Elder Mistreatment Within Stroke Family Caregiving.

This secondary data analysis sought to identify characteristics associated with mistreatment among chronic stroke survivors who transition to dementia. We examined baseline data from a multi-time series survey study (n = 453; where caregivers of those with stroke n = 107, and those without stroke, n = 346) on caregiving experiences influencing dementia family caregivers' abusive or neglectful behaviors. Inferential statistical analysis indicated that baseline mistreatment rates were similar across stroke and non-stroke subgroups, though this finding was not significant. Caregiver depression was significantly associated with mistreatment. Multi-morbidity, prescription medication use, and limited mobility were more common among stroke survivors. Stroke-related complications may impose a greater burden of care upon family caregivers whose care recipients also have dementia. Determining timepoints of heightened mistreatment risk for stroke survivors may significantly impact long-term trajectories of stroke management to screen and identify those who may benefit from added support and intervention.

Childhood Sexual Trauma, Substance Use, and Antiretroviral Therapy Adherence Among Older Adults Living With HIV: A Mediational Analysis.

Childhood sexual abuse (CSA) is linked to substance use and lower antiretroviral therapy (ART) adherence. However, studies examining the mediational role of substance use between CSA and ART adherence are lacking. Therefore, the aim of this study was to determine the potential mediational role of substance use between CSA and ART adherence among older adults living with HIV (OALH) (n = 91). Mediation analyses assessed the direct and indirect relationships between CSA, substance use, and ART adherence. Statistically significant differences existed in substance use by gender (male vs. female: 12.3 vs. 9.97) and ART adherence by race (Black vs. White: 98.2% vs. 99.6%) and employment. CSA was associated with ART adherence (ß = -3.27, p < .001) and substance use (ß = 2.14, p = .035), but substance use was not associated with ART adherence, and did not mediate the pathway between CSA and ART adherence in the adjusted model. Trauma-informed interventions may lower substance use among OALH with CSA.

Development and Validation of the Adolescent and Children Risk of Abuse and Maltreatment Unaccompanied Scale (ACRAM-US).

Independent migration of children and adolescents is becoming a political and social issue in recent years. Literature documents that the migration process of young people without an adult referent entail serious psychological problems. Moreover, the lack of coherence in the assessment and care processes aggravates the damage suffered by minors, which requires a greater investment of institutional resources. The aim of this research is to describe the development and provide psychometric properties of Adolescent and Children Risk of Abuse and Maltreatment Unaccompanied Scale (ACRAM-US), a 9-items scale for the assessment of risks factors of child abuse and neglect in the specific population of unaccompanied asylum-seeking children and adolescents. Structural validity, reliability and convergent-related validity were studied for this measure in a sample of 128 unaccompanied children and adolescents. The sample included cases of 14 different nationalities. Children's mean age was 16.94 (SD = 1.84), and 96.9% were male and 3.1% were female. Cases were informed by child welfare workers from different protective services in the XXXX Community (XXXX). The results of Exploratory Factor Analyses (EFA) indicate performance better solution with 2-dimensions which was also in line with theoretical formulation (χ 2 = 31.55, df = 19, p = .035, CFI = 0.991, SRMR = 0.081, RMSEA = 0.072, [90% CI: 0.019 - 0.115]). Results of convergent validity showed significant correlation with the Children Trauma Questionnaire-Short Form (CTQ-SF). Therefore, this study provides data of the first scale that assess risks factors of maltreatment for the unaccompanied asylum-seeking children and adolescents.

Patterns of Family Conflict and Accusations of Abuse in Dementia Family Caregivers: A Latent Class Analysis.

