Purpose To describe parents’ perspectives of health care provider actions that helped or did not around the time of infant/child’s intensive care unit (ICU) death. Semistructured interviews with 63 parents (Black, White, and Hispanic) 7 months post infant/child death were audio-recorded, transcribed, analyzed, and themes identified. Findings What helped most: compassionate, sensitive staff; understandable explanations of infant’s/child’s condition; experienced, competent nurses; providers did everything to help infant/child; and parents’ involvement in care decisions. What did not help: insensitive, nonsupportive staff; conflict between providers and parents; communication problems around the death; inexperienced nurses and doctors; parents not understanding child’s disease, care, complications. Conclusions Compassionate, sensitive staff and understandable explanations of children’s conditions were most helpful; insensitive, nonsupportive staff least helpful by gender, racial group, or care setting. Conflict between providers and parents was most problematic for minority parents and mothers.

Purpose To examine rituals (disposing remains, wakes, funerals/burials, celebrations) of White, Black, Hispanic parents post ICU infant/child death. Design and methods Qualitative design, 63 parents completed English or Spanish semi-structured interviews at 7 & 13 months after infant’s/child’s death. Interviews were audio-recorded, transcribed verbatim, and entered into Atlas.ti for analysis. An inductive approach to thematization was used to develop codes. Results Parents: mean age 35.1 years (SD = 9.03); 33% Black, 27% White, 40% Hispanic; from 17 countries. Three themes emerged: immediately after death - shock and stress, needing help with arrangements, decisions on burial or cremation (conflicts due to finances, religion, culture), when and where to hold wakes, funerals/burials. Wakes and funerals - who prepares child’s body, appropriate dress (deceased child, mourners), who can come (cultural restrictions),-variations by child age, parent choice, culture, religion, country. After burial/cremation - being with family, milestone celebrations. Conclusion Child death is devastating for parents, other children, grandparents, and family members. Practice Implications. Rituals after child death require decisions about the child’s remains, wakes, funerals/burials at time of great pain for parents. This is especially true for newly immigrated parents and those with language barriers where making arrangements is especially hard and often very isolating. Health professionals who provide support need to be cognizant of practice differences based on religion, culture, economics, family traditions, and individual preference and provide as much support and resource as possible. A list of religious leaders representing the community’s cultures and funeral service providers who may provide lower cost burials/cremations is helpful.

Spatial variability of rainfall was studied through a gauge network on the Delmarva Peninsula. The gauge network consists of 11 dual- or triple-tipping-bucket sites ranging from 1- to 150-km separation distances. The time of the tip (0.254 mm) was recorded to a datalogger, and a continuous dataset was available from all sites for over 5 yr (May 2005–July 2010). A three-parameter exponential function was fitted to the paired correlations and the resultant correlation distance was 8–13 km during summer and 51–85 km during winter. The correlation distances showed pronounced year-to-year variability as being 8–43 km and 13–67 km during spring and autumn, respectively. The airmass convection was the main weather system during summer while nor’easters played an important role during winter. The 30-min integration and two-tip rain/no-rain threshold was selected for the base of this study. The correlation distance increased with longer integration periods and was 17 and 32 km for 30 min and 1 h, respectively.

Background Understanding children’s health after a sibling’s death and what factors may affect it is important for treatment and clinical care. This study compared children’s and their parents’ perceptions of children’s health and identified relationships of children’s age, gender, race/ethnicity, anxiety, and depression and sibling’s cause of death to these perceptions at 2 and 4 months after sibling death. Methods 64 children and 48 parents rated the child’s health “now” and “now vs before” the sibling’s death in an ICU or ER or at home shortly after withdrawal of life-prolonging technology. Children completed the Child Depression Inventory and Spence Children’s Anxiety Scale. Sibling cause of death was collected from hospital records. Results At 2 and 4 months, 45% to 54% of mothers’ and 53% to 84% of fathers’ ratings of their child’s health “now” were higher than their children’s ratings. Child health ratings were lower for: children with greater depression; fathers whose children reported greater anxiety; mothers whose child died of a chronic condition. Children’s ratings of their health “now vs before” their sibling’s death did not differ significantly from mothers’ or fathers’ ratings at 2 or 4 months. Black fathers were more likely to rate the child’s health better “now vs before” the death; there were no significant differences by child gender and cause of death in child’s health “now vs before” the death. Conclusions Children’s responses to a sibling’s death may not be visually apparent or become known by asking parents. Parents often perceive their children as healthier than children perceive themselves at 2 and 4 months after sibling death, so talking with children separately is important. Children’s perceptions of their health may be influenced by depression, fathers’ perceptions by children’s anxiety, and mother’s perceptions by the cause of sibling death.

