A national house-staff audit of medical prophylaxis in medical patients for the PREVENTion of Venous ThromboEmbolism (PREVENT-VTE).

We established a national audit to assess the thromboprophylaxis rate for venous thromoembolism (VTE) in at risk medical patients in acute hospitals in the Republic of Ireland and to determine whether the use of stickers to alert physicians regarding thromboprophylaxis would double the rate prophylaxis in a follow-up audit. 651 acute medical admission patients in the first audit and 524 in the second re-audit were recruited. The mean age was 66.5 yrs with similar numbers of male and female patients and 265 (22.6%) patients were active smokers. The first and second audits identified 549 (84%) and 487 (93%) of patients at-risk for VTE respectively. Of the at-risk patients, 163 (29.7%) and 132 (27.1%) received LMWH in the first and second audit respectively. Mechanical thromboprophylaxis was instigated in 75 (13.6%) patients in the first and 86 (17.7%) patients in the second audit. The placement of stickers in patient charts didn't produce a significant increase in the number of at risk patients treated in the second audit. There is unacceptably low adherence to the ACCP guidelines in Ireland and more complex intervention than chart reminders are required to improve compliance.

Developmental pathways from child maltreatment to peer rejection.

Using a prospective longitudinal design, rejection by peers, aggressive behavior, and social withdrawal were examined among a representative community sample of 107 maltreated children and an equal number of non-maltreated children. Results revealed that chronic maltreatment was associated with heightened risk of rejection by peers. Chronically maltreated children were more likely to be rejected by peers repeatedly across multiple years from childhood to early adolescence. Maltreatment chronicity was also associated with higher levels of children's aggressive behavior, as reported by peers, teachers, and children themselves. Aggressive behavior accounted in large part for the association between chronic maltreatment and rejection by peers. Socially withdrawn behavior was associated with peer rejection, but did not account for the association between chronic maltreatment and peer rejection. These results held for both girls and boys, followed from childhood through early adolescence. Moreover, the links among chronic maltreatment, aggressive behavior, and peer rejection were already established by early school age. Implications of these results for developmental theory and intervention are discussed.

Pathways from child maltreatment to internalizing problems: perceptions of control as mediators and moderators.

Using a prospective longitudinal design, we examined internalizing problems and perceptions of control in a community sample of 785 children, 59 of whom had been maltreated. Children's internalizing problems and perceptions of control were measured via self-report at annual assessments in third grade through seventh grade (modal ages 9-13 years). Children's experiences of multiple types of maltreatment were rated based on social service records, using a standard coding system. Results of longitudinal analyses examining the roles of specific types of maltreatment (neglect, harsh parenting, and sexual abuse) revealed that neglect and sexual abuse were each associated with more internalizing problems, especially among children who experienced both these maltreatment types. Neglected children reported higher levels of perceived external control than other children did. Sexual abuse was associated with higher levels of perceived external control, but only among children who had also been neglected. Results of mediation analyses showed that higher levels of perceived external control accounted substantially for associations between specific maltreatment types and children's internalizing problems. Results of moderator analyses revealed that, among maltreated children, greater perceived internal control predicted fewer internalizing problems, suggesting that perceived internal control functioned as a protective factor. Children maltreated early in life were less likely to have this protective characteristic. Results are discussed in terms of their implications for understanding the developmental consequences of specific and co-occurring types of maltreatment.

Peer relationships and self-esteem among children who have been maltreated.

A prospective longitudinal design was employed to assess risks associated with maltreatment in a representative community sample of 107 maltreated children and an equal number of nonmaltreated comparison children. Heightened difficulties in peer relationships and self-esteem were associated with greater severity and chronicity of maltreatment. For example, children who experienced chronic maltreatment were less well-liked by peers. Type of maltreatment was also related to specific aspects of children's adjustment. For instance, sexual abuse predicted low self-esteem, but not problems in peer relationships. Emotional maltreatment, on the other hand, was related to difficulties in peer relationships, but not to low self-esteem. Thus, the best predictions of specific aspects of children's adjustment were provided by considering timing, type, and severity of maltreatment. For some groups of maltreated children, having a good friend was associated with improvement over time in self-esteem.