sábado, 1 de enero de 2011

Political Battle on Illegal Immigration Shifts to States

Political Battle on Illegal Immigration Shifts to States

Legislative leaders in at least half a dozen states say they will propose bills similar to a controversial law to fight illegal immigration that was adopted by Arizona last spring, even though a federal court has suspended central provisions of that statute.
The efforts, led by Republicans, are part of a wave of state measures coming this year aimed at cracking down on illegal immigration.
Legislators have also announced measures to limit access to public colleges and other benefits for illegal immigrants and to punish employers who hire them.
Next week, at least five states plan to begin an unusual coordinated effort to cancel automatic United States citizenship for children born in this country to illegal immigrant parents.
Opponents say that effort would be unconstitutional, arguing that the power to grant citizenship resides with the federal government, not with the states. Still, the chances of passing many of these measures appear better than at any time since 2006, when many states, frustrated with inaction in Washington, began proposing initiatives to curb illegal immigration.
Republicans gained more than 690 seats in state legislatures nationwide in the November midterms, winning their strongest representation at the state level in more than 80 years.
Few people expect movement on immigration issues when Congress reconvenes next week in a divided Washington. Republicans, who will control the House of Representatives, do not support an overhaul of immigration laws that President Obamahas promised to continue to push. State lawmakers say it has fallen to them to act.
“The federal government’s failure to enforce our border has functionally turned every state into a border state,” said Randy Terrill, a Republican representative in Oklahoma who has led the drive for anti-illegal immigration laws there. “This is federalism in action,” he said. “The states are stepping in and filling the void left by the federal government.”
But the proposals have already drawn opposition from some business groups. And they are forcing strategic soul-searching within the Republican Party nationwide, with a rising populist base on one side demanding tough immigration measures, and, on the other side, traditional Republican supporters in business and a fast-growing Latino electorate strongly opposing those measures.
In Utah, a state dominated by Republicans, leaders from business, law enforcement, several churches and the Latino community sought to bridge the divide by joining together in November in a compact urging moderation on immigration issues.
Some of the more contentious measures may not go into effect immediately, including Arizona-style bills and those intended to eliminate birthright citizenship for American-born children of illegal immigrants. Latino and immigrant advocate legal organizations are gearing up for a host of court challenges.
Among the states expected to introduce bills similar to Arizona’s are Georgia, Mississippi, Nebraska, Oklahoma, Pennsylvania and South Carolina.
The Arizona law authorized the state and local police to ask about the immigration status of anyone they detained for other reasons, if they had a “reasonable suspicion” that the person was an illegal immigrant.
Acting on a lawsuit filed by the Obama administration, a federal judge stayed central provisions of the law. In November, the United States Court of Appeals for the Ninth Circuit heard arguments on an appeal of that stay by Arizona.
“States will push ahead regardless of the Ninth Circuit,” said Kris Kobach, a law professor and politician from Kansas who helped many states devise immigration laws — including Arizona’s. “A lot of people recognize that the district judge’s decision is very much open to dispute.”
In Oklahoma, where Republicans won big majorities in both houses of the Legislature and the governor’s office, Mr. Terrill said he would introduce a bill he called “Arizona plus.” In addition to the terms of Arizona’s law, it would allow for the seizure of vehicles and property used to transport or harbor illegal immigrants.
In Georgia, an all-Republican commission of legislators plans to propose measures to enhance enforcement of tough laws already on the books. Georgia will also consider a bill to bar illegal immigrant students from all public universities.
The newly elected governor, Nathan Deal, a Republican, is expected to sign those bills. But the Georgia Farm Bureau, which represents the state’s powerful growers, voted to oppose any measures that would affect immigrant farm workers, most of whom do not have legal status.
In Kansas, Republicans won big majorities in both legislative houses and Sam Brownback, who just retired as a United States senator, was elected governor. Mr. Kobach, the law professor, was elected secretary of state after a campaign in which he vowed to pass a law requiring proof of citizenship for voters.
But the Kansas Chamber of Commerce has voiced its opposition, and Mr. Brownback has said he will focus on reducing unemployment.
The newest initiative is a joint effort among lawmakers from states including Arizona, Oklahoma, Missouri and Pennsylvania to pass laws based on a single model that would deny American citizenship to children born in those states to illegal immigrants. The legislators were to announce the campaign in Washington on Wednesday.
A leader of that effort is Daryl Metcalfe, a Republican state representative from Pennsylvania. At a recent news conference, Mr. Metcalfe said his goal was to eliminate “an anchor baby status, in which an illegal alien invader comes into our country and has a child on our soil that is granted citizenship automatically.”
The campaign is certain to run into legal obstacles. Courts have interpreted the 14th Amendment as guaranteeing birthright citizenship. Even among those who seek its repeal, debate has hinged on whether that would require a constitutional amendment, an act of Congress or a decision by the Supreme Court.
Some Republicans argue that the party is risking losing its appeal to Latino voters, the fastest-growing minority voter bloc.
“The Republican Party is divided between those who see that Hispanics are an essential constituency going forward, and those who don’t see that,” said Tamar Jacoby, a Republican who is the president of ImmigrationWorks USA, a business coalition that supports legalization for illegal immigrants.
Latino and immigrant advocate groups are resigned to being on the defensive for the next two years. “These laws are creating resentment within the Latino community that is going to last for decades,” said Tony Yapias, director of Proyecto Latino de Utah in Salt Lake City, an immigrant advocacy group.

