Foster Care for Child Maltreatment. II. Impact on School Performance

PEDIATRICS ◽  
1985 ◽  
Vol 76 (5) ◽  
pp. 841-847
Author(s):  
Desmond K. Runyan ◽  
Carolyn L. Gould
Keyword(s):  
Foster Care ◽  
Child Maltreatment ◽  
Home Care ◽  
School Performance ◽  
The United States ◽  
Care Group ◽  
Historical Cohort ◽  
School Year ◽  
The Impact

At least 150,000 children currently reside in foster care in the United States because of child maltreatment. Nearly 15% of all confirmed maltreatment reports record foster care as one of the acute interventions. Yet, the impact of foster care has been largely unexamined. We conducted a historical cohort study of the impact of foster care on subsequent school performances for 114 children placed in foster care because of maltreatment. A comparison cohort was constituted of 106 maltreated children who were similar in age, race, sex, and year of diagnosis but who were left in their homes after report. School records were reviewed for 96 of the foster care children and 69 of the home care children. School attendance had improved for both groups at the time of follow-up nearly 8 years later. Children in school at the time of report who were then placed in foster care missed an average of 15.6% of the school year prior to the report compared with missing only 3.48% of the most recent school year. The children from the comparison group missed an average of 8.5% of the school year prior to their index maltreatment report and 7.2% of their most recent year in school. Forty-four percent of the foster care group achieved average or above average grades on follow-up compared with the passing rate for the home care group of 32% (P = .17). The foster care children were more likely to receive special education services. Overall, both groups were doing poor work in school an average of 8 years after maltreatment report. There appears to be no evidence for a significant rehabilitative effect of foster care as measured by subsequent school performance.

Foster Care for Child Maltreatment: Impact on Delinquent Behavior

PEDIATRICS ◽  
1985 ◽  
Vol 75 (3) ◽  
pp. 562-568
Author(s):  
Desmond K. Runyan ◽  
Carolyn L. Gould
Keyword(s):  
Foster Care ◽  
Child Maltreatment ◽  
Foster Children ◽  
Maternal Education ◽  
Child Victims ◽  
Foster Home ◽  
Historical Cohort ◽  
Children In Foster Care ◽  
Cohort Differences ◽  
The Impact

Previous reports of child maltreatment Sequelae have not systematically examined the effects of societal intervention. A historical cohort study has been undertaken to examine the impact of one intervention, foster care, on the subsequent development of juvenile delinquency among child victims. One hundred fourteen foster children, aged 11 to 18 years, in foster care for three or more years, and who were in foster care as a result of maltreatment were studied. A comparison cohort was composed of 106 victims of maltreatment who were left in their family home; these children were similar to the children in foster care with regard to age, race, sex, and year of diagnosis. Cohort differences in maternal education, type of abuse, history of prior maltreatment, sex, and race were controlled in the analysis. Foster children committed 0.050 crimes per person-year after age 11 years; home care children committed 0.059 crimes per person-year after age 11 years (P > .2). Foster children were more likely to have committed criminal assault. Among foster children, increased number of foster home placements correlated with increased number of delinquency convictions. Overall, there appears to be no support for the idea that foster care is responsible for a significant portion of later problems encountered by victims of maltreatment.

Contemporary Surgical Management of Juvenile Nasopharyngeal Angiofibroma

2021 ◽  
Author(s):  
Salomon Cohen-Cohen ◽  
Kristen M. Scheitler ◽  
Garret Choby ◽  
Jeffrey Janus ◽  
Eric J. Moore ◽  
...  
Keyword(s):  
Surgical Management ◽  
Intracranial Extension ◽  
Preoperative Embolization ◽  
Tumor Diameter ◽  
Historical Cohort ◽  
Nasopharyngeal Angiofibroma ◽  
Estimated Blood Loss ◽  
The Impact ◽  
Previous Series

Abstract Objectives Juvenile nasopharyngeal angiofibromas (JNAs) are uncommon tumors with an evolving treatment paradigm. The objective of this study was to compare our prior experience reported in 2005 with our most contemporary series to compare practice improvements and the impact of expanded endonasal procedures. Design Retrospective review comparing a contemporary 22 patients with JNA who underwent surgical management between 2005 and 2019, compared with a historical cohort of 65 patients from the same center. Results The most common presenting symptom was epistaxis (68%). The median maximum tumor diameter was 4.4 cm. All patients underwent preoperative embolization. An endoscopic endonasal approach (EEA) was used in 18 patients (82%), compared with 9% in the series prior to 2005. Gross total resection was achieved in all patients. The median estimated blood loss was 175 and 350 mL for EEA and open (transfacial) cases, respectively. Only two patients (9%) required a blood transfusion compared with 52% on the previous series. The median follow-up was 19 months. The overall recurrence rate was 9% in this series and 24% in the previous series. No patient required radiation therapy in follow-up compared with 3% in our historical cohort. Conclusion There have been significant changes regarding the management of patients with JNA compared with the previous Mayo Clinic experience. The EEA has become the preferred route over the transfacial approaches to treat JNA in selected patients who do not have intracranial extension. Preoperative embolization has aided in reducing the postoperative transfusion rates.