BACKGROUND AND OBJECTIVES: Family conflict is a stressor for dementia family caregivers, yet its impact may differ based on the relationship between caregivers and their recipients. This study's objectives were to categorize caregivers into groups based on family conflict, examine whether the relationship to the recipient influences group membership, and determine whether these groups are associated with engaging in abusive and neglectful behaviors. RESEARCH DESIGN AND METHODS: This national, cross-sectional study of 453 dementia family caregivers used latent class analysis to generate groups based on family conflict and abuse accusations. A multinomial logistic regression determined if relationship type (i.e., being a spouse, child, or grandchild to the care recipient or having a nontraditional relationship) predicted group membership. Groups were examined as predictors of abusive and neglectful behaviors using analysis of variance. RESULTS: A 4-class solution emerged as the best fit: 3 groups with varying probabilities of family conflict and 1 group with elevated probabilities of abuse and neglect accusations. Relationship typed predicted membership in these classes. Group membership predicted abusive and neglectful behaviors. DISCUSSION AND IMPLICATIONS: Adult children were more likely to experience high amounts of family conflict, whereas nontraditional caregivers were less likely to experience abuse and neglect accusations. Membership in the accusations group was a unique risk factor for abusive and neglectful behaviors. These findings support the need for continued investigation of family conflict in dementia caregivers. They also call to examine how family relationship types, including nontraditional family structures, influence caregiving outcomes.

Exploring Overt Racial and Ethnic Conflict in Resident-to-Resident Aggression in Long-Term Care Facilities.

Objectives: Resident-to-resident aggression (RRA) in long-term care facilities is gaining recognition as a serious problem. Racial/ethnic conflict may be a contributing factor to RRA incidents, but it remains insufficiently studied. Our goal was to explore overt racial/ethnic conflict in RRA. Design: We used quantitative and qualitative secondary analyses of existing data from a large, rigorously conducted study of RRA to describe the involved residents and patterns of overt racial/ethnic conflicts. Setting and Participants: The parent study included information of 2011 residents in 10 randomly selected New York State nursing homes with a wide range of racial/ethnic minority residents (4.2%-63.2%). A subset of 407 residents were involved in RRA. Methods: We re-examined data from the parent study, which used an innovative approach to identify RRA incidents by reconstructing each incident based on residents' self-reports, staff interviews, field observations, and medical chart review. Resident and facility information was collected. Results: A total of 35 residents (8.6% of those involved in RRA incidents) were identified as involved in overt racial/ethnic conflicts. These residents were more likely to have had less education than residents involved in other types of RRA but not in overt racial/ethnic conflicts. More than half (56.9%) of the 51 incidents of RRA involving overt racial/ethnic conflict between a specific pair of residents occurred repeatedly. Manifestation of racial/ethnic conflicts included physical violence, discrimination, racial/ethnic slurs, stereotypes, and microaggression. Acute precipitants of these incidents included various communal-living challenges and unmet needs at the facility, relational, and individual levels. Psychological and behavioral consequences were also described. Conclusion and Implications: We found a broad range of manifestations, acute precipitants, circumstances surrounding, and consequences of overt racial/ethnic conflicts in RRA. Additional research is needed to improve understanding of this phenomenon and how staff may effectively intervene and prevent it.

Harnessing the Power of Machine Learning and Electronic Health Records to Support Child Abuse and Neglect Identification in Emergency Department Settings.

Emergency departments (EDs) are pivotal in detecting child abuse and neglect, but this task is often complex. Our study developed a machine learning model using structured and unstructured electronic health record (EHR) data to predict when children in EDs might need intervention from child protective services. We used a case-control study design, analyzing data from a pediatric ED. Clinical notes were processed with natural language processing (NLP) techniques to identify suspected cases and matched in a 1:9 ratio to ensure dataset balance. The features from these notes were combined with structured EHR data to construct a model using the XGBoost algorithm. The model achieved a precision of 0.95, recall of 0.88, and F1-score of 0.92, with improvements seen from integrating NLP-derived data. Key indicators for abuse included hospital admissions, extended ED stays, and specific clinical orders. The model's accuracy and the utility of NLP suggest the potential for EDs to better identify at-risk children. Future work should validate the model further and explore additional features while considering ethical implications to aid healthcare providers in safeguarding children.

Receipt of parenting, disability, unemployment, and other income support payments in persons aged 16 to 33 years - the associations with child maltreatment.