En este día...

On This Day in HistorySaturday, January 01st
The 001st day of 2011.
There are 364 days left in the year.
Go to a previous date.
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Today's Highlights in History
Buy a Reproduction
NYT Front PageSee a larger version of this front page.
On Jan. 1, 1959, Fidel Castro led Cuban revolutionaries to victory over Fulgencio Batista. (Go to article.)On Jan. 11895J. Edgar Hoover,the director of the Federal Bureau of Investigation from 1924-1972, was born. Following his death on May 2,1972his obituary appeared in The Times. (Go to obit. | Other Birthdays)
Editorial Cartoon of the Day

On January 1, 1859Harper's Weekly featured a cartoon about New Year's Day. (See the cartoon and read an explanation.)

On this date in:
1808A law prohibiting the importation of slaves into the United States went into effect.
1863President Abraham Lincoln signed the Emancipation Proclamation, declaring that slaves in rebel states were free.
1892The Ellis Island Immigrant Station in New York opened.
1898New York City was consolidated into five buroughs.
1901The Commonwealth of Australia was proclaimed.
1919J.D. Salinger, author of "The Catcher in the Rye," was born in New York City.
1953Country singer Hank Williams Sr., 29, died of a drug and alcohol overdose.
1958Treaties establishing the European Economic Community went into effect.
1979The United States and China established diplomatic relations.
1984AT&T was divested of its 22 Bell System companies under terms of an antitrust agreement.
1990David Dinkins was sworn in as New York City's first African-American mayor.
1993Czechoslovakia peacefully split into two new countries, the Czech Republic and Slovakia.
1994The North American Free Trade Agreement went into effect.
1999The euro became the official currency of 11 European countries.

Current Birthdays
Frank Langella turns 73 years old today.

AP Photo/Evan Agostini Actor Frank Langella ("Frost/Nixon") turns 73 years old today.

89Ernest Hollings
Former U.S. senator, D-S.C.
69Country Joe McDonald
Rock singer, musician (Country Joe and the Fish)
68Don Novello
Comedian
64Jon Corzine
Former governor of New Jersey
57Robert Menendez
U.S. senator, D-N.J.
53Grandmaster Flash
Rapper
47Dedee Pfeiffer
Actress
45Embeth Davidtz
Actress
42Verne Troyer
Actor ("Austin Powers" movies)
Historic Birthdays
J. Edgar Hoover
 
1/1/1895 - 5/2/1972
American director of the Federal Bureau of Investigation 

(Go to obit.)

43Lorenzo de' Medici
1/1/1449 - 3/9/1492
Italian statesman, ruler

51Mad Anthony Wayne
1/1/1745 - 12/15/1796
American Revolutionary general

84Betsy Ross
1/1/1752 - 1/30/1836
American, sewed the first American flag

87Sir James George Frazer
1/1/1854 - 5/7/1941
British anthropologist, wrote Golden Bough

82Alfred Stieglitz
1/1/1864 - 7/13/1946
American photographer

79Ernest Jones
1/1/1879 - 2/11/1958
British psychoanalyst

73William Fox
1/1/1879 - 5/8/1952
American motion picture executive

76William J Donovan
1/1/1883 - 2/8/1959
American Director of the O.S.S. in WW2

76Catherine Bowen
1/1/1897 - 11/1/1973
American writer

90Xavier Cugat
1/1/1900 - 10/27/1990
Cuban band leader

83Dana Andrews
1/1/1909 - 12/17/1992
American actor

89Barry M. Goldwater
1/1/1909 - 5/29/1998
American senator

76Kim Philby
1/1/1912 - 5/11/1988
British, Soviet double agent

71Rocky Graziano
1/1/1919 - 5/22/1990
American boxer

Go to a previous date.
SOURCE: The Associated Press
Front Page Image Provided by UMI

Presión del globo del tubo endotraqueal y de la mascarilla laríngea durante anestesia- Se requiere una vigilancia obligatoria

Presión del globo del tubo endotraqueal y de la mascarilla laríngea durante anestesia- Se requiere una vigilancia obligatoria
Tracheal tube and laryngeal mask cuff pressure during anaesthesia - mandatory monitoring is in need.
Rokamp KZ, Secher NH, Moller AM, Nielsen HB.
BMC Anesthesiol. 2010 Dec 3;10(1):20. [Epub ahead of print]