Impact of non-contrast enhanced volumetric MRI-based feeder localization in the treatment of spinal dural arteriovenous fistula

2016 ◽  
Vol 9 (2) ◽  
pp. 178-182 ◽  
Author(s):  
Santhosh Kumar Kannath ◽  
Bejoy Thomas ◽  
P Sankara Sarma ◽  
Jayadevan Enakshy Rajan
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Definitive Treatment ◽  
Spinal Angiography ◽  
Vertebral Level ◽  
Spinal Dural Arteriovenous Fistula ◽  
Historical Cohort ◽  
Contrast Enhanced ◽  
The Impact

BackgroundThe preoperative localization of the feeder of spinal dural arteriovenous fistula (SDAVF) could simplify the diagnostic spinal angiographic procedure. Localization by non-contrast-enhanced MRI-based techniques is an attractive option. However, the usefulness of such an approach for evaluation of SDAVF has not yet been reported.ObjectiveTo study the impact of non-contrast MRI-based feeder localization, followed by targeted spinal angiography, in the evaluation of SDAVF before endovascular intervention.Materials and methodsProspectively collected data were analyzed and the level of the feeder was localized preoperatively. The procedural time for targeted spinal angiography was calculated and compared with that of a historical cohort, who underwent routine spinal angiographic examination before the study period. Follow-up MRI was carried out to assess the reliability of this model for detection of occasional metachronous lesions that might be missed with this approach.ResultsSeven patients underwent targeted spinal angiography during the study. The feeder level was accurately identified in five patients and was localized to one vertebral level in six patients. The correlation between MRI and DSA was statistically significant. The number of spinal levels assessed was fewer and overall procedure time was significantly shorter compared to historical cohort (58 min vs 162 min, respectively; p<0.001). Intervention was coupled with targeted angiography in two patients. Follow-up MRI demonstrated flow voids in one patient, who had recurrent fistula at one vertebral level below the previously embolized feeder.ConclusionsThe non-contrast MRI-based localization technique can reliably detect the level of feeder and help in therapeutic planning of SDAVF. The localization techniques potentially shorten the angiographic procedure and may facilitate simultaneous endovascular definitive treatment. Inclusion of follow-up MRI may be useful for detection of synchronous or metachronous lesions if a targeted approach is adopted. Additionally, this helps to identify failed endovascular therapy.

Abstract 225: A Depression Quality Program and Cardiovascular Disease: Assessing the Impact on Care

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Linda Gordon ◽  
Amanda Malecky ◽  
Andrew Althouse ◽  
Nicole Ansani
Keyword(s):  
Usual Care ◽  
Goal Attainment ◽  
Intervention Group ◽  
Phone Call ◽  
Categorical Variables ◽  
Care Group ◽  
Control Group ◽  
Surrogate Outcome ◽  
The Impact

Background: Data demonstrate an adverse association between depression and coronary artery disease prognosis. Therefore, a depression screening program was initiated in the catheterization (cath) lab. The goals were to improve HEDIS depression compliance rates and determine the impact on clinical outcomes. Methods: Adult patients in an inpatient cath lab from 3 cardiology practices were screened for enrollment in a randomized controlled trial. All cath lab patients received a PHQ-9 depression screener. Those who screened positive for depression (score ≥ 10) were randomized to intervention or usual care. The usual care group received a follow-up phone call to re-administer the PHQ-9 at 6-8 weeks and within 210 days of discharge. The intervention group was administered the PHQ-9 and received intensive education at baseline, 6-8 weeks, and within 210 days of discharge. Education included targeted depression information with a mental health care provider and comprehensive disease management education with a cardiovascular nurse practitioner. Outcomes included: differences in HEDIS depression goal attainment; depression response/remission rates; and cardiovascular goals. Differences between groups were tested using chi-squared tests (categorical variables) and t-tests (continuous variables). Results: Baseline characteristics were similar between control (N=43) and intervention (N=40) groups, with the exception of significantly fewer African American patients in the control group (N=2, 4.7%) vs intervention (N=9, 22.5%). Changes in HEDIS goal attainment show that patients in the intervention group were slightly more likely to be referred to a provider to address depression (95.0% vs 86.0%, p=0.314), or receive meds for depression (65.0% vs 51.2%, p=0.219), but these differences are not statistically significant. More patients in the intervention group refused meds for depression compared to control (15.0% vs. 2.3%, p=0.041); have received blood work (65.0% vs 41.9%, p=0.030); and have received follow-up within 210 days (82.5% vs 46.5%, p<0.001). Treatment adjustment rate was higher in the intervention group compared to control (85.0% vs. 65.1%, p=0.037). Hospital readmission rate was similar between groups (p=0.896) and there was no difference in depression remission or response rates (p=0.426). Further, no differences were seen in cardiovascular surrogate outcome parameters, including cholesterol, A1c, CRP, or BNP between groups; except SGOT was significantly different between groups (-5.0 intervention vs 2.0 control p=0.045). Conclusions: These data demonstrate improvements in attaining a surrogate outcome measure of quality (HEDIS goals); however, this does not appear to translate to a significant clinical impact. Quality measures may need to be continuously reassessed to ensure efficiency and effectiveness of care.