BACKGROUND: Child maltreatment (CM) is a major public health concern with life-long effects. Its impact on income support has rarely been studied. OBJECTIVE: To examine the association between CM and receipt of income support payments and the budgetary impact for persons 16 to 33 years. PARTICIPANTS AND SETTING: A South Australian birth cohort, born 1986 to 2004 (n = 339,411). METHODS: We linked child protection (CP) administrative records with national welfare payment records, ending March 2020. Receipt of income support payments and mean payment amounts were described by CP contact (adjusted for child and family attributes). Budget impact was modelled at the national level. RESULTS: Adjusted odds ratio (AOR) for receipt of any income support payment was 3.01 (2.95-3.07) for individuals with any CP contact versus no CP contact. Among those receiving any payment, adjusted annualised mean benefit payment was $3754 (US$1446) among individuals with no CP contact, $6262 (US$4,307) in persons with any CP contact, and $9,747 in persons who'd been in OOHC. Cumulative payments modelled from age 16 to 33 years totalled $38,570 (US$26,652) for individuals with no CP contact, and $181,743 (US$125,003) for individuals who'd been in OOHC. Modelled for the Australian population to age 33, the extra cost associated with CP contact added 39 % to the government income support budget. CONCLUSION: CM is strongly associated with receipt of income support payments. Investment in effective preventive and protective strategies for CP involved children could address this core social determinant of health, while providing budget savings.

A comparison of virtual versus in-person delivery of SafeCare on parent and implementation outcomes.

BACKGROUND: Evidence-based prevention services for child abuse and neglect (CAN), typically delivered via home visiting (HV), pivoted to virtual delivery in 2020 to continue family services while adhering to the COVID-19 public health guidelines. OBJECTIVE: The study aims are to compare parent and implementation outcomes for the HV program, SafeCare©, delivered virtually versus in-person, across a 2-year period. METHODS: Three data sources were used to examine parent program engagement and skill mastery, as well as provider fidelity. Sources included: 1) quantitative service data collected as part of routine SafeCare implementation (in-person families, n = 923; virtual families, n = 1978), 2) qualitative survey data collected from SafeCare providers (n = 212) and 3) focus group data with SafeCare Providers (n = 9). RESULTS: Service data were examined using mixed models due to the nesting of the data, with all analyses controlling for time. Qualitative data from the survey and focus groups were analyzed using thematic coding. Data were triangulated from the three sources to answer the primary research question. Findings suggest that virtual delivery of SafeCare holds promise, with parents who participated virtually completing more modules at a faster pace than in-person clients. SafeCare parents demonstrated positive programmatic outcomes regardless of whether they participated in the program virtually or in-person. Provider fidelity remained high in the transition to virtual delivery. However, technology-related logistical issues and provider self-efficacy related to virtual delivery presented challenges to program success. CONCLUSIONS: The study has multiple implications for the HV field about the viability of virtual service delivery. Further research is warranted with data collected directly from parents, and a more critical analysis of what works best for whom and when to further advance the field.

Home Visiting and Child Welfare Involvement: A Matched Comparison Group Study.

The present study is one of the largest quasi-experimental studies to date on the effects of home visiting on documented child maltreatment during a child's first two years of life. In this matched comparison group study, we compare 8796 families that participated in a home visiting program (HV families) to 8796 similar non-participating families (non-HV families) selected from birth records using Coarsened Exact Matching. Using sequential logistic regression, we identify that HV families have significantly higher odds of experiencing a child maltreatment investigation by their child's second birthday compared to non-HV families; however, among those that were investigated, HV families have significantly lower odds of having their first investigation substantiated for maltreatment. Overall, HV families do not differ significantly from non-HV families in the odds of experiencing a substantiated investigation over 2 years. We share implications for considering surveillance bias, and we highlight the importance of including both substantiated and unsubstantiated investigations when studying the effects of home visiting on documented child maltreatment.

Transdiagnostic factors in the COVID-19 pandemic: Examining the role of childhood abuse and neglect in establishing latent profiles of risk and resilience.

