Child maltreatment in U.S. emergency departments: Imaging and admissions

ObjectiveWe report imaging and admission ratios for children with definitive and suggestive maltreatment in a national sample of emergency departments (EDs).MethodsUsing the 2012 Nationwide Emergency Department Sample (NEDS), we generated national estimates of ED visits for children <10 years with both definitive and suggestive maltreatment. Outcomes were admission/transfer ratios for children <10 years and screening ratios by skeletal surveys and head computed tomography (CT) for children <2 years with suspected physical abuse. We compared hospitals with low, medium, and high pediatric ED volumes using multivariable logistic regression.ResultsThe 2012 national estimate of U.S. ED visits (children <10 years) with definitive maltreatment is 14,457 (95% CI: 11,987–16,928). Suggestive child maltreatment was seen in an additional 103,392 (95% CI: 90,803–115,981) pediatric ED visits. After controlling for patient case mix, high volume hospitals had a significantly higher adjusted odds ratio (AOR) of admission/transfer among definitive cases (AOR = 1.74, 95% CI: 1.08–2.81), and medium volume hospitals had a higher odds of admission/transfer among suggestive cases (AOR = 1.24, 95% CI: 1.02–1.50) when compared with low volume hospitals. In hospitals with reliable reporting of imaging procedures, high volume hospitals reported skeletal surveys (age <2 years) significantly more often than low volume hospitals, AOR = 3.32 (95% CI: 1.25–8.84); the AORs for head CT did not differ by hospital volume.ConclusionsLow volume hospitals were less likely to screen by skeletal survey, but head CT ratios were not affected by ED volume. Low volume hospitals were also less likely to admit or transfer.     

Epidemiology of abusive head trauma in West Virginia children <24 months: 2000–2010

BackgroundFew states have published statewide epidemiology of abusive head trauma (AHT).ObjectiveTo examine the statewide epidemiology of AHT in West Virginia (WV), with the primary objective of establishing AHT incidence for comparison to national data, and to use as a baseline for comparison to incidence post-implementation of a statewide AHT prevention program.Participants and settingAHT cases in children less than 2 years old were identified from the 3 tertiary pediatric centers in WV.MethodsCases were identified by using ICD-9 codes for initially identifying those with injuries which might be consistent with AHT, followed by medical record review to determine which of these met the criteria for inclusion as a case. Medical examiner data was used to find additional cases of AHT. Using the number of cases identified along with relevant census data, incidence of AHT was calculated.ResultsThere were 120 cases of AHT treated in WV hospitals from 2000 to 2010, 100 of which were WV residents. The incidence was 36.1/100,000 children <1 year of age and was 21.9 cases per 100,000 children <2 years of age. Incidence in infants increased during the latter years (2006–2010) of the study to 51.8/100,000 compared to the incidence during 2000–2005, which was 24.0/100,000 (p < .01).ConclusionsCompared to US national, state and regional figures, the WV incidence of AHT was among the highest. In addition, the incidence of AHT increased significantly over the study period. Possible factors contributing to the rise in incidence are discussed.     

The lifetime costs of pediatric abusive head trauma and a cost-effectiveness analysis of the Period of Purple crying program in British Columbia,Canada

BackgroundAbusive head trauma (AHT) is a severe form of child abuse causing devastating outcomes for children and families, but its economic costs in Canada has yet to be determined. The Period of PURPLE crying program (PURPLE) is an AHT prevention program implemented in British Columbia for which success in reducing AHT events was recently reported.ObjectiveThis study estimated the lifetime costs to society of incidental AHT events and compared the benefits and associated costs of AHT before and after the implementation of the PURPLE program.Participants and Setting: Children aged 0–24 months old with a definite diagnosis of AHT between 2002 and 2014 in British Columbia were included in this study.MethodsAn incidence-based cost-of-illness analysis, using the human capital approach was used to quantify the lifetime costs of AHT events according to their severity (least severe, severe and fatal). A cost-effectiveness analysis of the PURPLE program was conducted from both a societal and a health services’ perspectives using decision tree models.ResultsThere were sixty-four AHT events between 2002–2014, resulting in a total cost of $354,359,080 to society. The costs associated with fatal, severe and least severe AHT averaged $7,147,548, $6,057,761 and $1,675,099, respectively. The investment of $5 per newborn through the PURPLE program resulted in a $273.52 and $14.49 per child cost avoidance by society and by the healthcare system.ConclusionsThis study provides evidence to policymakers and health practitioners that investing upstream in well-developed AHT prevention programs, such as PURPLE, not only promote child safety and health, but also translates into avoided costs to society.     

