The authors tested the hypothesis that early physical abuse is associated with later externalizing behavior outcomes and that this relation is mediated by the intervening development of biased social information-processing patterns. They assessed 584 randomly selected boys and girls from European American and African American backgrounds for the lifetime experience of physical abuse through clinical interviews with mothers prior to the child's matriculation in kindergarten. Early abuse increased the risk of teacher-rated externalizing outcomes in Grades 3 and 4 by fourfold, and this effect could not be accounted for by confounded ecological or child factors. Abuse was associated with later processing patterns (encoding errors, hostile attributional biases, accessing of aggressive responses, and positive evaluations of aggression), which, in turn, predicted later externalizing outcomes.

BackgroundSome cerebrovascular events are not diagnosed promptly, potentially resulting in death or disability from missed treatments. We sought to estimate the frequency of missed stroke and examine associations with patient, emergency department (ED), and hospital characteristics.MethodsCross-sectional analysis using linked inpatient discharge and ED visit records from the 2009 Healthcare Cost and Utilization Project State Inpatient Databases and 2008–2009 State ED Databases across nine US states. We identified adult patients admitted for stroke with a treat-and-release ED visit in the prior 30 days, considering those given a non-cerebrovascular diagnosis as probable (benign headache or dizziness diagnosis) or potential (any other diagnosis) missed strokes.ResultsThere were 23,809 potential and 2243 probable missed strokes representing 12.7% and 1.2% of stroke admissions, respectively. Missed hemorrhages (n = 406) were linked to headache while missed ischemic strokes (n = 1435) and transient ischemic attacks (n = 402) were linked to headache or dizziness. Odds of a probable misdiagnosis were lower among men (OR 0.75), older individuals (18–44 years [base]; 45–64:OR 0.43; 65–74:OR 0.28; ≥ 75:OR 0.19), and Medicare (OR 0.66) or Medicaid (OR 0.70) recipients compared to privately insured patients. Odds were higher among Blacks (OR 1.18), Asian/Pacific Islanders (OR 1.29), and Hispanics (OR 1.30). Odds were higher in non-teaching hospitals (OR 1.45) and low-volume hospitals (OR 1.57).ConclusionsWe estimate 15,000–165,000 misdiagnosed cerebrovascular events annually in US EDs, disproportionately presenting with headache or dizziness. Physicians evaluating these symptoms should be particularly attuned to the possibility of stroke in younger, female, and non-White patients.

This investigation examined the relation between maternal depressive symptomatology and the development of externalizing behavior problems in children by incorporating mother-child interaction quality into a series of models. A representative sample of 376 first-grade boys and girls (mean age = 6.52) from diverse backgrounds (234 from the lowest 2 socioeconomic classes) and their mothers completed an interaction task designed to measure the quality of mother-child interaction. Latent variable structural equations analyses revealed that mother-child interaction quality partially mediated the relation between maternal depressive symptomatology and child behavior problems even when the effects of socioeconomic status on both variables were taken into account. Although this model held for boys, girls, and Caucasians, the relation between maternal depression and interaction quality was not significant for African-Americans. Further investigation is required to understand the lack of generalizability of the model to African-American mother-child dyads.

This study examined influences on the rate and quality of parent participation in the Fast Track Program, a multi-system, longitudinal preventive intervention for children who are at risk for conduct problems. A theoretical model of the relations among family coordinator characteristics, parent characteristics, the therapeutic engagement between family coordinator and parent, and rate and quality of parent participation was the basis for this study. "Family coordinators" are the Fast Track program personnel who conduct group-based parent-training sessions and home visits. Participants in this study included 12 family coordinators (42% were African American, 58% European American) and 87 parents (55% were African American, 45% European American). The level of therapeutic engagement between the parent and the family coordinator was positively associated with the rate of parent attendance at group training sessions. The extent of family coordinator-parent racial and socioeconomic similarity and the extent of the family coordinator's relevant life experiences were highly associated with the level of therapeutic engagement. The quality, but not the rate, of participation was lower for African American parents. Implications of these findings for preventive intervention with this population are discussed.

No abstract