BACKGROUND: Ample studies have focused on the negative consequences of COVID-19 on mental well-being, but fewer have explored the specific role of childhood abuse and neglect in the context of risk and resilience during this unprecedented crisis. OBJECTIVE: We aimed to identify distinct profiles of individuals based on their experiences of childhood abuse and neglect, coping strategies, and psycho-social transdiagnostic risk and protective factors, using a person-centered approach. PARTICIPANTS AND SETTING: A convenience sample of 914 Israelis completed self-report questionnaires during the second wave of COVID-19. METHODS: Latent Profile Analysis was employed based on levels of childhood abuse and neglect, coping strategies, and established factors underpinning risk and resilience in mental health: dissociation, self-criticism, self-efficacy, self-compassion, attachment insecurity, psychological resilience, mentalizing, distress disclosure, psychopathology, and relationship satisfaction. Profiles were compared in COVID-19-related distress and well-being using ANOVAs. RESULTS: A four-profile solution was found to be optimal for describing individuals with different profiles of risk and resilience: "risk" (5.1 %)-individuals with meaningfully high levels of childhood abuse and neglect and dissociation; "vulnerable" (14.2 %)-individuals high in risk factors and low in protective factors; "moderately resilient" (47.6 %)-those with moderate levels of protective and risk factors; "highly resilient" (33.1 %)-individuals high in protective factors and low in risk factors; groups differed in mental well-being and COVID-19-related distress. CONCLUSIONS: Results highlight the importance of childhood abuse and neglect in differentiating between the two distinct profiles of at-risk individuals. Implications for risk assessment and treatment in the context of potential traumatic stress are discussed.

Cost effectiveness of interventions to prevent the occurrence and the associated economic impacts of child maltreatment: A systematic review.

BACKGROUND: Child maltreatment is a pressing public health concern that poses long-lasting health and economic impacts on children and society. While several preventive interventions have demonstrated their effectiveness in reducing the occurrence of child maltreatment and its associated economic impacts, the cost-effectiveness of such interventions remains unclear. OBJECTIVE: This study aims to provide a comprehensive overview and a narrative synthesis of the available economic evidence on child maltreatment preventive interventions in both high-income and low-middle-income countries. METHOD: Systematic searches were conducted in MEDLINE, PsycINFO, Embase, CINAHL, Web of Science, and Econlit to identify full economic evaluations and return-on-investment studies on child maltreatment preventive interventions. The methodological quality of eligible studies was assessed using Drummond's 10-point checklist. This review adhered to the PRISMA guidelines, and summarized findings in a narrative synthesis. RESULTS: Twenty-six studies met the inclusion criteria. Of these, eight evaluated home visiting, four evaluated early childhood education (ECE), four assessed multi-component (MC), and three examined group-based parent education (GPE) interventions. The remaining studies assessed interventions to prevent abusive head trauma (AHT; n = 2), child sexual abuse (n = 2), physical abuse at school (n = 1), as well as individualized intensive parenting (IIP; n = 2), and counseling (n = 1) interventions. Two studies were conducted in low-middle-income countries, while the others were all in high-income countries. CONCLUSIONS: The included studies generally exhibited high methodological quality. Only AHT, ECE, IIP, and MC interventions demonstrated promising cost-effectiveness credentials in preventing child maltreatment. More economic evaluations are needed for interventions with mixed findings (e.g. GPE) and in low-middle-income countries.

Insights into child abuse and neglect: Findings from the Minnesota Longitudinal Study of Risk and Adaptation.

The Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) is a landmark prospective, longitudinal study of human development focused on a sample of mothers experiencing poverty and their firstborn children. Although the MLSRA pioneered a number of important topics in the area of social and emotional development, it began with the more specific goal of examining the antecedents of child maltreatment. From that foundation and for more than 40 years, the study has produced a significant body of research on the origins, sequelae, and measurement of childhood abuse and neglect. The principal objectives of this report are to document the early history of the MLSRA and its contributions to the study of child maltreatment and to review and summarize results from the recently updated childhood abuse and neglect coding of the cohort, with particular emphasis on findings related to adult adjustment. While doing so, we highlight key themes and contributions from Dr Dante Cicchetti's body of research and developmental psychopathology perspective to the MLSRA, a project launched during his tenure as a graduate student at the University of Minnesota.

