply (n = 14) and regulate eating patterns (n = 15). Well-documented stratagems, such as overeating when food is available and cycling monthly eating patterns, were confirmed. Novel practices were identified. Practices causing food safety or nutritional risks included removing spoiled sections, slime, mold, and insects from food; eating other peoples leftovers; and, eating meat found as road kill. A foundation was formed for a grounded theory concerning food management practices by people with limited resources. Verification of these results with audiences with limited resources and determination of prevalence and relative risk of these practices is necessary. This research is important for nutrition professionals who work with people with limited resources because it elucidated a spectrum of safe and risky food management practices, proposed methods to ameliorate monthly eating pattern cycles, and exposed the possibility of food insecurity in unsuspected cases.

Treatment of Maladaptive Aggression in Youth: CERT Guidelines II. Treatments and Ongoing Management

OBJECTIVE: To develop guidelines for management and treatment of maladaptive aggression in youth in the areas of psychosocial interventions, medication treatments, and side-effect management. METHODS: Evidence was assembled and evaluated in a multistep process, including systematic reviews of published literature; an expert survey of recommended practices; a consensus conference of researchers, policymakers, clinicians, and family advocates; and review by the steering committee of successive drafts of the recommendations. The Center for Education and Research on Mental Health Therapeutics Treatment of Maladaptive Aggression in Youth guidelines reflect a synthesis of the available evidence, based on this multistep process. RESULTS: This article describes the content, rationale, and evidence for 11 recommendations. Key treatment principles include considering psychosocial interventions, such as evidence-based parent and child skills training as the first line of treatment; targeting the underlying disorder first following evidence-based guidelines; considering individual psychosocial and medical factors, including cardiovascular risk in the selection of agents if medication treatment (ideally with the best evidence base) is initiated; avoiding the use of multiple psychotropic medications simultaneously; and careful monitoring of treatment response, by using structured rating scales, as well as close medical monitoring for side effects, including metabolic changes. CONCLUSIONS: Treatment of children with maladaptive aggression is a “moving target” requiring ongoing assimilation of new evidence as it emerges. Based on the existing evidence, the Treatment of Maladaptive Aggression in Youth guidelines provide a framework for management of maladaptive aggression in youth, appropriate for use by primary care clinicians and mental health providers.

Psychiatric diagnosis and antiretroviral adherence among adolescent Medicaid beneficiaries diagnosed with human immunodeficiency virus/acquired immunodeficiency syndrome.

Research on adults with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has suggested that psychiatric and substance abuse comorbidities are prevalent in this population, and that these may sometimes be associated with use of antiretroviral therapy (ART) and adherence. For adolescents with HIV/AIDS, much less is known about patterns of mental health comorbidity, and even fewer data are available that compare them to socioeconomically comparable youth without HIV/AIDS. Using medical and pharmacy data from 1999 to 2000 Medicaid claims (Medicaid Analytic Extract) from 4 states for beneficiaries aged 12 to 17 years, we identified 833 youth under care for HIV/AIDS meeting study criteria within the HIV/AIDS group, receipt of ART was less likely for youth who had diagnoses of substance abuse, conduct disorders, or emotional disorders than for others. Once ART was initiated, adherence did not significantly differ between adolescents living with a psychiatric condition, and those who were not, with the exception of an association between conduct disorder and lower adherence. Among those with HIV/AIDS, ART use and adherence were more common among youth with higher rates of service use, regardless of psychiatric status. Associations between race and adherence varied by gender: compared with their white counterparts, minority girls had lower, and minority boys had higher adherence.

Valued Characteristics of Children in a Changing Social Environment

Social scientists believe that social change impacts individual as well as family value orientations. The current study uses data from the 1986 and 2000 General Social Survey to compare these years on the types of social factors affecting the selection of child autonomy relative to obedience. Results indicate that several individual and family factors predict the inclination for autonomy versus obedience, including religious affiliation, income, education, and race. However, no significant differences were found between the two years, indicating that social change alone does not affect value orientation. The discussion offers the implication of these findings to family practitioners, specifically focusing on the necessity of cultural sensitivity and respect in achieving optimum results.