Association of perpetrator relationship to abusive head trauma clinical outcomes

The diagnosis of abusive head trauma (AHT) remains a significant public health problem with limited prevention success. Providing protection from further harm is often challenged by the difficulty in identifying the alleged perpetrator (AP) responsible for this pediatric trauma. The objective of this study was to evaluate demographic and clinical characteristics of children with AHT and the relationship between APs and their victims in a large, multi-site sample. Understanding the AHT risks from various caregivers may help to inform current prevention strategies. A retrospective review of all cases of AHT diagnosed by child protection teams (CPT) from 1/1/04 to 6/30/09 at four children's hospitals was conducted. Clinical characteristics of children with AHT injured by non-parental perpetrators (NPP) were compared to parental perpetrators (PP). There were 459 children with AHT; 313 (68%) had an identified AP. The majority of the 313 children were <1 year of age (76%), Caucasian (63%), male (58%), receiving public assistance (80%), and presented without a history of trauma (62%); mortality was 19%. Overall, APs were: father (53%), parent partner (22%), mother (8%), babysitter (8%), other adult caregiver (5%); NPP accounted for 39% of APs. NPPs were more likely to cause AHT in children ≥1 year (77% vs. 23%, p < 0.001) compared to PP. Independent associations to NPP included: older child, absence of a history of trauma, retinal hemorrhages, and male perpetrator gender. While fathers were the most common AP in AHT victims, there is a significant association for increased risk of AHT by NPPs in the older child, who presents with retinal hemorrhages, in the hands of a male AP. Further enhancement of current prevention strategies to address AHT risks of non-parental adults who provide care to children, especially in the post-infancy age seems warranted.     

Maltreatment experiences and associated factors prior to admission to residential care: A sample of institutionalized children and youth in western Kenya

Objectives

This study aims to determine the prevalence of maltreatment experienced by institutionalized children prior to their admission to Charitable Children's Institutions (orphanages) in western Kenya, and to describe their socio-demographic characteristics, reasons for admission, and the factors associated with prior experiences of maltreatment.

Methods

A systematic file review was undertaken in five CCIs. Demographic, prior caregiving settings and maltreatment data were extracted. Forms of maltreatment were recorded according to WHO and ISPCAN guidelines. Logistic regression was used in bivariate and multivariable analyses of factors associated with reasons for placement and forms of maltreatment.

Results

A total of 462 files were reviewed. The median (interquartile range) age of children was 6.8 (5.08) years at admission, 56% were male, and 71% had lost one or both parents. The reasons for admission were destitution (36%), abandonment (22%), neglect (21%), physical/sexual abuse (8%), and lack of caregiver (8%). The majority of child and youth residents had experienced at least one form of maltreatment (66%): physical abuse (8%), sexual abuse (2%), psychological abuse (28%), neglect (26%), medical neglect (18%), school deprivation (38%), abandonment (30%), and child labor (23%). The most common reason for non-orphans to be admitted was maltreatment (90%), whereas the most common reason for orphans to be admitted was destitution (49%). Girls (adjusted odds ratio, AOR: .61, 95% CI: .39–.95) and orphans (AOR: .04, 95% CI: .01–.17) were both independently less likely to have a history of maltreatment irrespective of whether it was the reason for admission. Children whose primary caregiver had not been a parent (AOR: .36, 95% CI: .15–.86) and orphans (AOR: .17, 95% CI: .06–.44) were less likely to have been admitted for maltreatment, while children who were separated from siblings were more likely to have been admitted for maltreatment (AOR: 1.62, 95% CI: 1.01–2.60).