The neurobiological effects of childhood maltreatment on brain structure, function, and attachment.

Childhood maltreatment is a risk factor for psychopathologies, and influences brain development at specific periods, particularly during early childhood and adolescence. This narrative review addresses phenotypic alterations in sensory systems associated with specific types of childhood maltreatment exposure, periods of vulnerability to the neurobiological effects of maltreatment, and the relationships between childhood maltreatment and brain structure, function, connectivity, and network architecture; psychopathology; and resilience. It also addresses neurobiological alterations associated with maternal communication and attachment disturbances, and uses laboratory-based measures during infancy and case-control studies to elucidate neurobiological alterations in reactive attachment disorders in children with maltreatment histories. Moreover, we review studies on the acute effects of oxytocin on reactive attachment disorder and maltreatment and methylation of oxytocin regulatory genes. Epigenetic changes may play a critical role in initiating or producing the atypical structural and functional brain alterations associated with childhood maltreatment. However, these changes could be reversed through psychological and pharmacological interventions, and by anticipating or preventing the emergence of brain alterations and subsequent psychopathological risks.

Patterns for Child Protective Service Referrals in a Pediatric Burn Cohort.

BACKGROUND: Pediatric non-accidental trauma often necessitates the involvement of protective services. However, the subjectivity and lack of standardization of referral infrastructure may result in some discrepancies between referral patterns and instances of child abuse. METHODS: An institutional retrospective chart review was conducted between 2015 and 2021, in which all cases of patients under the age of 14 who suffered a burn injury and received a child protective service (CPS) consult were reviewed. Baseline demographics and characteristics were defined. Multivariate analysis was utilized to identify predictors of CPS involvement, while the regression analysis was employed to parse associations between burn injuries and CPS involvement. RESULTS: Between July 2015 and December 2021, 340 patients (median age two years, IQR: 1-6 years) under the age of 14 who experienced a burn injury were evaluated. Forty-four (12.9%) of the patients' cases received a CPS referral, of which three (0.9%) resulted in a CPS intervention. The most common mechanism of burn within the cohort was scald (241 patients, 70.9%). The median total body surface area (TBSA) was 3.0% (IQR: 1.0%-6.0%), and 76 (22.4%) suffered a high TBSA (>75th percentile). Caucasian race (p < 0.001) and scald mechanisms (p = 0.014) were associated with higher TBSA. When considering how such injuries translated to CPS referrals, increasing age was found to be associated with a decreased likelihood of CPS involvement. Meanwhile, the Black race (p = 0.027) and increasing area deprivation index (ADI) (p = 0.038) were associated with CPS involvement. Those with CPS involvement experienced a greater length of hospital stay (p = 0.001). Black race and intensive care unit level of care were found to be positive predictors of CPS involvement. In total, three (6.82%) of the 44 cases with CPS involvement were found to be substantiated. The three children who required CPS intervention were discharged to foster care settings. CONCLUSION: Hospitalized pediatric burn injuries must be investigated due to concern of child abuse, yet external factors such as race and socioeconomic status may play a role in the involvement of CPS. Such referrals may not always be substantiated and could lead to further injurious sequelae for children and their families.

Intergenerational effects of child maltreatment on adolescents' anxiety and depression in Ethiopia: the important mediating and moderating roles of current psychological distress.

