Predictors of Early Engagement in Home Visitation

Predictors of engagement in mothers receiving home visitation in the first year of service was examined. Early engagement was studied in three ways: (1) length of time active in the program during the first year of service (duration), (2) number of visits received (quantity), and (3) gaps in service between visits (consistency). Examined visits received in 515 first-time mothers in a Healthy Families America (HFA) program. Parameters of engagement were investigated, and predictors of engagement were identified using demographics and the Kempe Family Stress Inventory. Inclusive of the Assessment Visit, 31.8% of mothers disengaged prior to the first month of service. Remaining active in the program was associated with being Caucasian, and increased parenting risk (mental health/substance abuse history, low social support, increased stress). Most mothers had fewer home visits than prescribed. Gaps in prescribed service were common, with 89.4% of mothers experiencing gaps between visits of 1 month, and dropping to 16.4% having gaps of 2 months. In contrast to findings from clinic-based interventions, early engagement in home visitation is associated with lower levels of functioning and acute needs. These findings add to a growing body of literature suggesting that increased adversity promotes engagement in prevention programs in general, and home visitation programs in particular. To the extent that mothers who are actively engaged in home visitation are likely to have increased psychosocial needs, curricula may require modification and augmentation to address these needs and optimize program effectiveness.     

Legionnaires' disease at autopsy

Sporadic deaths from Legionnaires' disease may escape detection at autopsy. Known epidemiological and clinical features of the disease should arouse suspicion and prompt appropriate bacteriological studies. The pathological findings in Legionnaires' disease are almost entirely confined to the lungs and are not distinct from any other severe bacterial bronchopneumonia. The causative organism, Legionella pneumophila, is difficult to identify on a Gram stain but will stain nonspecifically with the Giemsa, Warthin-Starry, and Dieterle techniques. The direct fluorescent antibody method allows specific identification of Legionella in paraffin-embedded tissue sections.