Conclusions

The high prevalence of maltreatment prior to admission, particularly among nonorphans, suggests the need for better child abuse and neglect prevention programs in communities, and psychosocial support services in institutions. The significant proportion of children admitted for poverty, predominantly among orphans, indicates that community-based poverty-reduction programs might reduce the need for institutionalization.     

Association between receipt of school-based HIV education and contraceptive use among sexually active high school students — United States, 2011–2013

Sexual health education, including HIV prevention information, can help prevent unintended pregnancy and sexually transmitted infections. National Youth Risk Behavior Survey data from 2011 and 2013 were used to determine HIV education prevalence among 9,825 currently sexually active students in grades 9–12. Associations between HIV education and contraceptive methods used at last sexual intercourse were examined for: (1) condom use; (2) any contraceptive method; (3) dual use of a condom and either birth control pills; IUD or implant; or shot, patch, or birth control ring; and (4) primary contraceptive method. Primary contraceptive method options were (1) no method; (2) birth control pills; (3) condoms; (4) IUD or implant; (5) shot, patch, or birth control ring; (6) withdrawal or some other method; and (7) not sure. Logistic regression (prevalence ratios [PRs] and 95% confidence intervals [CIs]) and Chi-squares were used for testing. Students who received HIV education were more likely than students who did not to use a condom (PR:1.09;CI:1.01,1.18) and any contraceptive method (PR:1.08;CI:1.04,1.12); there was no significant association with dual use. Primary contraceptive method varied significantly by receipt of HIV education (p < .001). School-based HIV education may be important for promotion of adolescent condom and contraceptive use.     

Abusive head trauma in Maine infants: medical,child protective,and law enforcement analysis

OBJECTIVE: To collect and compare the results of medical, child protective, and law enforcement evaluation of a sample of Maine children who were victims of abusive head trauma (AHT) in order to describe the clinical and evaluative characteristics as they relate to victims, families and perpetrators of such trauma and to improve the professional response to AHT in Maine.METHOD: Retrospective chart review of medical, child protective, and law enforcement records of all AHT victims admitted to two tertiary care hospitals in Maine or seen by the state medical examiner from 1991 to 1994.RESULTS: Nineteen children (age range 2 weeks to 17 months) were identified as victims of AHT (out of a total of 94 head trauma admissions) accounting for 20 hospitalizations during the study period. There was a history of prior injury in 30%, history of prior medical evaluations for possibly abuse related problems in 65%, while, on presentation, 75% had evidence or history of prior injury. The hospitals notified child protective services (CPS) in all 20 cases and correctly identified abuse in 18 (90%). Parental risk factors for abuse identified in CPS records included substance abuse (53%), domestic violence (42%), criminal history (32%), unrealistic expectations (42%), and attachment problems (32%). However, risk factors were inadequately assessed in 53% of homes. Law enforcement identified a likely perpetrator in 79% of cases and in the majority the identified suspect was the father. In the 15 cases where a perpetrator was identified by law enforcement, that person was alone with the child at symptom onset in 14 (93%).CONCLUSIONS: The medical response, at least at the inpatient level, was generally well done with regard to suspicion and reporting. Cases are possibly being missed at the outpatient level. Child protective risk assessment was limited overall yet in a third of the homes where AHT occurred, few if any risk factors were present to aid in identification and prevention. Law enforcement results suggest that a primary suspect for AHT is the caretaker alone with the child at the time of symptom onset.     

Formal and parental sex education differences among Hispanic young women by nativity status

This study sought to investigate the association between nativity status and Hispanic young women’s formal sex education and parental sex education in the USA. We used data from a cross-sectional sample of 310 Hispanic young women aged 18–24 years old from the 2013–2015 US National Survey of Family Growth. We assessed 11 outcomes: four formal sex education topics; receiving any formal sex education; a formal sex education scale; four parental sex education topics; and receiving any parental sex education. The majority of our sample was US-born Hispanic versus foreign born (72.6% and 27.4% respectively). Foreign-born Hispanics were less likely to have received any type of formal sex education than US-born Hispanics (adjusted odds ratio = 0.81; 95% confidence interval: 0.24, 0.68, p < 0.01). Foreign-born Hispanics were less likely to have received parental HIV sex education than U.S.-born Hispanics (aOR = 0.36; 95% CI: 0.14, 0.97, p < 0.05). Nativity status did not have a significant effect on each unit increase on the scale (aB = –0.07, SE = 0.16; aβ = –0.42, p > 0.05). Our results indicate that having appropriate sex education knowledge is better than not being cognisant. Future studies should however examine the quality and content of sex education programmes so policymakers can better understand these young women’s sexual behaviours and decisions.     