BACKGROUND: Child abuse is widespread around the world, and one continent with particularly high rates is Africa. Research in high- and middle-income countries shows the cascading effect of parental history of child abuse and neglect on adolescents' maltreatment and, in turn, on mental health problems. This cascade has been reported in young children but has rarely been studied in parent-adolescent dyads or in low-income countries (LICs). The goal of this study was to test intergenerational associations of child abuse and neglect and to examine how these experiences are in turn associated with youth anxiety and depression in an LIC. METHODS: A total of 231 adolescents (age: 13-21 years) and 185 of their parents (n = 90 fathers and n = 95 mothers) were recruited from secondary schools in Addis Abeba, Ethiopia. Using a cross-sectional design, participants completed a set of questionnaires assessing child maltreatment (in adolescence and own past history in parents), parental psychological distress, youth depression and anxiety, and sociodemographic factors. RESULTS: The frequencies of child maltreatment exposure were 68% for adolescents and 65% for their parents (when they were a child). Fifty-one percent and 42% of adolescents had borderline to clinical levels of anxiety and depression symptoms, respectively. Adolescents of parents with a history of child abuse and neglect also reported higher exposure to maltreatment themselves (p < 0.001). Current paternal, but not maternal, psychological distress mediated this intergenerational association of maltreatment experiences (95% CI [1.164, 9.467]). We further found parents' psychological distress to be a significant moderator of the indirect pathways of the intergenerational effect of child maltreatment on adolescents' anxiety and depression (95% CI [- 0.770, - 0.012]). CONCLUSIONS: We found child maltreatment to be intergenerationally associated, and this effect subsequently affected adolescents' anxiety and depression through different pathways supporting the cascading effects across generations. Intervention plans may be effective through an array of possible indirect pathways and encourage the implementation of multiple access points to facilitate change in the lives of affected youth in Africa.

Associations between nurse characteristics, institutional characteristics and perceived nurse knowledge and self-efficacy of reporting suspected child abuse and neglect.

AIM: To determine the association between nurse and institutional characteristics and perceived professional nurse knowledge and self-efficacy of reporting child abuse and neglect. DESIGN: A sample of N = 166 nurses were recruited to respond to the Reporting of Suspected Child Abuse and Neglect (RSCAN) survey. METHODS: A multiple linear regression examined whether nurse characteristics and institutional characteristics were associated with the two RSCAN survey domain scores. RESULTS: Perceived knowledge of a workplace child abuse and neglect protocol was associated with the knowledge subscale. Education and child abuse and neglect expertise were significant predictors of the self-efficacy subscale. Nurses with a master's or higher degree and those who identified as being either forensic, paediatric or Emergency Department nurses, had less perceived institutional barriers to self-efficacy of reporting child abuse and neglect. CONCLUSION: This study provides a preliminary insight into the institutional barriers and facilitators of nurses as child abuse and neglect mandated reporters. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: To encourage innovative education and collaborations to support nurses as fully informed child abuse and neglect mandated reporters. IMPACT: This research identifies the gaps and facilitators of nurses as child abuse and neglect mandated reporters to inform healthcare professionals and academic institutions on the importance of nurse education and experience in nurse knowledge and self-efficacy in reporting suspected child abuse and neglect. REPORTING METHODS: The authors of this study have adhered to relevant EQUATOR guidelines: STROBE. PATIENT OR PUBLIC CONTRIBUTION: There is no patient or public contribution as the study only looked at nurses.

Training Senior Companion Volunteers to Identify and Report Adult Abuse, Neglect, and Exploitation.

Elder abuse is a national public health challenge that can have dire consequences for the older adults who experience it in any form. The Senior Companion Program presents a unique opportunity to address this public health challenge. An in-person training for Senior Companion volunteers across Ohio on how to recognize and report elder abuse was developed, implemented, and evaluated prior to the COVID-19 pandemic. Evaluation consisted of surveys distributed prior to and at the conclusion of the training. A total of 302 volunteers were trained with a survey response rate of 76%. While there was significant knowledge improvement in one of the five knowledge items (p < .000, all other ps ≥ .065), volunteers' subjective rating of their knowledge on abuse significantly improved (p = .029). Training older adult volunteers working with other community-dwelling adults is likely a valuable strategy to educate and protect against elder abuse.

Child and family characteristics in multisystemic therapy for child abuse and neglect (MST-CAN): Are there associations with treatment outcome?