Abstract
BACKGROUND: To prevent endothelium and nerve lesions, tracheal tube and laryngeal mask cuff pressure is to be maintained at a low level and yet be high enough to secure air sealing. METHOD: In a prospective quality-control study, 201 patients undergoing surgery during anaesthesia (without the use of nitrous oxide) were included for determination of the cuff pressure of the tracheal tubes and laryngeal masks. RESULTS: In the 119 patients provided with an endotracheal tube, the median cuff pressure was 30 (range 8 - 100) cm H2O and the pressure exceeded 30 cm H2O (upper recommended level) for 54 patients. In the 82 patients provided with a laryngeal mask, the cuff pressure was 95 (10 - 121) cm H2O and above 60 cm H2O (upper recommended level) for 56 patients and in 34 of these patients, the pressure exceeded the upper cuff gauge limit (120 cm H2O). There was no association between cuff pressure and age, body mass index, type of surgery, or time from induction of anaesthesia to the time the cuff pressure was measured.CONCLUSION: For maintenance of epithelia flow and nerve function and at the same time secure air sealing, this evaluation indicates that the cuff pressure needs to be checked as part of the procedures involved in induction of anaesthesia and eventually checked during surgery.

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Artí­culo en PDF
Manejo urgente de la vía aérea
Emergency airway management.
Gudzenko V, Bittner EA, Schmidt UH.
Department of Anesthesiology, Critical Care, and Pain Management, Massachusetts General Hospital, Gray-Bigelow 444, 55 Fruit Street, Boston, MA 02114, USA.
Respir Care. 2010 Aug;55(8):1026-35.
Abstract
Emergency airway management is associated with a high complication rate. Evaluating the patient prior to airway management is important to identify patients with increased risk of failed airways. Pre-oxygenation of critically ill patients is less effective in comparison to less sick patients. Induction agents are often required, but most induction agents are associated with hypotension during emergency intubation. Use of muscle relaxants is controversial for emergency intubation, but they are commonly used in the emergency department. Supervision of emergency airway management by attending physicians significantly decreases complications. Standardized algorithms may increase the success of emergency intubation. Attention should be paid to cardiopulmonary stability in the immediate post-intubation period.

Aspectos organizacionales del manejo de la vía aérea difícil. Piense globalmente y actúe localmente
Organizational Aspects of Difficult Airway Management. Think Globally, Act Locally
Ulrich Schmidt, M.D., Ph.D., Matthias Eikermann, M.D.,
Ph.D., Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
Anesthesiology 2011; 114:3- 6
In 1858, Eugène Bouchut, a pediatrician from Paris, published a series of seven cases of successful orotracheal intubation to bypass laryngeal obstruction resulting from diphtheria. His presentation was reportedly not well received by the French Academy of Sciences because of safety concerns. Today, millions of tracheal intubation procedures are performed every year, and in emergent situations, the procedure still carries a high risk of complications of up to 30%. Accordingly, new information that could potentially lead to improved outcome of tracheal intubation is important. In this issue of Anesthesiology, four groups of clinical researchers 2-5 present important new insight that might help improve the safety of patients undergoing emergency tracheal intubation. The work of Combes et al and Martin et al focused on emergent intubation, whereas Amathieu et al. and Aziz et al report on their experiences with new devices to manage a difficult airway in the operating room.

Atentamente
Dres. Enrique Hernández-Cortes, Juan C. Flores-Carrillo y Víctor M. Whizar-Lugo.
Ings. Ana I. Whizar-Figueroa, Victor M. Whizar-Figueroa
Anestesiología y Medicina del Dolor

Manejo general y en medicina extrahospitalaria de los síndromes alérgicos

Manejo general y en medicina extrahospitalaria de los síndromes alérgicos
Debido a la alta prevalencia de las enfermedades alérgicas, éstas constituyen una causa muy frecuente de consulta en los distintos niveles asistenciales. Es el médico de familia el que se plantea inicialmente la valoración de la sintomatología, las pruebas complementarias y el seguimiento, cuándo derivar al paciente al especialista y cómo modificar las dosis de los fármacos utilizados para el tratamiento de los distintos síndromes según su evolución. Estos aspectos del manejo general y extrahospitalario del paciente con enfermedad alérgica son los que vamos a comentar a continuación.
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Recent advances in antileukotriene therapy