Re-Examination of Traditional Admissions Criteria in Predicting Academic Success in a Counselor Education Program

The purpose of this study was to re-evaluate the validity of traditional admissions criteria—UGPA and GRE scores—in predicting academic success for students admitted to a counselor education program in the United States. In contrast to prior research, we also included the newer GRE-Analytical Writing scores in our analyses. In general, we found that both UGPA and GRE scores were useful for predicting both graduate grade point averages (GGPAs) and students’ scores on the Counselor Preparation Comprehensive Exam (CPCE). We also found that a discriminant model that included all four admission variables was useful for predicting program completion outcomes: successfully graduated, dropped out, or dismissed from the program. Implications for the admissions and screening process are presented.     

Spotlight on the Shift to Remote Anatomical Teaching During Covid-19 Pandemic: Perspectives and Experiences from the University of Malta

Covid-19 has spread globally, affecting all nations. Preventive measures were implemented by governments including the closure of universities. The aim of this study was to evaluate the student's perspectives and experiences on the shift to remote preclinical medical education while inquiring whether there has been any psychological impact on the students. A customized questionnaire utilizing Likert-scale-based questions and the Generalized Anxiety Disorder-7 assessment tool was distributed online to enrolled preclinical medical students at the Faculty of Medicine and Surgery at the University of Malta. Quantitative and qualitative analyses of the data gathered was carried out. Multivariate logistic regression analyses was performed to establish independent variables associated with anxiety symptoms. A total of 172 responded out of a cohort of 299 preclinical students (58%). The majority perceived a positive learning experience following the shift to remote lectures, however, it was not the case for small group teaching including dissection sessions. Nonetheless students reported concerns about their education, examinations, progression to next academic year and wellbeing. Less than half the students exhibited symptoms of anxiety. Students exhibiting “moderate” worry (OR:7.6; CI 95%:1.98–29.31; P < 0.01) and “severe” worry (OR: 2.0; CI 95%: 5.0–80.5; P < 0.01) on their mental, emotional, and wellbeing due to Covid-19 were associated with anxiety symptoms after adjusting for cofounders. Apart from the short-term effects, the Covid-19 pandemic may have a long-term impact on both the medical education and the students' future careers. It is important that the implemented changes in medical education are recorded and studied since such data will be essential on how to proceed post-Covid-19 pandemic.     

Role of adjuvant (chemo)radiotherapy for resected extrahepatic cholangiocarcinoma: a meta-analysis

Background

Adjuvant (chemo)radiotherapy (A(C)RT) may be an important supplement to surgery for extrahepatic cholangiocarcinoma (EHCC). However, whether all patients would achieve benefits from A(C)RT and which adjuvant regimen, adjuvant radiotherapy (ART) or adjuvant chemoradiotherapy (ACRT), would be preferred, are still undetermined. The low incidence of EHCC makes it difficult to carry out randomized controlled trials (RCTs); therefore, almost all clinical studies on radiotherapy are retrospective. We have conducted a meta-analysis of these retrospective studies.

Methods

We conducted a meta-analysis of current retrospective studies using PubMed, Embase, and ClinicalTrials databases. All studies published in English that were related to A(C)RT and which analyzed overall survival (OS), disease-free survival (DFS), or locoregional recurrence-free survival (LRFS) were included. Estimated hazard ratios (HRs) were calculated for OS, DFS, and LRFS.