Purpose Physical inactivity and obesity are major U.S. health concerns. Hispanics have higher rates of obesity and lower incidence of meeting physical activity (PA) recommendations, however most studies on PA focus on non‐Hispanic Whites. This study examined type and amount of physical activities, and their relationship to age, BMI, employment, and stress in adult female Hispanics. Data sources Sixty‐three female Hispanics (mean age 34 years, SD = 10.5) were recruited in the Miami community. By BMI, of 47 women reporting both weight and height, 8.5% were underweight, 38.3% were normal weight, 27.2% were overweight, and 26.0% were obese. Women completed two instruments measuring PA and two measuring stress. Conclusions Attitudes toward PA were positive; greatest concerns were job security and finances not exercise. Leisure walking (14.3%) was the most common type of PA followed by activities watching TV (32.8%) and using video games (32.8%). Women with greater stress had higher BMIs and were less physically active (p < .05). Implications for practice In this sample, exercise was not a main priority although 53% were overweight/obese. Stress related to employment and finances was a major concern. Interventions on stress reduction and incorporating exercise within their daily lives are important strategies.

Purpose Examine parents’ concerns about subsequent pregnancies after experiencing an infant or child death (newborn to 18 years). Data sources Thirty‐nine semistructured parent (white, black, Hispanic) interviews 7 and 13 months post infant/child death conducted in English and/or Spanish, audio‐recorded, transcribed, and content analyzed. Mothers’ mean age was 31.8 years, fathers’ was 39 years; 11 parents were white, 16 black, and 12 Hispanic. Conclusions Themes common at 7 and 13 months: wanting more children; fear, anxiety, scared; praying to God/God's will; thinking about/keeping the infant's/child's memory and at 7 months importance of becoming pregnant for family members; and at 13 months happy about a new baby. Parents who lost a child in neonatal intensive care unit (NICU) commented more than those who lost a child in pediatric intensive care unit (PICU). Black and Hispanic parents commented more on praying to God and subsequent pregnancies being God's will than white parents. Implications for practice Loss of an infant/child is a significant stressor on parents with documented negative physical and mental health outcomes. Assessing parents’ subsequent pregnancy plans, recognizing the legitimacy of their fears about another pregnancy, discussing a plan should they encounter problems, and carefully monitoring the health of all parents who lost an infant/child is an essential practitioner role.

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This qualitative study used semi-structured interviews to describe adolescents’ responses at 7 and 13 months to siblings’ NICU/PICU/ED death. At 7 months, adolescents were asked about events around the sibling’s death; at 7 and 13 months, about concerns/fears, feelings, and life changes. Seventeen adolescents participated (13-18 years; M=15); 65% Black, 24% Hispanic, 11% White. Themes included death circumstances, burial events, thinking about the deceased sibling, fears, and life changes. Adolescents reported shock and disbelief that the sibling died; 80% knew the reason for the death; many had difficulty getting through burials; all thought about the sibling. From 7 - 13 months fears increased including losing someone and thoughts of dying. Adolescents reported more changes in family life and greater life changes in them (more considerate, mature) by 13 months; some felt friends abandoned them after the sibling’s death. Girls had more fears and changes in family life and themselves. Adolescent’s responses to sibling death may not be visually apparent. One recommendation from this study is to ask adolescents how they are doing separately from parents since adolescents may hide feelings to protect their parents, especially their mothers. Older adolescents (14-18 years) and girls may have more difficulty after sibling death.