Recent advances in antileukotriene therapy. 
Pharmacotherapy and evidence based medicine
Current Opinion in Allergy & Clinical Immunology. 10(4):370-376, August 2010.
Scadding, Guy W a; Scadding, Glenis K b
Abstract: 
Purpose of review: Despite profound effects of leukotrienes in experimental models, clinical responses to antileukotriene drugs are highly heterogeneous. This review discusses recent advances concerning the molecular mechanisms of antileukotrienes as well as their efficacy in various clinical scenarios and patient groups.
Recent findings: Appreciation of the role of leukotriene E4 and the existence of its distinct receptors may explain the limited efficacy of current leukotriene receptor antagonists. Pharmacogenetic studies highlight the influence of several leukotriene pathway genes on clinical responsiveness. Benefits of addition of antileukotrienes to inhaled corticosteroids in chronic adult asthmatics have been shown, but their role in acute asthma is unclear. Evidence suggests they are not a first-line treatment for allergic rhinitis or urticaria, but may provide useful additional therapy. In children antileukotrienes provide symptomatic benefit in preschool wheezers, but have no clear role in bronchiolitis or acute asthma. Adherence to montelukast appears superior to inhaled corticosteroids. Use in sleep-disordered breathing and eosinophilic gastroenteropathies warrants further investigation. Despite recent concerns thorough analysis of existing data suggests antileukotrienes are well tolerated drugs. The possible link with Churg-Strauss syndrome requires further investigation.
Summary: The leukotriene pathway remains an attractive target in asthma and allergic disease, particularly in light of renewed appreciation of the role of leukotriene E4. Clarification of the clinical role of antileukotrienes is needed.
(C) 2010 Lippincott Williams & Wilkins, Inc.

Epinephrine and its use in anaphylaxis: current issues

Epinephrine and its use in anaphylaxis: current issues.

Anaphylaxis and insect allergy
Current Opinion in Allergy & Clinical Immunology. 10(4):354-361, August 2010.
Simons, Keith J a; Simons, F Estelle R b

Abstract:
Purpose of review: Epinephrine is a life-saving medication in the treatment of anaphylaxis, in which it has multiple beneficial pharmacologic effects. Here, we examine the evidence base for its primary role in the treatment of anaphylaxis episodes in community settings.

Recent findings: We review the practical pharmacology of epinephrine in anaphylaxis, its intrinsic limitations, and the pros and cons of different routes of administration. We provide a new perspective on the adverse effects of epinephrine, including its cardiac effects. We describe the evidence base for the use of epinephrine in anaphylaxis. We discuss the role of epinephrine auto-injectors for treatment of anaphylaxis in community settings, including identification of patients who need an auto-injector prescription, current use of auto-injectors, and advances in auto-injector design. We list reasons why physicians fail to prescribe epinephrine auto-injectors for patients with anaphylaxis, and reasons why patients fail to self-inject epinephrine in anaphylaxis. We emphasize the primary role of epinephrine in the context of emergency preparedness for anaphylaxis in the community.

Summary: Epinephrine is the medication of choice in the first-aid treatment of anaphylaxis in the community. For ethical reasons, it is not possible to conduct randomized, placebo-controlled trials of epinephrine in anaphylaxis; however, continued efforts are needed towards improving the evidence base for epinephrine injection in this potentially fatal disease.
(C) 2010 Lippincott Williams & Wilkins, Inc

PDF

http://pt.wkhealth.com/pt/re/merck/pdfhandler.00130832-201008000-00016.pdf;jsessionid=NpMQm545K3v7m1qrJd2jfqssp93cnSHrn77JQT1mQvgnGXGC1vCS!1507367712!181195629!8091!-1

viernes, 31 de diciembre de 2010

El control de la obesidad y de la diabetes reduce el riesgo de ciertos tipos de cáncer

ENDOCRINOLOGÍA

El control de la obesidad y de la diabetes reduce el riesgo de ciertos tipos de cáncer

JANO.es y agencias · 29 Diciembre 2010 12:52

Los pacientes con diabetes tipo 2 u obesidad tienen un riesgo mayor de desarrollar cáncer, así como un peor pronóstico cuando la enfermedad ya se ha manifestado y confluyen ambas patologías, según ha señalado el Dr. Enrique Palacio, jefe del Servicio de Endocrinología del Hospital Nuestra Señora de la Candelaria (Tenerife), en el marco del simposio “Seguridad de análogos de insulina”.
Se estima que la mitad de los diabéticos tipo 2 presenta obesidad y un 60% no alcanza un control óptimo de la enfermedad.

 
En España se estima que la diabetes tipo 2 afecta a 4,6 millones de personas, que aproximadamente la tercera parte de ellas no están diagnosticadas, y que prácticamente la mitad de los pacientes presentan obesidad.
 
Por este motivo, este especialista señala que estos pacientes deben controlar el peso para conseguir un mejor control metabólico, “ya que resulta mucho más fácil si tiene un peso adecuado que si padece sobrepeso”. Asimismo, ha explicado que “la obesidad y el sobrepeso aumentan la probabilidad de presentar hipertensión, colesterol o patología cardiovascular”.
 