Food Insecurity and Mortality in American Adults: Results From the NHANES-Linked Mortality Study

2020 ◽  
pp. 152483992094592 ◽  
Author(s):  
Srikanta Banerjee ◽  
Tim Radak ◽  
Jagdish Khubchandani ◽  
Patrick Dunn
Keyword(s):  
Health Risk ◽  
Food Insecurity ◽  
Public Health Problem ◽  
The United States ◽  
Mortality Data ◽  
Long Term Outcomes ◽  
Interdisciplinary Approaches ◽  
The Impact

Food insecurity is a significant public health problem in the United States leading to substantial social, economic, and health care–related burdens. While studies continue to estimate the prevalence of food insecurity, the long-term outcomes are not extensively explored. The purpose of this study was to assess the impact of food insecurity on mortality. We analyzed data on adults (≥ 20 years) from the 1999–2010 National Health and Nutrition Examination Survey, with mortality data obtained through 2015. Among the total study participants (n = 25,247), 17.6% reported food insecurity. Food-insecure individuals were more likely to be younger in age, minorities, poorer, with lesser education, obese, smokers, and with diabetes compared to food-secure counterparts. During a 10.2-year follow-up, among the food insecure, 821 individuals died (11%). The hazard ratio (HR) for mortality among the food insecure compared with the food secure, with adjustment for age and gender only, was 1.58; 95% confidence interval [CI: 1.25, 2.01]. The adjusted HRs for all-cause mortality, HR = 1.46, CI [1.23, 1.72], p < .001, and cardiovascular mortality, HR = 1.75, CI [1.19, 2.57], p < .01, were statistically significantly higher among food-insecure individuals, after adjustment for multiple demographic and health risk factors. Individuals who are food-insecure have a significantly higher probability of death from any cause or cardiovascular disease in long-term follow-up. Comprehensive and interdisciplinary approaches to reducing food insecurity–related disparities and health risks should be implemented. Including food insecurity in health risk assessments and addressing food insecurity as a determinant of long-term outcomes may contribute to lower premature death rates.

scholarly journals Fiducial marker placement with electromagnetic navigation bronchoscopy: a subgroup analysis of the prospective, multicenter NAVIGATE study

2019 ◽  
Vol 13 ◽  
pp. 175346661984123 ◽  
Author(s):  
Mark R. Bowling ◽  
Erik E. Folch ◽  
Sandeep J. Khandhar ◽  
Jordan Kazakov ◽  
William S. Krimsky ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Subgroup Analysis ◽  
The United States ◽  
Lung Lesion ◽  
Endobronchial Ultrasound ◽  
Complication Rates ◽  
Electromagnetic Navigation ◽  
Cancer Management ◽  
The Impact