Results

Data from eight studies including 685 patients were included. Our analysis showed that A(C)RT significantly improved OS (HR 0.69, 95% confidence interval (CI) 0.48–0.97, P=0.03), DFS (HR 0.60, 95% CI 0.47–0.76, P<0.0001), and LRFS (HR 0.27, 95% CI 0.17–0.41, P<0.00001) of EHCC overall. In subgroups, patients with microscopically positive resection margin (R1) could achieve a benefit from A(C)RT (HR 0.44, 95% CI 0.27–0.72, P=0.001). No statistically OS difference was observed in negative resection margin (R0) subgroup (HR 0.98, 95% CI 0.30–3.19, P=0.98). Significant OS benefit was found in patients who received concurrent ACRT (HR 0.40, 95% CI 0.26–0.62, P<0.0001), while the result of ART without chemotherapy showed no significant benefit (HR 1.14, 95% CI 0.29–4.50, P=0.85). In the distal cholangiocarcinoma subgroup, no significant difference was seen when ACRT and ART were included (HR 0.61, 95% CI 0.14–2.72, P=0.52), but a significant difference was seen when analyzing the concurrent ACRT only (HR 0.29, 95% CI 0.13–0.64, P=0.002).

Conclusions

A(C)RT may improve OS, DFS, and LRFS in EHCC patients, especially in those with R1 resection margins. ACRT may be superior to ART especially in distal patients.

     

Adolescent psychosocial factors and participation in education and employment in young adulthood: A systematic review and meta-analyses

Adolescence is a critical period for successful transition into adulthood. This systematic review of empirical longitudinal evidence investigated the associations between adolescent psychosocial factors and education and employment status in young adulthood. Five electronic databases (MEDLINE, PsycINFO, CINAHL, ASSIA and ERIC) were searched. Meta-analysis was conducted by using odds ratios (OR) as our common effect size; a narrative synthesis of results was also completed. Of the 8970 references screened, 14 articles were included and mapped into seven domains, namely, behavioral problems, peer problems, substance use, prosocial skills, self-evaluations, aspirations and physical activity. The results showed that behavioral problems (overall OR: 1.48; 95% CI: 1.26–1.74) and peer problems (overall OR_adj: 1.27; 95% CI: 1.02–1.57) were significantly associated with being out of education, employment and training (NEET) as young adults. Prosocial skills did not present a significant association (overall OR: 1.03; 95% CI: 0.92–1.15). Other domains were narratively synthesized. The role of substance use was less clear. Only a few studies were available for self-evaluations, aspirations and physical activity domains. Implications for research and practice are discussed.     

Radiofrequency ablation versus hepatic resection for breast cancer liver metastasis: a systematic review and meta-analysis

Objective

To evaluate the comparative therapeutic efficacy of radiofrequency ablation (RFA) and hepatic resection (HR) for breast cancer liver metastases (BCLMs).

Methods

Studies that had examined the outcomes for both RFA and HR for BCLM were identified by searching the electronic databases PubMed, EMBASE, and the Cochrane Library. Pooled analyzes of the overall survival (OS), disease-free survival (DFS), and short-term outcomes of BCLM were performed.

Results

Patients with BCLM gained many more survival benefits from HR than from RFA with regard to the 3-year OS rate (combined odds ratio (OR) 0.41, 95% confidence interval (CI) 0.29–0.59, P<0.001), 5-year OS rate (combined OR 0.38, 95% CI 0.32–0.46, P<0.001), 3-year DFS (combined OR 0.36, 95% CI 0.27–0.49, P<0.001), and 5-year DFS (combined OR 0.51, 95% CI 0.40–0.66, P<0.001). RFA had fewer postoperative complications (combined OR 0.30, 95% CI 0.20–0.44, P<0.001) and shorter hospital stays (combined OR -9.01, 95% CI -13.49–4.54, P<0.001) than HR.

Conclusions

HR takes precedence over RFA in the treatment of patients with BCLM, considering the better survival rate. RFA gives rise to fewer complications and can be carried out with a shorter hospital stay, compared to HR. RFA should be reserved for patients who are not optimum candidates for resection.