Los datos disponibles hasta la actualidad indican que el 60% de los pacientes no alcanza un control óptimo de la enfermedad, es decir, de los 246 millones de personas que padecen diabetes tipo 2 en el mundo, en torno a 150 millones tienen un nivel de glucosa en sangre superior al objetivo.
 
Al respecto, el Dr. Palacio ha recordado que “el control de los niveles de glucosa en el paciente con diabetes es fundamental, dado que no alcanzar un control metabólico puede suponer lesiones en múltiples tejidos, entre ellos, la retina, los riñones y el sistema cardiovascular. Las personas con diabetes, por ejemplo, tienen entre 15 y 40 veces más riesgo de sufrir una amputación de extremidades inferiores, y aumentan la posibilidad de padecer una enfermedad cardiovascular”.
 
Durante el encuentro, celebrado en Santa Cruz de Tenerife con la colaboración de Novo Nordis, el Dr. Arturo Rolla, profesor de Medicina Clínica en la Universidad de Harvard, aseguró que “el hecho de que la obesidad y la diabetes aumenten el riesgo de cáncer podría ser debido a la actividad trófica de la insulina, en general”.
 
Por este motivo, recuerda la importancia de controlar las glucemias y de la hemoglobina glicosilada que, como señala, además “disminuye las complicaciones crónicas de la diabetes”.
 
Para un control terapéutico óptimo han recordado que los análogos de insulina han mejorado el tratamiento de la diabetes en los últimos años, hasta tal punto que se han convertido en la opción terapéutica más eficaz.
 
Según el Dr. Rolla, “los análogos de acción rápida permiten un mejor control de la glucemia posprandial con la conveniencia de que los pacientes se pueden inyectar antes de las comidas, mientras que por su parte, los análogos de larga duración mejoran la calidad de vida de los pacientes, dada su menor variabilidad ya que duran 24 horas y no tienen un pico de actividad muy acusado”.

Investigadores de Barcelona redefinen el síndrome mielodisplásico

Investigadores de Barcelona redefinen el síndrome mielodisplásico

JANO.es · 30 Diciembre 2010 11:41

Investigadores del Hospital del Mar de Barcelona han liderado un estudio multicéntrico internacional que ha logrado redefinir el síndrome mielodisplásico (SMD), enfermedad hematológica también conocida como preleucemia, así como su tratamiento.
Su investigación, publicada en “Leukemia”, también confirman los buenos resultados de un tratamiento del que se había desaconsejado el uso a causa de efectos indeseados que ahora se han desestimado.

 
La investigación, publicada en la revista Leukemia, arroja datos de referencia sobre los parámetros que determinan la evolución del síndrome y describe cambios citogenéticos en el cromosoma 5 (5q-), que tienen valor pronóstico.
 
Hematólogos citogenetistas de Austria, Alemania, Japón, Estados Unidos y España, todos ellos miembros del grupo Cytogenetics MDS Working Group (MDS Foundation), han participado en el estudio y análisis de una serie de 541 pacientes, la muestra más grande en un estudio con pacientes con esta anomalía.
 
Los hallazgos podrían suponer un antes y un después para los pacientes afectados por esta enfermedad, ya que no sólo redefinen la enfermedad, sino que confirman los buenos resultados de un tratamiento del que se había desaconsejado el uso a causa de efectos indeseados que ahora se han desestimado.
 
“Poder disponer de un tratamiento que ayude a normalizar la vida de estos pacientes y que mejore su calidad de vida es una buena noticia”, ha celebrado el coordinador del estudio, Francesc Solé, del grupo de expertos MDS Foundation. “Hace unos años –añade- se desaconsejó el uso de este fármaco a causa de la sospecha de que producía una mayor tasa de evolución a leucemia aguda”.
 
Desde entonces, los pacientes afectados por SMD se quedaron huérfanos de tratamiento. “Con los resultados de este estudio, hemos confirmado que los pacientes con SMD y tratados con lenalidomida no padecen más leucemias que los afectados por SMD sin tratamiento, ya que estas leucemias forman parte de la historia natural de la evolución de la enfermedad y algunos pacientes la sufrirán, tomen o no el fármaco”, ha argumentado el citado especialista.
 
Por el contrario, los pacientes con SMD mejoran mucho las alteraciones sanguíneas que padecen hasta el punto de que el 70% de ellos en dos meses dejan de tener que hacerse transfusiones continuadas.
 
Los síndromes mielodisplásicos son un grupo de enfermedades de la sangre y la médula ósea y presentan un bajo número de células sanguíneas sanas. El origen de la dolencia es una anomalía en las células madre de la medula ósea, las responsables de fabricar las células de la sangre, que imposibilitan que éstas se conviertan en glóbulos blancos, rojos y plaquetas.