Background: Fiducial markers (FMs) help direct stereotactic body radiation therapy (SBRT) and localization for surgical resection in lung cancer management. We report the safety, accuracy, and practice patterns of FM placement utilizing electromagnetic navigation bronchoscopy (ENB). Methods: NAVIGATE is a global, prospective, multicenter, observational cohort study of ENB using the superDimension™ navigation system. This prospectively collected subgroup analysis presents the patient demographics, procedural characteristics, and 1-month outcomes in patients undergoing ENB-guided FM placement. Follow up through 24 months is ongoing. Results: Two-hundred fifty-eight patients from 21 centers in the United States were included. General anesthesia was used in 68.2%. Lesion location was confirmed by radial endobronchial ultrasound in 34.5% of procedures. The median ENB procedure time was 31.0 min. Concurrent lung lesion biopsy was conducted in 82.6% (213/258) of patients. A mean of 2.2 ± 1.7 FMs (median 1.0 FMs) were placed per patient and 99.2% were accurately positioned based on subjective operator assessment. Follow-up imaging showed that 94.1% (239/254) of markers remained in place. The procedure-related pneumothorax rate was 5.4% (14/258) overall and 3.1% (8/258) grade ⩾ 2 based on the Common Terminology Criteria for Adverse Events scale. The procedure-related grade ⩾ 4 respiratory failure rate was 1.6% (4/258). There were no bronchopulmonary hemorrhages. Conclusion: ENB is an accurate and versatile tool to place FMs for SBRT and localization for surgical resection with low complication rates. The ability to perform a biopsy safely in the same procedure can also increase efficiency. The impact of practice pattern variations on therapeutic effectiveness requires further study. Trial registration: ClinicalTrials.gov identifier: NCT02410837.

scholarly journals Ethnic Diversity, Social Trust and the Moderating Role of Subnational Integration Policy

2016 ◽  
Vol 65 (2) ◽  
pp. 413-431 ◽  
Author(s):  
Birte Gundelach ◽  
Anita Manatschal
Keyword(s):  
Ethnic Diversity ◽  
Social Trust ◽  
Negative Relationship ◽  
The United States ◽  
Integration Policy ◽  
Integration Policies ◽  
Mere Existence ◽  
The Impact

Increasing ethnic diversity and whether or not it impacts on social trust are highly debated topics. Numerous studies report a negative relationship between diversity and trust, particularly in the United States. A growing body of follow-up studies has examined the extent to which these findings can be transferred to Europe, but the results remain inconclusive. Moving beyond the discussion of the mere existence or absence of diversity effects on trust, this study is concerned with the moderation of this relationship. It addresses the neglected role of subnational integration policies influencing the impact of diversity on trust. Empirical tests not only indicate that integration policies moderate the relationship but also suggest that the influence of policies varies substantively according to the specific policy aspect under consideration.

scholarly journals PERIACETABULAR OSTEOTOMY IN ACTIVE DUTY U.S. MILITARY PERSONNEL: A SINGLE CENTER’S EXPERIENCE WITH A MINIMUM OF TWO YEARS FOLLOW-UP

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0014
Author(s):  
Andrew S. Murtha ◽  
Matthew R. Schmitz
Keyword(s):  
United States ◽  
Military Service ◽  
Periacetabular Osteotomy ◽  
The United States ◽  
Active Duty ◽  
Service Members ◽  
Military Service Members ◽  
Active Service ◽  
The Impact

Background: The primary focus of periacetabular osteotomy (PAO) literature has been survivorship until hip arthroplasty. This endpoint overlooks its impact on young, active patients. Hypothesis/Purpose: This study sought to assess the impact of the PAO on the careers of active duty members of the United States Armed Forces. Methods: A retrospective review identified 38 patients who underwent PAO performed by a single surgeon at an academic, military medical center from January 2014 through April 2017. Twenty-one of the patients were active duty United States military service members (16 female, 5 male) and had a minimum 28 months of post-operative follow-up at the time of review. Preoperative and postoperative duty restrictions were noted and referrals to the U.S Army and U.S. Air Force Medical Evaluation Boards (MEB) were queried. Results: The average age at surgery was 25.6 years (range, 19-40y). Preoperatively, sixteen patients (94.1%) were on duty restrictions, one had been referred to the MEB, and records were not available on three patients who separated from the military prior to review. Average follow-up was 3.4 years (range, 2.3 – 5.4y). Among the patients without a preoperative MEB referral, 85.0% remained on active duty (n = 12) or completed their military service commitment (n=5). Of the fourteen patients with temporary duty restrictions preoperatively, 35.7% (n=5) were relieved of their restrictions and returned to full duty and 50% (n=7) were retained on active service with permanent duty restrictions. Such permanent duty restrictions typically consisted of modifications to the aerobic component of the semiannual military fitness testing. Six patients (28.6%) were referred to the MEB including one who was referred prior to PAO. Of these patients, two were deemed fit to retain on active service with permanent duty restrictions, two were medically separated for non-hip conditions, and two were medically separated for a hip condition. The average Veteran Affairs (VA) disability score related to hip pathology in patients referred to MEB was 16% (range 0-40%). Conclusion: This is the first study to look at the PAO in active duty military service members. In patients with symptomatic acetabular dysplasia, PAO may provide an opportunity to relieve preoperative duty restrictions and allow for continued military service. Further study with the inclusion of patient reported outcomes are necessary assess the impact of the procedure in this active patient population.

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