     

Association of CASP9, CASP10 gene polymorphisms and tea drinking with colorectal cancer risk in the Han Chinese population

The initiators caspase-9(CASP9) and caspase-10(CASP10) are two key controllers of apoptosis and play important roles in carcinogenesis.This study aims to explore the association between CASPs gene polymorphisms and colorectal cancer(CRC) susceptibility in a population-based study.A two-stage designed population-based case-control study was carried out,including a testing set with 300 cases and 296 controls and a validation set with 206 cases and 845 controls.A total of eight tag selected single nucleotide polymorphisms(SNPs) in CASP9 and CASP10 were chosen based on HapMap and the National Center of Biotechnology Information(NCBI) datasets and genotyped by restriction fragment length polymorphism(RFLP) assay.Multivariate logistic regression models were applied to evaluate the association of SNPs with CRC risk.In the first stage,from eight tag SNPs,three polymorphisms rs4646077(odds ratio(OR) AA+AG:0.654,95% confidence interval(CI):0.406-1.055;P=0.082),rs4233532(OR CC:1.667,95% CI:0.967-2.876;OR CT:1.435,95% CI:0.998-2.063;P=0.077),and rs2881930(OR CC:0.263,95% CI:0.095-0.728,P=0.036) showed possible association with CRC risk.However,none of the three SNPs,rs4646077(OR AA+AG:1.233,95% CI:0.903-1.683),rs4233532(OR CC:0.892,95% CI:0.640-1.243;OR CT:1.134,95% CI:0.897-1.433),and rs2881930(OR CC:1.096,95% CI:0.620-1.938;OR CT:1.009,95% CI:0.801-1.271),remained significant with CRC risk in the validation set,even after stratification for different tumor locations(colon or rectum).In addition,never tea drinking was associated with a significantly increased risk of CRC in testing set together with validation set(OR:1.755,95% CI:1.319-2.334).Our results found that polymorphisms of CASP9 and CASP10 genes may not contribute to CRC risk in Chinese population and thereby the large-scale case-control studies might be in consideration.In addition,tea drinking was a protective factor for CRC.     

Child maltreatment and risk patterns among participants in a child abuse prevention program

The relationship between risk factors and Child Protective Services (CPS) outcomes in families who participate in home visiting programs to prevent abuse and neglect and who are reported to CPS is largely unknown. We examined the relationship between parental risk factors and the substantiation status and number of CPS reports in families in a statewide prevention program. We reviewed CPS reports from 2006 to 2008 for families in Connecticut's child abuse prevention program. Six risk factors (histories of CPS, domestic violence [DV], mental health, sexual abuse, substance abuse, and criminal involvement) and the number of caregivers were abstracted to create risk scores for each family member. Maltreatment type, substantiation, and number of reports were recorded. Odds ratios were calculated. Of 1,125 families, 171 (15.6%) had at least one CPS report, and reports of 131 families were available for review. Families with a substantiated (25.2%) versus unsubstantiated (74.8%) first report had a high number of paternal risk factors (OR = 6.13, 95% CI [1.89, 20.00]) and were more likely to have a history of maternal DV (OR = 8.47, 95% CI [2.96, 24.39]), paternal DV (OR = 11.23, 95% CI [3.33, 38.46]), and maternal criminal history (OR = 4.55; 95% CI [1.32, 15.60]). Families with >1 report (34.4%) versus 1 report (65.6%) were more likely to have >3 caregivers, but this was not statistically significant (OR = 2.53, 95% CI [0.98, 6.54]). In a prevention program for first-time families, DV, paternal risk, maternal criminal history, and an increased number of caregivers were associated with maltreatment outcomes. Targeting parental violence may impact child abuse prevention.     

论高校招生中的行为失范

高校招生工作关系到我国高等教育事业的健康发展和人才培养的质量,涉及千家万户的切身利益,是全社会关注的热点。高校招生行为失范包括个人、教育行政部门和高校三个层面,给国家和社会带来了极大的危害。高校招生行为失范,主要是因为高校招生政策法规不健全、利益驱动、招生工作缺乏透明度、招生工作的监管力度不够、部分招生工作人员素质不高所致。完善招生立法、建立和完善招生信息公开机制、健全招生工作监督体制、加大对招生失范行为的处理力度、提高招生工作人员素质,是防止高校招生行为失范的关键。     