Families Bear Brunt of Deployment Strains

A YEAR AT WAR

Families Bear Brunt of Deployment Strains

Marcus Yam/The New York Times
Sgt. First Class Brian Eisch embraced his sons, Joey, 8, left; and Isaac, 12, before returning to his deployment in Afghanistan after a two week midtour leave.



WAUTOMA, Wis. — Life changed for Shawn Eisch with a phone call last January. His youngest brother, Brian, a soldier and single father, had just received orders to deploy from Fort Drum, N.Y., to Afghanistan and was mulling who might take his two boys for a year. Shawn volunteered.

A Year at War

The Home Front
Articles in this series are chronicling the yearlong deployment of the First Battalion, 87th Infantry Regiment, based in Kunduz Province, Afghanistan. The series follows the battalion’s part in the surge in northern Afghanistan and the impact of war on individual soldiers and their families back home.
Marcus Yam/The New York Times
Joey, left, and Isaac Eisch with their father, Sgt. First Class Brian Eisch, before his return to Afghanistan from leave.

Readers' Comments

Readers shared their thoughts on this article.
So began a season of adjustments as the boys came to live in their uncle’s home here. Joey, the 8-year-old, got into fistfights at his new school. His 12-year-old brother, Isaac, rebelled against their uncle’s rules. And Shawn’s three children quietly resented sharing a bedroom, the family computer and, most of all, their parents’ attention with their younger cousins.
The once comfortable Eisch farmhouse suddenly felt crowded.
“It was a lot more traumatic than I ever pictured it, for them,” Shawn, 44, said. “And it was for me, too.”
The work of war is very much a family affair. Nearly 6 in 10 of the troops deployed today are married, and nearly half have children. Those families — more than a million of them since 2001 — have borne the brunt of the psychological and emotional strain of deployments.
Siblings and grandparents have become surrogate parents. Spouses have struggled with loneliness and stress. Children have felt confused and abandoned during the long separations. All have felt anxieties about the distant dangers of war.
Christina Narewski, 26, thought her husband’s second deployment might be easier for her than his first. But she awoke one night this summer feeling so anxious about his absence that she thought she was having a heart attack and called an ambulance. And she still jumps when the doorbell rings, worried it will be officers bearing unwanted news.
“You’re afraid to answer your door,” she said.
Social scientists are just beginning to document the rippling effects of multiple combat deployments on families — effects that those families themselves have intimately understood for years. A study published in The New England Journal of Medicine in January found that wives of deployed soldiers sought mental health services more often than other Army wives.
They were also more likely to report mental health problems, including depression, anxiety and sleep disorder, the longer the deployments lasted.
And a paper published in the journal Pediatrics in late 2009 found that children in military families were more likely to report anxiety than children in civilian families. The longer a parent had been deployed in the previous three years, the researchers found, the more likely the children were to have had difficulties in school and at home.
But those studies do not describe the myriad ways, often imperceptible to outsiders, in which families cope with deployments every day.
For Ms. Narewski, a mother of three, it has meant taking a grocery store job to distract her from thinking about her husband, a staff sergeant with the First Battalion, 87th Infantry, now in northern Afghanistan.
For Tim Sullivan, it has meant learning how to potty train, braid hair and fix dinner for his two young children while his wife, a sergeant in a support battalion to the 1-87, is deployed.
For young Joey Eisch, it meant crying himself to sleep for days after his father, a platoon sergeant with the battalion, left last spring. His older brother, Isaac, calm on the outside, was nervous on the inside.
“It’s pretty hard worrying if he’ll come back safe,” Isaac said. “I think about it like 10 or more times a day.”
Joining the Army Life
Soon after Christina and Francisco Narewski married in 2004, he applied for a job with the local sheriff’s office in Salinas, Calif. But he got tired of waiting and, after talking things over with Christina, enlisted in the Army instead.
“We both signed up for it,” Ms. Narewski said. “We knew deployments were going to come.”
That day arrived in the fall of 2007, when their third child was just 5 months old. Ms. Narewski missed Francisco dearly and sometimes cried just hearing his voice when he called from Iraq. But when he returned home in October 2008, it took them weeks to feel comfortable together again, she recalled.

Families Bear Brunt of Deployment Strains


(Page 2 of 3)
“It’s almost like you’ve forgotten how to be with each other,” she said. “He’s been living in his spot for 15 months. Me and the kids have our own routine. It’s hard to get back to, ‘Oh, you’re home.’ ”
Marcus Yam/The New York Times
TWO WEEKS ON LEAVE, TOO SHORT A TIME Sgt. First Class Brian Eisch as his son Joey, 8, gets the “high and tight” look like his father’s.