Evidence-based indication for targeted interventions is a central approach in the field of child welfare and psychotherapy. This study explored the characteristics of children and families referred to Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) in Switzerland and their associations with treatment outcomes. We sought to identify subgroups of children and families referred to MST-CAN and understand their specific needs and alignment with the program. We identified five distinct subgroups of children: (a) those characterized by clinically significant "social withdrawal" and "anxiety/depression," (b) with multiple clinically significant emotional and behavioral problems, (c) with predominantly externalizing problems, (d) with no pathological findings at all, with parents who were less stressed and had fewer mental health problems, and (e) with mainly internalizing problems and parents whose mental health problems deteriorated during treatment. Investigating the fit of children and families referred to treatment programs can enhance the understanding of their healthcare needs and enable more individualized interventions.

Pediatric Traumatic Brain Injury Outcomes and Disparities During the COVID-19 Pandemic.

BACKGROUND: To study the impact of the COVID-19 pandemic on traumatic brain injury (TBI) patient demographic, clinical and trauma related characteristics, and outcomes. METHODS: Retrospective chart review was conducted on pediatric TBI patients admitted to a Level I Pediatric Trauma Center between January 2015 and June 2022. The pre-COVID era was defined as January 1, 2015, through March 12, 2020. The COVID-19 era was defined as March 13, 2020, through June 30, 2022. Bivariate analysis and logistic regression were performed. RESULTS: Four hundred-thirty patients were treated for pediatric TBI in the pre-COVID-19 period, and 166 patients during COVID-19. In bivariate analyses, the racial/ethnic makeup, age, and sex varied significantly across the two time periods (p < 0.05). Unwitnessed TBI events increased during the COVID-19 era. Logistic regression analyses also demonstrated significantly increased odds of death, severe disability, or vegetative state during COVID-19 (AOR 7.23; 95 % CI 1.43, 36.41). CONCLUSION: During the COVID-19 pandemic, patients admitted with pediatric TBI had significantly different demographics with regards to age, sex, and race/ethnicity when compared to patients prior to the pandemic. There was an increase in unwitnessed events. In the COVID period, patients had a higher odds ratio of severe morbidity and mortality despite adjustment for confounding factors. LEVEL OF EVIDENCE AND STUDY TYPE: Level II, Prognosis.

Effects of the Sacramento Neighborhood Alcohol Prevention Project on rates of child abuse and neglect 7 years post-implementation (1999-2010).

INTRODUCTION: Evaluations of alcohol environmental prevention efforts examine short-term effects of these interventions on alcohol-related problems. We examine whether the effects of the Sacramento Neighborhood Alcohol Prevention Project (SNAPP), an alcohol environmental intervention aimed to reduce alcohol-related problems in two neighbourhoods, on child abuse and neglect remained 7 years post-implementation. METHODS: SNAPP used a quasi-experimental non-equivalent control group design, where intervention activities occurred in the South area, followed by those in the North area 2 years later. Our sample size is 3912 space-time units (326 census block groups × 12 years [1999-2010]). Outcomes were measured at the household level and included: (i) all foster care entries total; and (ii) the subset of foster care entries that were alcohol related. Data were analysed using Bayesian conditionally autoregressive space-time models. RESULTS: We find that the decreases in total (relative rate [RR] = 0.882, 95% credible interval [CrI] 0.795, 0.980) and alcohol-related (RR = 0.888, 95% CrI 0.791, 0.997) foster care entries remain in the North intervention area although the magnitude of those changes are smaller than immediately post-intervention. Increases found in alcohol-related foster care entries in the South area immediately post-intervention were not significant 7 years later (RR = 1.128, 95% CrI 0.975, 1.307). DISCUSSION AND CONCLUSIONS: Reductions in child abuse and neglect due to an alcohol environmental intervention can be maintained. Environmental interventions that provide community-level primary prevention strategies could be more easily sustained and more cost effective than individual-level interventions, although more research is needed to identify why interventions may be successful in specific contexts and not others.