Examining the Motivation of Health Profession Students to Study Human Anatomy

Students' motivation is a vital determinant of academic performance that is influenced by the learning environment. This study aimed to assess and analyze the motivation subscales between different cohorts (chiropractic, dental, medical) of anatomy students (n = 251) and to investigate if these subscales had an effect on the students' anatomy performance. A 31-item survey, the Motivated Strategies for Learning Questionnaire was utilized, covering items on intrinsic and extrinsic goal orientation, task value, control of learning belief, self-efficiency for learning and performance, and test anxiety. First-year dental students were significantly more anxious than chiropractic students. Second-year chiropractic students attached more value to anatomy education than second-year medical students. The outcome of this research demonstrated a significant relationship between first- and second-year chiropractic students between anatomy performance and motivation subscales controlling for gender such as self-efficacy for learning and performance was (β = 8, CI: 5.18–10.8, P < 0.001) and (β = 6.25, CI: 3.40–9.10, P < 0.001) for first year and second year, respectively. With regards to intrinsic goal orientation, it was (β = 4.02, CI: 1.19–6.86, P = 0.006) and (β = 5.38, CI: 2.32–8.44, P = 0.001) for first year and second year, respectively. For the control of learning beliefs, it was (β = 3.71, 95% CI: 0.18–7.25, P = 0.04) and (β = 3.07, CI: 0.03–6.12, P = 0.048) for first year and second year, respectively. Interventions aimed at improving these motivation subscales in students could boost their anatomy performance.     

Using time-to-event analysis to identify preconception and prenatal predictors of child protective services contact

We examined preconception and prenatal predictors of time to first child protective services (CPS) contact among Alaska children. Data were from the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project, a population-representative data source linking 2009–2011 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) data with administrative data sources through 2015. We examined the incidence CPS contact using the Kaplan-Meier method and predictors of CPS contact using Cox proportional hazards regression. Using data from the Alaska Permanent Fund Dividend and Child Death Review, we censored children who emigrated out-of-state or died during the study period. Significant predictors included low socioeconomic status (HR = 2.23, 95% CI 1.68, 2.96), maternal smoking during pregnancy (HR = 1.87, 95% CI 1.55, 2.24), unmarried maternal marital status (HR = 1.62, 95% CI 1.31, 1.99), urban residence (HR = 1.59, 95% CI 1.32, 1.92), lower maternal education (HR = 1.54, 95% CI 1.24, 1.92), maternal experience of intimate partner violence in the 12 months before childbirth(HR = 1.32, 95% CI 1.01, 1.74), Alaska Native/American Indian race (HR = 1.40, 95% CI 1.15, 1.71), a greater number of living children (HR = 1.20, 95% CI 1.13, 1.29), a greater number of stressful life eventsin the 12 months before childbirth (HR = 1.16, 95% CI 1.11, 1.21), and younger maternal age at childbirth (HR = 0.95, 95% CI 0.93, 0.97). Use of multiple linked data sources and time-to-event analysis methods adds to the growing literature regarding predictors of CPS contact. Results suggest that assessing for and addressing clinical, social, and environmental indicators during the prenatal period may aid prevention efforts in mitigating family need for involvement with CPS.     

Implementation of Health Promotion in the Older Adults in Bangkok,Thailand

ABSTRACT

Effective strategies that bring health promotion messages to older adults in a developing country are needed. To evaluate the impact of various education media upon changes in knowledge and health behavior, a double-blind, randomized controlled trial was conducted involving 1,268 older adults in a southwest Bangkok suburb. Group teaching supplemented by a video program was provided in the communities. A simplified booklet and an audiotape containing the same health education information as in the videotape were given to the older adults for self-study. Health knowledge was assessed before the health education program. Identical assessment was performed again 3 months after the intervention. The quadriceps exercise and Cawthorne-Cooksey head-and-neck-balance exercise—representing changes in health promotion behavior—were also evaluated. Those who attended the group-teaching program had higher test scores than the control group. Only those who both read the booklet and listened to the audiotape in the intervention group gained more knowledge than the control group. The combination of group teaching supplemented by the video program and self-study using the booklet and audiotape was effective in improving health knowledge and behavior.