A Year at War

The Home Front
Articles in this series are chronicling the yearlong deployment of the First Battalion, 87th Infantry Regiment, based in Kunduz Province, Afghanistan. The series follows the battalion’s part in the surge in northern Afghanistan and the impact of war on individual soldiers and their families back home.
Marcus Yam/The New York Times
Isaac Eisch, 12, in the back seat of his uncle’s car after saying goodbye to his father, who was returning to Afghanistan.

Readers' Comments

Readers shared their thoughts on this article.
Last April, he left again, this time to Afghanistan. Ms. Narewski, who lives in Watertown, N.Y., thought she was prepared. Her mother came to live with them. She signed up for exercise classes to fill the hours. She and Francisco bought BlackBerrys with instant messaging service so they could communicate daily. And yet.
“I’ve never missed him as much as I do right now,” she said recently. “It doesn’t feel like we’re moving. It’s like you’re in a dream and you’re trying to get something and you can’t get it.”
Not all the spouses back home are women. Tim Sullivan’s days have revolved almost entirely around his two children, Austin, 4, and Leah, 2, since his wife, Sgt. Tamara Sullivan, deployed to Afghanistan in March.
He rises each weekday at 5:30 a.m. to dress and feed them before shuttling them to day care. Evenings are the reverse, usually ending with him dozing off in front of the television at their rented ranch-style house in Fayetteville, N.C.
He has moved twice and changed jobs three times in recent years to accommodate his wife’s military career. But he does not mind being home with the children, he says, because his father was not, having left the family when Mr. Sullivan was young.
“I’m not going to put my kids through that,” said Mr. Sullivan, 35, who handles child support cases for the county. “I’m going to be there.”
He worries about lost intimacy with his wife, saying that they have had a number of arguments by phone, usually about bill paying or child rearing. “She tells me: ‘Tim, you can’t just be Daddy, the hard person. You have to be Mommy, too,’” he said. “I tell her it’s not that easy.”
Yet he says that if she stays in the Army — as she has said she wants to do — he is prepared to move again or even endure another deployment. “I love her,” he said. “I’m already signed up. I made a decision to join the life that goes with that.”
Doing What Uncle Sam Asks
Isaac and Joey Eisch have also had to adjust to their father’s nomadic life. “I don’t try to get too attached to my friends because I move around a lot,” said Isaac, who has lived in five states and Germany with his father. (Joey has lived in three states.) “When I leave, it’s like, hard.”
When Sergeant Eisch got divorced in 2004, he took Isaac to an Army post in Germany while Joey stayed with his mother in Wisconsin. Soon after returning to the States in 2007, the sergeant became worried that his ex-wife was neglecting Joey. He petitioned family court for full custody of both boys and won.
In 2009, he transferred to Fort Drum and took the boys with him. Within months, he received orders for Afghanistan.
After nearly 17 years in the Army with no combat deployments, Sergeant Eisch, 36, was determined to go to war. The boys, he felt, were old enough to handle his leaving. Little did he know how hard it would be.
When Shawn put the boys in his truck at Fort Drum to take them to Wautoma, a two-stoplight town in central Wisconsin, Isaac clawed at the rear window “like a caged animal,” Sergeant Eisch said. He still tears up at the recollection.
“I question myself every day if I’m doing the right thing for my kids,” he said. “I’m trying to do my duty to my country and deploy, and do what Uncle Sam asks me to do. But what’s everybody asking my boys to do?”
Within a few weeks of arriving at his uncle’s home, Joey beat up a boy so badly that the school summoned the police. It was not the last time Shawn and his wife, Lisa, would be summoned to the principal’s office.
The boys were in pain, Shawn realized. “There was a lot more emotion,” he said, “than Lisa and I ever expected.”

Shawn, a state water conservation officer, decided he needed to set strict rules for homework and behavior. Violations led to chores, typically stacking wood. But there were carrots, too: for Joey, promises of going to Build-a-Bear if he obeyed his teachers; for Isaac, going hunting with his uncle was the prize. Gradually, the calls from the principal declined, though they have not ended.
Marcus Yam/The New York Times
Sergeant Eisch and the boys at the boys’ grandparents’ home on his last night before returning.

A Year at War

The Home Front
Articles in this series are chronicling the yearlong deployment of the First Battalion, 87th Infantry Regiment, based in Kunduz Province, Afghanistan. The series follows the battalion’s part in the surge in northern Afghanistan and the impact of war on individual soldiers and their families back home.
Marcus Yam for The New York Times
WOUNDED, BUT STILL IN ONE PIECEIsaac, with Joey, helping his father at Walter Reed Army Medical Center in Washington. Sitting with them was Sergeant Eisch’s brother, Shawn, who has been keeping the boys.

