2009 H1N1 Fatalities: The New Mexico Experience

Abstract: Histopathologic features of New Mexico 2009 H1N1 fatalities have not been representative of those reported nationwide. We retrospectively reviewed medical records of all New Mexico 2009 pandemic influenza A (pH1N1) fatalities (n = 50). In cases in which autopsy was performed (n = 12), histologic sections and culture results were examined. In contrast to previously published studies, the majority of our fatalities did not have diffuse alveolar damage (DAD) (2/12; 16.7%). Common findings included pulmonary interstitial inflammation and edema, tracheobronchitis, and pneumonia. Two cases had significant extra‐pulmonary manifestations: myocarditis and cerebral edema with herniation. The majority had a rapid disease course: range from 1 to 12 days (median, 2 days), and Native Americans were disproportionately represented among fatalities. These findings suggest that New Mexico H1N1 fatalities generally did not survive long enough to develop the classic picture of DAD. Pathologists should be aware that H1N1 may cause extra‐pulmonary pathology and perform postmortem cultures and histologic sampling accordingly.     

Influences of Childhood Abuse on Parenting Perspectives of Pregnant Cohabitors

Using thematic analysis, we examine the effects of childhood abuse regarding parenthood for pregnant cohabitors from qualitative interviews. Participants (N?=?18; 10 women and 8 men) recalled childhood abuse during the Adult Attachment Interview. Three themes emerged: (1) “Learning what not to do,” whereby abuse is discussed as something not to continue, and harmful toward children; (2) “Use but modify parents’ discipline,” whereby individuals state that they will employ methods of their parents, but in ways different for their children; and (3) “Ambiguous,” whereby discussions are unclear and confused about how the abuse will affect their parenting. These results suggest that even when pregnant cohabitors want to parent differently than their own parents, they may not have relevant models or skills. For practitioners, we suggest interventions aimed at providing alternative models for how to parent, and effective and appropriate disciplining methods, as ways to deter intergenerational abuse.     

The effect of a judicial declaration of competence on the perceived credibility of children and defendants

Purpose. Three studies were conducted to determine the effect of a judicial declaration of competence on perceptions of credibility towards a child witness and an adult defendant. Methods. Undergraduates read vignettes about a 5‐ or a 13‐year‐old child witness or an adult involved in either a sexual assault case or a motor vehicle accident case. In the child conditions, the case was either preceded by a declaration of the child's competence to testify (either specific or general declaration) or there was no mention of the competence of the child. Participants then rated the perceived credibility of both the complainant/witness and the defendant. Results. A judicial declaration of competence that was targeted at the particular child sometimes increased the credibility ratings of the child and decreased those of the defendant, sometimes to levels beyond those observed in the adult conditions. These effects on credibility were not replicated when a general declaration of all children's competence was used. In fact, the general declaration sometimes resulted in more positive ratings of the defendant. Conclusions. These results are discussed in the context of recommendations for the use of competence evaluations and declarations of competence in court.     

U.S. policy on health inequities: the interplay of politics and research

What is the relationship between scientific research and government action in addressing health inequalities in the United States? What factors increase the impact of scientific research on public policy? To answer these questions, we focus on racial and ethnic disparities in health status and health care in the United States. We first review the history of the disparities issue to elucidate how the continual and persistent interplay between political action and scientific research drives government policy. We then analyze two recent government-sponsored reports about racial and ethnic disparities to understand the strategic consequences of issue framing. We draw lessons about how disparities research can have a greater impact on public policy.     

Reframing the racial disparities issue for state governments

Although racial and ethnic disparities in health have been on the federal government's agenda since 1985, no policy reforms have significantly reduced disparities. The question arises whether states can effectively address this issue without waiting for solutions from the national government. The purpose of this article is to propose ways of reframing the disparities issue that might give state policy makers more leverage and might strengthen political will to address the issue. I suggest a moral frame based on a concept of distributive justice in which medical care must be distributed according to need. I explain the rationales for such a frame and consider its strategic advantages and disadvantages. In the last section, I suggest some policies based on this framing that are within the power of state legislatures.