In September, Sergeant Eisch returned for midtour leave and the homecoming was as joyful as his departure had been wrenching. Father and sons spent the first nights in hotels, visited an amusement park, went fishing and traveled to New York City, where they saw Times Square and the Intrepid Sea, Air and Space Museum.
But the two weeks were over in what seemed like hours. In his final days, Sergeant Eisch had prepped the boys for his departure, but that did not make it any easier.
“Why can’t we just, like, end the war?” Isaac asked at one point.
As they waited at the airport, father and sons clung to each other. “I’m going to have to drink like a gallon of water to replenish these tears,” the sergeant said. “Be safe,” Isaac implored him over and over.
Sergeant Eisch said he would, and then was gone.
Despite his worries, Isaac tried to reassure himself. “He’s halfway through, and he’s going to make it,” he said. “With all that training he’s probably not going to get shot. He knows if there’s a red dot on his chest, run. Not toward the enemy. Run, and shoot.”
But his father did not run.
Dad Comes Home
Just weeks after returning to Afghanistan, Sergeant Eisch, the senior noncommissioned officer for a reconnaissance and sniper platoon, was involved with Afghan police officers in a major offensive into a Taliban stronghold south of Kunduz city.
While directing fire from his armored truck, Sergeant Eisch saw a rocket-propelled grenade explode among a group of police officers standing in a field. The Afghans scattered, leaving behind a man writhing in pain. Sergeant Eisch ordered his medic to move their truck alongside the officer to shield him from gunfire. Then Sergeant Eisch got out.
“I just reacted,” he recalled. “I seen a guy hurt and nobody was helping him, so I went out there.”
The police officer was bleeding from several gaping wounds and seemed to have lost an eye. Sergeant Eisch started applying tourniquets when he heard the snap of bullets and felt “a chainsaw ripping through my legs.” He had been hit by machine gun fire, twice in the left leg, once in the right.
He crawled back into his truck and helped tighten tourniquets on his own legs. He was evacuated by helicopter and taken to a military hospital where, in a morphine daze, he called Shawn.
“Are you sitting down?” Brian asked woozily. “I’ve been shot.”
Shawn hung up and went into a quiet panic. He could not tell how badly Brian had been wounded. Would he lose his leg? He called the school and asked them to shield the boys from the news until he could get there.
Outside school, Shawn told Isaac, Joey and his 12-year-old daughter, Anna, about Brian’s injury. Only Isaac stayed relatively calm.
But later, Shawn found Isaac in his bedroom weeping quietly while looking at a photograph showing his father outside his tent, holding a rifle. Shawn helped him turn the photograph into a PowerPoint presentation titled, “I Love You Dad!”
For Shawn, a gentle and reserved man, his brother’s injury brought six months of family turmoil to a new level. Sensing his distress, Lisa urged him to go hunting, a favorite pastime. So he grabbed his bow and went to a wooded ridge on his 40 acres of property.
To his amazement, an eight-point buck wandered by. Shawn hit the deer, the largest he had ever killed with a bow. It seemed a good omen.
A few days later, Shawn flew with the boys, his father and Brian’s twin sister, Brenda, to Washington to visit Sergeant Eisch at Walter Reed Army Medical Center. At the entrance, they saw men in wheelchairs with no arms and no legs. Others were burned or missing eyes. Shawn feared what the boys would see inside Brian’s room.
But Brian, giddy from painkillers, was his cheerful self. His right leg seemed almost normal. His left leg, swollen and stapled together, looked terrible. But it was a real leg, and it was still attached. The boys felt relieved.
Within days, Brian was wheeling himself around the hospital and cracking jokes with nurses, a green-and-yellow Green Bay Packers cap on his head. While Joey lost himself in coloring books and television, Isaac attended to his father’s every need.
“I feel a little more grown up,” Isaac said. “I feel a lot more attached to him than I was when he left.”
One doctor told Brian that he would never be able to carry a rucksack or run again because of nerve damage in his left leg. Someone even asked him if he wanted the leg amputated, since he would certainly be able to run with a prosthetic. Brian refused, and vowed to prove the doctor wrong. By December, he was walking with a cane and driving.
For Shawn, too, the future had become murkier. It might be many weeks before Brian could reclaim his sons. But he also knew how glad the boys were to have their father back in one piece.
“Brian came home,” Shawn said one evening after visiting his brother in the hospital. “He didn’t come home like we hoped he would come home, but he came home.”
“Every single day I think about all those families and all those kids that are not going to have a dad come home from Afghanistan,” he said. “That hurts more than watching my brother try to take a step because I know my brother will take a step and I know he’s going to walk down the dock and get in his bass boat someday.”
It was late, and he had to get the boys up the next morning to visit their father at the hospital again. The holidays were fast approaching and the snow would soon be arriving in Wisconsin. Shawn wondered whether he could get Isaac out hunting before the season ended.
Yeah, he thought. He probably could.

This article has been revised to reflect the following correction:
Correction: December 31, 2010
Picture captions with an earlier version of this article misstated the rank of Sgt. First Class Brian Eisch
.